Government Outsourced Solutions

  • banner-doctor-left-older-woman-jpg-741x246

  • Government expertise across your business needs

    More than ever, the business of healthcare is complex. To operate effectively in this evolving environment, you need a partner who can quickly deliver what you need to get your government programs up and running.

    You have that partner when you choose Cognizant and TriZetto.

    Our combined expertise gives you premier business process services outsourcing solutions for government programs in the U.S. market, offering the following comprehensive services:

    • Claims administration – claims adjudication and adjustment, CMS Encounter submissions, RAPS submissions and COB processing
    • Enrollment Services – CMS/State eligibility and enrollment processing, Special status management, Medicare and Medicaid-specific and health plan correspondence
    • Billing Services including CMS financial reconciliation
    • Medical & Care Management – UM services, Nurse line, HEDIS Management, STARS Management, Wellness programs
    • Provider Network Management - Credentialing, Contract set-up and maintenance, Provider A&G
    • Financial Management - Identification and Audit Services, Recovery management services
    • Front End and Mailroom - Mailroom Processing, Imaging and Storing, OCR, Output generation, Document Management
    • Print and Fulfillment - Welcome Kits, ID Cards, EOBs, Letters, Booklets
    • Customer Service - Inbound/Outbound Member & Provider Customer Service, Multi-channel engagement

    But, our outsourcing solutions don’t end with administration. Our technology, infrastructure, and compliance capabilities deliver a comprehensive, end-to-end solution to support your government lines of business.

    • Technology Solutions – Our TriZetto portfolio of solutions automate key business processes and enhance efficiency across the organization. Our solutions provide payers with the flexibility and scalability to administer diverse plans, integrate with third-party solutions and adapt to the changing business requirements of government health plans.
    • IT Infrastructure Services – We provide our combined experience, intellectual property, and proprietary tools to deliver a consistent experience across your IT ecosystem. With our Infrastructure Services, you can fully leverage your IT investments to address the demands of the government market with the efficiency and predictability required to remain competitive.
    • Compliance and Assurance - We understand the importance of ongoing compliance monitoring and adjust operational controls as necessary to help meet government requirements—regardless of how quickly they change.