TriZetto and its Payer Solutions-II

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

Today we will throw some on TriZetto's Core Administration. It consists of  Facets, QNXT and  QicLink .

1. Facets

Facets can be called one-stop-service center for healthcare payers. The Facets system gives them a platform for fostering collaboration and building connections among members, employers, brokers and providers. Facets and its components facilitate all aspects of their operations, including:

Ø  Medical and dental claims processing

Ø  Claims re-pricing

Ø  Capitation/risk fund management

Ø  Premium billing

Ø  Provider network management

Ø  Group/membership administration

Ø  Referral management

Ø  Hospital and medical pre-authorization

Ø  Case management

Ø  Customer service

Ø  Electronic data interchange

Facets also offers deeply integrated HIPAA compliance, e-business platforms, workflow process automation, alternate pricing and consumer-driven functionality to address the wide scope of customers' business needs.

The Facets application is a powerful system on its own. When customers integrate it with other TriZetto solutions, they get an industry-leading system driving efficiency and productivity. The Facets system can integrate with other TriZetto solutions, including:

Ø  Care management solutions

Ø  Network management solutions

Ø  Value-based solutions

Ø  Utilization management solutions

Ø  Payment bundling solutions

Ø  Portal solutions

2. QNXT

The the QNXT application is built on an open platform with service-oriented architecture which provides a rules-driven system that healthcare payers can configure to meet the needs of their organization, and scales easily to serve organizations large and small. The QNXT application helps them better coordinate interactions among members, employers, brokers and providers. They can provide decision-makers with the information they need in real time. It improves efficiency in key areas of their business, including:

Ø  Medical and dental claims processing

Ø  Claims re-pricing

Ø  Capitation/risk fund management

Ø  Premium billing

Ø  Provider network management

Ø  Group/membership administration

Ø  Referral management

Ø  Hospital and medical pre-authorization

Ø  Case management

Ø  Customer service

Ø  Electronic data interchange

The QNXT solution supports payer organizations across all lines of business and provides comprehensive consumer-directed health capabilities with advanced HSA/HRA.

3. QicLink

QicLink is an innovative core administration system for the Third-party Administrators (TPAs) that can automate processes and increase efficiency. The QicLink application supports the management of self-insured, PPO, HMO, Medicare Supplement, and multi-option point-of-service plans. With the QicLink application, TPAs can increase efficiency through greater automation, manage the cost and quality of care more easily through pre-integration with premier solutions vendors, and keep their business running smoothly through QicLink’s advanced architecture.

The QicLink application provides a range of integrated components that enable TPAs to tailor the solution to the specific needs of their business. The components include

Ø  Claimrules

Ø  Claimsexchange Service

Ø  Claimworkflow

Ø  Clinicalogic

Ø  Datapiction

Ø  Cost Containment

Ø  Premium Billing

Ø  Utilization Management