Prospective Payment Specialists

What Prospective Payment Specialists does

Prospective Payment Specialists, now operating as Cognizant RCM, is a Manhattan Beach, California-based revenue cycle management (RCM) provider founded in 1992 and operating as a business unit of Cognizant (NASDAQ: CTSH). The company delivers compliance-based medical coding, billing, and end-to-end RCM services to large U.S. health systems, hospitals, and physician groups, with a documented case study with MetroHealth System producing a 30% reduction in claim denials and $13M in additional annual revenue.

The product platform is organized around two core offerings — Hospital RCM and Physician RCM — augmented by approximately 18 specialized modules covering eligibility enrollment and secondary verification, third-party liability, workers' compensation, ICD-10/CPT/HCPCS coding, chargemaster management, complex denials, patient access, SSDI services, credentialing, charge entry, AR follow-up, complex claims, cash posting, and underpayments recovery. Two distinct software products extend the portfolio: a dedicated Anesthesia Billing Software for time-based anesthesia billing, and the Chargemaster Monitor cloud-based tool (hosted at ccm.cognizantrcm.com) for chargemaster compliance and optimization. The underlying technology stack combines intelligent automation with Cognizant-parent infrastructure and human RCM specialists; an Avectus client portal provides customer access.

The business operates on a managed services revenue model delivered via direct enterprise sales targeting large health system and physician group clients. Pricing is not publicly disclosed and prospects are directed to request a demo. The company has 101–250 employees and is led by Founder & President Jay Janov, CFO Jeannie Yoo, and Reporting Director Sue Underberg. Third-party credibility is anchored by Everest Group Industry Leader recognition in the 2023 PEAK Matrix for Provider RCM, KLAS customer-rated performance data, and 2024 recognitions from HFS Research, Healthcare Finance, and Change Healthcare.

Name

Prospective Payment Specialists

Legal name

Cognizant

Website

https://ppscompliance.com

Company type

Private

Founded year

1992

Operating status

Operating

Headcount range

101–250 employees

Short description

Prospective Payment Specialists (Cognizant RCM) provides compliance-based medical coding and end-to-end revenue cycle management services to large U.S. health systems, hospitals, and physician groups, operating as a business unit of Cognizant.

Ownership category

akta.pro rank

Product category

Healthcare Revenue Cycle Management Services

NAICS

Custom Computer Programming Services (541511), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Prepackaged Software (7372), Hospital & Medical Service Plans (6324)

akta.pro primary industry

RCM Outsourcing & Managed Billing Services (HLACACAN)

akta.pro secondary industries

Claims Management, Scrubbing & Clearinghouse (HLACACAB), RCM Analytics, Benchmarking & Underpayment Detection (HLACACAL), Patient Access, Registration & Intake (Front-End RCM) (HLACACAE), Medical Debt Collection & Revenue Cycle Bad-Debt Recovery (FSAKAJAM)

Keywords

• Revenue cycle management
• Medical billing services
• Medical coding solutions
• Healthcare denial management
• Chargemaster monitoring

Headquarters

HQ city

Manhattan Beach

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Revenue Cycle Management Services: Professional RCM services delivered through partnership with Cognizant, providing end-to-end revenue cycle solutions for healthcare providers including hospitals, health systems, and physician groups. Services include coding, billing, eligibility verification, denial management, and accounts receivable optimization.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

Prospective Payment Specialists (operating as Cognizant RCM) provides outsourced and co-managed revenue cycle management services to hospitals, health systems, and physician practices. Offerings span the full RCM lifecycle including eligibility verification, medical coding (ICD-10/CPT/HCPCS), chargemaster management, claims submission, denial management, accounts receivable follow-up, underpayment recovery, cash posting, and patient access services. The firm also sells specialized software products including a cloud-based Chargemaster Monitor tool and an Anesthesia Billing Software solution.

Product overview

Cognizant RCM (formerly Prospective Payment Specialists) offers a comprehensive, modular revenue cycle management platform designed for healthcare organizations including health systems, hospitals, and physician practices. The platform consists of core Hospital RCM and Physician RCM solutions augmented by specialized add-on modules addressing specific revenue cycle functions such as eligibility verification, coding, denial management, accounts receivable follow-up, and underpayments recovery. Specialized offerings include Anesthesia Billing Software for anesthesia practices and the Chargemaster Monitor cloud-based tool for chargemaster management. The platform is powered by intelligent automation combined with experienced professionals and proven operational methods, enabling clients such as MetroHealth to achieve measurable outcomes including 30% reduction in denials and $13M in additional annual revenue.

Differentiator

Problem solved

Functional benefit

Products and services

• Hospital RCM Comprehensive revenue cycle management solutions designed for health systems and hospitals, encompassing the full billing and collections lifecycle from patient registration through final payment resolution.
• Physician RCM Revenue cycle management solutions tailored for physician practices and medical groups, addressing the distinct billing challenges of outpatient care settings.
• Self-Pay & Bad Debt Management Services for managing self-pay patient accounts and recovering bad debt, helping healthcare organizations recover revenue from accounts not covered by insurance.
• Accounts Receivable Management AR management services focused on improving cash flow and reducing outstanding receivables through systematic follow-up and resolution processes.
• Eligibility Enrollment Enrollment services that assist patients in obtaining and verifying insurance eligibility, ensuring coverage is confirmed before services are rendered.
• Eligibility Seconds Secondary eligibility verification services to confirm patient coverage details and maximize clean claim submission rates.
• Third Party Liability Services for identifying and pursuing payment from third-party liability sources such as auto insurance, workers' compensation, or other liability carriers.
• Workers' Compensation Billing Specialized billing and follow-up services for workers' compensation claims, handling the unique requirements of workplace injury billing.
• Coding Solutions Medical coding services ensuring accurate ICD-10, CPT, and HCPCS code assignment for proper claim submission and reimbursement.
• Chargemaster Management Chargemaster management and optimization services including the Chargemaster Monitor tool to ensure accurate charge capture and pricing compliance.
• Complex Denials Management Specialized denial management services for handling complex, appealed, or escalated claim denials that require expert intervention.
• Patient Access Front-end revenue cycle services focused on patient registration, pre-service collections, and insurance verification to improve clean claim rates.
• Social Security Disability Income (SSDI) Services Assistance services for patients seeking Social Security Disability Income benefits, supporting healthcare organizations through the complex SSDI billing and documentation requirements.
• Credentialing Provider credentialing and re-credentialing services ensuring physicians and other providers are properly enrolled with health plans.
• Charge Entry Charge entry services for accurate and timely recording of services provided, ensuring claims are submitted with correct charge amounts.
• AR Follow-Up Accounts receivable follow-up services with systematic outreach to payers to resolve outstanding claims and accelerate payment collection.
• Complex Claims Specialized handling of high-difficulty claims requiring additional documentation, appeals, or payer escalation for resolution.
• Cash Posting Cash posting services for accurate recording and allocation of payments received, maintaining clean patient accounts and accurate financial records.
• Anesthesia Billing Software Specialized billing software designed for anesthesia practices, handling the unique time-based and modifier-driven billing requirements of anesthesia services.
• Underpayments Recovery Services focused on identifying and recovering underpaid claims, ensuring healthcare organizations receive full contractual reimbursement from payers.
• Chargemaster Monitor A cloud-based monitoring tool that tracks and analyzes chargemaster data to ensure pricing accuracy, compliance, and optimization across healthcare organizations.

Quantifiable outcome

• 30% reduction in denials for health system clients
• +1 more outcomes

Named customers1 record

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability1 record

Feature6 records

Partnerships

One partnership is on record.

• MetroHealth SystemcoreStrategic or Co-development PartnerMetroHealth partnered with Cognizant RCM to implement revenue cycle management improvements. The partnership resulted in measurable outcomes including a 30% reduction in denials and $13M in additional revenue year-over-year. This case study demonstrates Cognizant RCM's ability to deliver significant financial improvements for health system clients.

Scale indicators4 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• R1 RCM: R1 RCM (now operating as Tower RCM/CDI under TowerBrook) is a leading dedicated end-to-end hospital revenue cycle management outsourcer — directly comparable to Cognizant RCM in customer base (large health systems), service scope (end-to-end RCM), and delivery model. Cognizant was the acquirer of R1 RCM in a $8.9B take-private deal, making it the most direct analog.
• Conifer Health Solutions: Conifer Health Solutions is a hospital RCM and patient access services provider owned by Tenet Healthcare. It serves large hospital systems with end-to-end RCM, eligibility, and denials services — directly competing with Cognizant RCM for enterprise hospital accounts.
• Parallon: Parallon, a subsidiary of HCA Healthcare, provides end-to-end revenue cycle management, patient access, and physician billing services to hospitals and physician groups. As a captive enterprise-scale RCM provider, it is a structurally close competitor to Cognizant RCM in the hospital and physician segments.

Broad incumbents

• Oracle Health (Cerner): Oracle Health (formerly Cerner) provides EHR systems with embedded RCM and revenue cycle capabilities for hospitals and health systems. It is a broad incumbent competitor because many health systems can satisfy a meaningful portion of RCM workflows through their core EHR, displacing or reducing spend with dedicated RCM outsourcers like Cognizant RCM.
• Optum (UnitedHealth Group): Optum is the health services arm of UnitedHealth Group and one of the largest healthcare RCM, analytics, and payer-services providers in the US. It competes broadly with Cognizant RCM across hospital, physician, and payer-adjacent RCM workflows, often as part of bundled managed-care offerings.
• McKesson Business Performance Services: McKesson offers hospital and physician RCM, billing, and revenue cycle services as part of its broader healthcare distribution and technology portfolio. It is a broad incumbent comparable to Cognizant RCM in target customers and end-to-end service scope.

Emerging players

• AKASA: AKASA is an AI-native RCM automation company serving large health systems, focusing on automating prior authorization, denials, and patient access workflows. It is an emerging competitor to Cognizant RCM's automation ambitions, especially where health systems are piloting AI-led RCM as an alternative to traditional outsourcing.
• Waystar: Waystar is a cloud-based healthcare payments and RCM technology platform serving hospitals, health systems, and physician groups with claims management, denials, and patient payment solutions. It competes with Cognizant RCM on the software/automation layer of RCM, though its model is more SaaS-led than services-led.
• Availity: Availity is a healthcare information network and RCM platform offering eligibility, claims, denials, and prior authorization automation for providers and payers. It overlaps with Cognizant RCM in eligibility verification and front-end RCM workflows but is positioned as a technology platform rather than a managed services outsourcer.

Others

• Experian Health: Experian Health provides patient access, identity management, eligibility, and RCM-adjacent technology solutions to hospitals and physician groups. It is a thematic/adjacent competitor to Cognizant RCM in the front-end and data-driven portions of the revenue cycle.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/prospective-payment-specialists

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Subsidiaries2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Prospective Payment Specialists