Now — perhaps more than ever — every healthcare claim has the potential to significantly impact a life. That’s because claims don’t impact how care is paid for; they shape how it’s experienced.
These are the moments that matter.
For regional health plans juggling rising costs and higher expectations, a more effective claims journey isn’t just nice-to-have. It’s crucial.
That’s why Zelis, in partnership with Cognizant, is ensuring that each moment of claims management is handled with the utmost performance and care. Together, we’re dedicated to driving efficiency, lowering the cost of care and reducing provider abrasion.
Zelis and Cognizant: The Power of Partnership
The decade-long collaboration between Zelis and Cognizant is built on a foundation of trust and our shared commitment to innovation. And the partnership has stood the test of time – together, we’ve helped over 50 health plans and TPAs, representing more than 20 million members across the healthcare industry.
By integrating Cognizant’s claims adjudication platforms, TriZetto® Facets® and QNXT™,with Zelis’ honed healthcare pricing capabilities, we’ve streamlined claims review and pricing workflows that enhance data visibility. The result? Better decision-making for our clients.
Our integrated solution handles multiple aspects of claim management within one platform. It was created to reduce complexity and maintain a consistent user experience — right-sized for regional health plans. It prioritizes scalability, easy integration and operational efficiency.
Learn more about the partnership.
How We Helped One Client Lower Their Cost of Care
The partnership with Zelis and Cognizant has helped tackle challenges across the healthcare industry. One client wanted to manage outlier reviews to meet their plan’s unique requirements, reduce administrative costs and work with a partner that could grow with them – addressing payment integrity areas and automating processes over time.
To support the client, two primary solutions were used: one for itemized bills and another that could find and fix coding errors before payment processing.
With Zelis Expert Claims Review®, certified coders review itemized bills to find discrepancies. Zelis’ speedy turnaround times and high success rates help minimize provider abrasion.
An integrated Claims Editing solution was crafted with Cognizant’s TriZetto® FACETS®adjudication platform in mind, using a centralized ticketing system. The single-stream setup allows for custom workflows and real-time, post-adjudication routing of claims for payment processing.
Both solutions were designed to enhance service, efficiency and cost management for the client’s claims, and the results speak for themselves.
Impact
Collaborative Claims Management, Improved Care
We’ve partnered with Cognizant to help health plans streamline their claim review processes.
Our focus is on lowering the cost of care by improving accuracy and simplifying operations—ultimately helping to improve the Medical Loss Ratio. With a unified but flexible system, health plans can easily add new tools as needed– without burdening IT or other busy teams.
This approach makes it easier for health plans to manage vendors, enhance communication and strengthen the moments that matter most: caring for members and building stronger provider relationships.
