Cognizant
109 Case Studies
Case Study: El Paso First Health Plans achieves 50% productivity gain and 75% faster investigation response with Cognizant's TriZetto QNXT Appeals and Grievance Workflow
A Cognizant Case Study
Reaping the Rewards of Automating the Appeals and Grievance Process
El Paso First Health Plans, a non-profit serving El Paso and Hudspeth counties in Texas, faced a cumbersome, paper-based appeals and grievance process that required manual case research, hand-delivered routing and spreadsheet tracking. As case volumes grew, the manual workflow became inefficient, time-consuming and difficult to maintain for regulatory compliance.
The plan implemented the TriZetto QNXT Appeals and Grievance Workflow to centralize cases, embed CMS and ACA business rules and automate routing, reporting and correspondence. The solution cut investigation response time by 75%, boosted Complaints and Appeals Specialist productivity by 50%, eliminated staff overtime and delivered faster case creation, routing and automated regulatory reporting.
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