TriZetto's Payer Solutions cover the following areas:
1. Core Administration
2. Care Management
3. Health TranZform
4. Network Management
5. Value-Based Solutions
6. Portal Technology Solutions
7. Optimization
Tools
So far we have discussed 1-6 areas. Now we
will throw some light on TriZetto
Optimization Tools suite.
7. TriZetto
Optimization Tools suite
TriZetto Optimization Tools suite is
designed specifically to automate operational tasks associated with TriZetto
core healthcare technology solutions—tasks such as migrating and managing
configurations, keeping security data synchronized among environments, and
speeding the auto-enrollment process. The current tools of the suite are as
follows:
i: Claim Test Pro™
ii: Configuration Maintenance Tool
iii: Configuration Migration Utility (for
Facets™ & QNXT™)
iv: Facets Enrollment Toolkit
v: Test Data Generator for Facets™
vi: Security Management Tool
vii: Supplemental Mapping Management Tool
for Facets™
7.i:
Claim Test Pro
CLAIMS TESTING HAS NEVER BEEN SO ORGANIZED.
The TriZetto Claim Test Pro greatly reduces
the need for manual creation of test cases, automates the management and
reconciliation of results, tracks and documents test projects and cases, and
electronically converts system data to applicable testing data sets to create a
robust and applicable testing environment.
The Claim Test Pro application provides a
comprehensive set of testing suites that provide for more diverse testing schemas,
enabling testing of a multitude of provider reimbursement scenarios. The
solution automates many processes that previously were done manually, helping
plans increase administrative efficiency by reducing the resources needed to
manage these initiatives. The Claim Test Pro solution provides management tools that track and
report progress.
What The Claim Test Pro can do for healthcare payers :
Ø
Reduce over payments to providers. Data that has been thoroughly
vetted helps ensure that their plan is paying its contracted providers the
correct amounts.
Ø
Reduce administrative costs. Reducing errors in provider payments
reduces manual rework, helping drive down costs.
Ø
Reduce test cycle time. Automation can help them save hundreds of
hours building and documenting test cases.
Ø
Reduce critical defects introduced to production. The application
is virtually self-documenting, automatically summarizing what you have tested
and reconciled.
7.ii: Configuration Maintenance Tool
Change is a constant with which all health
plans of Insurance companies must deal. Changes
may be the result of software implementations/upgrades, new lines of business,
new products, acquisitions or expansions of member/provider groups, or
improvements in administrative efficiency. So healthcare organizations configure
these changes in their systems or tools. Any change in any place means
configuration, so configuration is a continuous process. But is very vital to
maintain and track configuration changes. TriZetto's Configuration Maintenance
Tool can do a good job in this regard.
7.iii:
Configuration Migration Utility (for Facets & QNXT)
The TriZetto Configuration Migration Utility
helps healthcare payers to control and manage system configuration changes and
successfully execute configuration promotions. Versions are available for both
Facets and QNXT core administration systems. The Configuration Migration
Utility gives non-healthcare IT personnel the ability to migrate specific
aspects of configuration changes from environment to environment in a manner
that is controlled, workflow-integrated and audit-capable.
With
this tool, they can:
Ø
Eliminate
wholesale environment copies. Perform targeted component migrations of desired
configurations.
Ø
Reduce
demands of specialty healthcare IT resources. Reduce the demands on database
administrators during change promotions.
Ø
Ensure
adherence to change procedures and approval processes. Enforce a rigorous
workflow process while distributing the execution work efforts.
Ø
Reduce
testing demands and rework. Test only the migrated component instead of
re-executing wholesale test cycles.
7.iv:
Facets Enrollment Toolkit
TriZetto’s Facets Enrollment Toolkit is a
set of integrated tools and adapters that streamline the auto-enrollment
process. The toolkit increases the auto-enrollment success rate by
intelligently managing the data receipt and correction process for enrollment records
that help healthcare payers to be ensured
that data is correct and validated before it is submitted to Facets. This
significantly increases the number of records that will be accepted on first
pass. For those records that require rework, the toolkit expedites the error identification
process, so records can be corrected and resubmitted quickly. The Facets Enrollment
Toolkit enhances healthcare payers' confidence
in automation routines by:
Ø
Reducing
manual labor in enrollment-record processing. The toolkit reduces failure rates
and, if failures do occur, improves time to resolution.
Ø
Increasing
data accuracy and record-processing success. Front-end automation in the
staging database helps ensure data is correct before it is inserted into the
Facets system.
Ø
Decreasing
demands on healthcare IT specialist during error-resolution cycles. The error
record reader helps identify and resolve issues quickly.
Ø
Improving
customer satisfaction. Data-management flexibility helps improve the intake
process and expedite enrollment completion.
7.v:
Test Data Generator for Facets
TriZetto Test Data Generator for Facets
helps address the issue of exposing protected health information (PHI) when
creating non-production data sets for use in testing with the TriZetto Facets
core claims administration system.
This data copy tool allows for a subset
selection of transaction data and masks key personal identifiable data. It
permits a user to request a specific number of members from a production
database, and acquire all the relevant groups, providers, and claims from the
source database. The tool strips the data of personal identifying information
and creates key word files with all new identity information. The result is
size-controlled data sets of randomized non-production data. Using Test Data
Generator for Facets, health plans can:
Ø
Reduce
the risk of exposing PHI that occurs when production data is simply copied into
non-production data bases for testing.
Ø
Allow
for creation of multiple specialized test databases and control their size and
composition.
Ø
Reduce
non-targeted environment copies
Ø
Reduce
demands on specialty IT resources
Ø
Improve
security
7.vi:
Security Management Tool
The TriZetto Security Management Tool
provides an efficient way to configure, manage, import, troubleshoot and
distribute Facets security configurations across multiple Facets environments.
The solution provides a single, centralized repository of Facets security configuration
data, with a user-friendly interface and full Facets integration that
streamline the security configuration process. The tool provides a controlled,
managed process for keeping configuration data in sync among environments such
as training, development and production.
What TriZetto’s solution can do for healthcare payers:
Ø
Reduce time required
to configure Facets security profiles. New profile configurations can be
completed in minutes instead of hours.
Ø
Streamline
administrative tasks and reduce manual errors. Leverage the solution’s “compare
and copy” features across environments to improve administration of profiles
and access management.
Ø
Increase visibility
into access-provisioning actions. Maintain a continuous log of security
configuration changes. Create and customize audit-ready reports.
Ø
Provide audit-ready
capabilities for their Facets security management. Ensure that their
access-management process conforms to industry best-practices.
Ø
Implement a
repeatable process. Configure Facets security profiles once and
then push them to multiple Facets environments.
7.vii:
Supplemental Mapping Management Tool for
Facets
The Facets core administrative system from
TriZetto and its optional modules provides payers the tools and resources to
accommodate their business needs and new benefit plans. One of the ways the
Facets solution accomplishes this is through the new supplemental mappings,
which enable payers to have greater precision and more ways to configure the
claims processing rules and qualifiers required by those new benefit plans.
The Supplemental Mapping Management Tool
provides payer organization additional capability to manage new rules and
qualifier groups, make configuration changes faster and more accurately, increase
administrative efficiency, and optimize configurations for increased
performance. With SMM, payer organization can:
Ø
Save
hundreds of hours annually in configuration time by providing increased
transparency of the current configuration and dependencies while streamlining
configuration management tasks.
Ø
Improve
configuration accuracy by reducing resource-intensive, error-prone manual
editing, researching, and mapping of existing configurations.
Ø
Quickly
edit, copy, or re-order rules that apply to specific criteria instead of
scanning all rules individually.
Ø
Easily
search the qualifier groups and rules within the Supplemental Mapping
Management module with an easy to use interface.
