Realize the Full Potential of Health Insurance Exchange … · 2020-06-05 · The Health Insurance...
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Realize the Full Potential of Health Insurance Exchange Participation Prepare for open enrollment and position your organization for growth with Cognizant’s end-to-end Health Insurance Exchange services • Cognizant Healthcare Solution Overview Health insurance exchanges (HIX) represent great potential as well as uncertainty and challenges for health insurers. While meeting deadlines for open enrollment call for prompt action, it’s important to keep the long-term in perspective. That means taking a critical path to meeting short-term imperatives that also positions your organization to seize opportunities arising in a maturing HIX market. With Cognizant as your HIX partner, your orga- nization will be prepared for open enrollment as well as be ready to transform processes and reduce costs to take full advantage of these new distribution channels as they mature. We streamline your preparation for open enrollment with our comprehensive HIX solution built on our industry expertise, robust technology and deep understanding of HIX structures. Streamline Your Critical Path to Open Enrollment with Cognizant’s End-to- End HIX Solution As the deadline for the national HIX launch and open enrollment quickly approaches, many critical details and regulations are still fluid or ill defined. Cognizant insulates your organiza- tion from these issues, enabling you to complete these time-sensitive critical steps toward open enrollment readiness. • Plan management: We assess HIX work streams across your business, IT and operations functions, determine readiness for HIX par- ticipation and initiate any required change management activities. We also develop a plan management strategy, integrating your product database with those of state-run and federal HIX. • HIX Integration and Testing: We ensure your organization is integrated with all state and federally run exchanges according to their specific timelines. We conduct functional and technical validation across all key areas — enrollment/billing/claims/PM — as well as assessing and addressing effects on your business processes, vendors and partners. • Enrollment: Exchanges require the HIX 834; our easily configured enrollment solution is HIX 834-ready. We also validate the enrollment solution to ensure it scales to meet your expected volume during open enrollment. • Billing: Managing large volumes of individual premium billing and reconciling subsidies are critical to HIX participation. Cognizant enhances and upgrades your organization’s billing capabilities, with special attention on subsidy reconciliation functions and workflows. cognizant solution overview | june 2013
Transcript of Realize the Full Potential of Health Insurance Exchange … · 2020-06-05 · The Health Insurance...
Realize the Full Potential of Health Insurance Exchange ParticipationPrepare for open enrollment and position your organization for growth with Cognizant’s end-to-end Health Insurance Exchange services
• Cognizant Healthcare Solution Overview
Health insurance exchanges (HIX) represent great potential as well as uncertainty and challenges for health insurers. While meeting deadlines for open enrollment call for prompt action, it’s important to keep the long-term in perspective. That means taking a critical path to meeting short-term imperatives that also positions your organization to seize opportunities arising in a maturing HIX market.
With Cognizant as your HIX partner, your orga-nization will be prepared for open enrollment as well as be ready to transform processes and reduce costs to take full advantage of these new distribution channels as they mature. We streamline your preparation for open enrollment with our comprehensive HIX solution built on our industry expertise, robust technology and deep understanding of HIX structures.
Streamline Your Critical Path to Open Enrollment with Cognizant’s End-to-End HIX Solution As the deadline for the national HIX launch and open enrollment quickly approaches, many critical details and regulations are still fluid or ill defined. Cognizant insulates your organiza-tion from these issues, enabling you to complete these time-sensitive critical steps toward open enrollment readiness.
• Plan management: We assess HIX workstreams across your business, IT and operationsfunctions, determine readiness for HIX par-ticipation and initiate any required changemanagement activities. We also develop aplan management strategy, integrating yourproduct database with those of state-run andfederal HIX.
• HIX Integration and Testing: We ensure yourorganization is integrated with all state andfederally run exchanges according to theirspecific timelines. We conduct functionaland technical validation across all key areas— enrollment/billing/claims/PM — as well asassessing and addressing effects on yourbusiness processes, vendors and partners.
• Enrollment: Exchanges require the HIX 834;our easily configured enrollment solution isHIX 834-ready. We also validate the enrollmentsolution to ensure it scales to meet yourexpected volume during open enrollment.
• Billing: Managing large volumes of individualpremium billing and reconciling subsidiesare critical to HIX participation. Cognizantenhances and upgrades your organization’sbilling capabilities, with special attention onsubsidy reconciliation functions and workflows.
cognizant solution overview | june 2013
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• Reconciliation: Exchanges create important new reconciliation requirements. We ensure you have the capacity to conduct enrollment and billing reconciliations with state and federal exchanges.
• Operations: HIX participation and high volumes of new members will put great demand on support and operations functions. Cognizant offers complete operations support with busi-ness process services for all HIX-related func-tions across enrollment, billing, claims process-ing, call centers, member services, and more.
• Reinsurance, Risk adjustment, and Risk corridors (3Rs): Payers will experience member churn as a result of changes in income, employment status, family status or health. Care co-ordination of the members can create challenges for effective risk adjustment. Cognizant offers a full suite of services to manage risk in accordance with 3Rs.
Cognizant Capabilities and Services Ensure Maximum Value from Your HIX ParticipationOur end-to-end services cover every aspect of HIX participation, ensuring your organization is equipped to seize opportunities arising in the HIX market. We deliver these benefits:
• Infrastructure integration: We will ensure your systems and applications are ready to process HIX transactions, including such functions as changes to HIPAA, re-enrollment and financial reconciliation. From validation and management of enrollment and billing transactions to coordinating communica-tions and exception flows from exchanges and providing required notification via mobile apps and web portals, Cognizant ensures smooth integration between your operations and the HIX.
• Acquire and retain members: With our sophis-ticated analytics we help you identify which of your best members are at risk for joining health exchanges so you can communicate with them and present options to increase retention.
Cognizant also can help you design and manage data-driven marketing outreach campaigns, increasing the effectiveness of member acqui-sition efforts. In addition, we can help address the high customer call volumes expected with new HIX populations with variable staffing solutions, increasing customer satisfaction
while enabling you to control costs.
• Streamlined HIX revenue flows: Efficient back-end processes are critical to ensuring smooth data and revenue flows among the parties in an HIX transaction. Cognizant ensures your organization’s key internal processes are fully integrated with federal and state-run HIX, including: enrollment, including HIX 834 transactions; eligibility; billing; benefits set-up; claims adjudication; and risk adjustment. Our solution includes automated reconciliation of enrollment and billing.
• Lower costs: Highly cost efficient and effective operations will enable your organization to bring its costs in line with expected exchange population reviews. We insulate your organi-zation from the differences among HIX imple-mentations, providing one point of integration so you receive a uniform data flow and can retain existing internal processes.
HIX Business Processes Delivered as a Service for Greater Efficiency Gains and Value GenerationWhen the HIX open enrollment critical path deadlines have been met and HIX participation is under way, Cognizant can help you gain even greater efficiency and value from your HIX par-ticipation through our HIX Business Process as a Service (BPaaS) offering.
Our HIX BPaaS solution is comprehensive, providing enrollment, claims processing, operations support and more. It also extends to medical management services, including wellness programs, care and disease management and uti-lization management. With our BPaaS solution, your organization retains complete control over product design and contracting, while greatly reducing HIX population management costs with more virtualized operations.
Make Cognizant Your HIX PartnerThe HIX market represents a dynamic shift in the healthcare industry’s foundations, and HIX par-ticipants like your organization are pioneers in testing its new structures. Cognizant is ready to be your partner, guiding your organization through HIX open enrollment and ongoing operations.
We already have invested significant resources in tracking and understanding the various HIX models and best practices for integration with them. Cognizant will adapt to HIX models as they
About CognizantCognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process out-sourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 162,700 employees as of March 31, 2013, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant.
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© Copyright 2013, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners.
evolve so that your organization can focus on its core business, reduce costs and generate value.
With Cognizant, your organization will simplify its HIX participation now while gaining the power
and flexibility to capitalize on emerging opportu-nities as the HIX market matures. Partner with us on the critical path to open enrollment and beyond. For more information, contact [email protected] or visit us at www.cognizant.com.
