Case Study: Texas Children’s Health Plan achieves 65% claims backlog reduction and major cost and time savings with Cognizant

Automation Saves the Hardest Work for the Pros

Texas Children’s Health Plan (TCHP), the nation’s first children’s HMO and part of Texas Children’s Hospital, faced rapid growth after launching a new service line and anticipated staffing needs rising from 350 to over 1,100 within a year. At the same time TCHP struggled with an error-prone, time-consuming monthly EDI data load and a growing claims workload that threatened quality and increased costs.

Cognizant’s TriZetto team modeled workflows, validated payment accuracy, implemented a Healthcare Process Automation solution for low-to-medium complexity claims, and cleaned and automated the Texas 834 EDI file load. Software robots now process hundreds of claims daily, enabling 65% reduction in backlog in one week, more than 75% faster monthly-file processing (four days to overnight), and $4,800 per examiner monthly cost savings over six months—supporting growth without added headcount or overtime.

Texas Children’s Health Plan