More efficient providers, better patient experiences

• Mitigating denials, improving financial outcomes
• Proper insurance verification for reduced write-offs
• Improved call center operations
• Increased upfront patient collections

The challenge

MetroHealth, a large, safety-net healthcare system needed to mitigate a spike in payer claim denials to shorten outstanding accounts receivables days and increase cash collections.

Our approach

Deployed the Cognizant® Revenue Cycle Management Workflow solution and the Cognizant® Advanced Reimbursement Manager (ARM) Pro denials management solutions. This combination continuously deployed automation to improve process quality and financial outcomes while automating the previously manual process of identifying the root cause of initial claim denials.

Business outcomes

• 30% decrease in denials
• $13M increase in revenue
• 25% increase in average daily collections

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The challenge

Anesthesia Financial Solutions (AFS) required an insurance verification coverage strategy to lower the number of denials due to missed filing deadlines and prevent future write-offs.

Our approach

Cognizant’s TriZetto Eligibility solution was introduced and provided immediate gains in operational efficiency, reliability of data validation and increased payer remittance. The solution became the cornerstone of the revenue cycle process and is used as the foundation for all patient and staff validations.

Business outcomes

• Reduced timely filing denials by 47%
• Reduced 44% overall write-off between 2022 and 2023
• Reduced eligibility and registration denials by 11%
• Reduced coordination of benefit (COB) inquiries by 98%

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The challenge

Help MetroHealth implement a strategic and sustainable operations solution to support business changes and increased call center volumes.

Our approach

• Collected and analyzed data to identify opportunities and prioritize actions
• Identified technology solutions, streamlined workflows and determined additional staffing needs
• Onboarded a new employee using change management tactics, which improved training, documentation and morale

Business outcomes

• 100% increase in call volume with minimal staff expansion
• 4.49/5 customer satisfaction levels
• 4.25% lower than industry-standard call center abandonment rate

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The challenge

Client faced staffing challenges that hindered their ability to improve front-end patient access, particularly upfront payments and prior authorization.

Our approach

• Provided well-trained staff who integrated into revenue cycle management roles

• Ensured accurate patient liability estimates and timely prior authorization filing

Business outcomes

• 49% increase in upfront collections within first 6 months

• 304% increase within first 12 months

• 4.25% lower than industry-standard call

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