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Case study

The challenge

SelectHealth was planning a transition to Medicare Advantage enrollment to serve the community in a better and more efficient way. Although the move was strategically sound, without an upgrade to its existing enrollment and financial solutions, the transition would be difficult, costly and inefficient. The company also wanted a long-term solution that would help it meet Centers for Medicare and Medicaid Services compliance standards. Because the company had prior experience with Cognizant TriZetto® Healthcare Products, SelectHealth opted to go with the TriZetto Enrollment Administration Manager (EAM) solution.

Our approach

Cognizant helped SelectHealth merge Medicare Advantage with its existing business lines. This helped create efficiencies by unifying certain tasks. For example, nightly cash postings and running statements could be combined and a single vendor could be used to print statements. “Our previous solution wasn’t very efficient and wasn’t calculating correctly,” said Tracy Worsley, AR Premium Billing Operations Manager at SelectHealth.

While developing the TriZetto EAM solution, SelectHealth also considered a TriZetto Financial Reconciliation Manager (FRM) module that would piggyback on the EAM solution. “Cognizant’s FRM module was much more robust—that was a big plus for us,” Worsley said.

TriZetto healthcare products improve accuracy and performance

The user-friendly FRM solution enables SelectHealth to forecast financials more effectively and report plan information more accurately. Additionally, the health plan is confident that its data is more accurate throughout every phase of the process. By reducing redundancy and increasing efficiency, the FRM solution has helped the health plan enhance performance. Two years after implementing the solution, SelectHealth says the difference has been “night and day.”

Increased

reporting functionality and efficiency

More efficient and accurate

financial reporting

More detailed

discrepancy reporting

Reduced

redundancy