TriZetto and its Payer Solutions-IV

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 1-4 areas. Now we will throw some light on TriZetto Value-Based Solutions and Portal Technology Solutions .

5. Value-Based Solutions under Payer Solutions

Value-Based Solutions consist of Value-Based Benefits Solution and  NetworX Payment Bundling Administration.

5.i: Value-Based Benefits Solution

Value-Based Benefits Solution is a benefit design and incentive management software application that enables payers to customize benefits and other incentives for individual members based on health status, chronic conditions, or activities to  promote their health and wellness. his comprehensive automation solution enables payers to:

Ø  Design and manage member incentive programs using an easy-to-use graphic interface

Ø  Automate adjudication of value-based benefits at the member level

Ø  Automate enrollment, achievement and reward issuance, processing, and member incentive program communication

5.ii: NetworX Payment Bundling Administration

TriZetto NetworX Payment Bundling Administration provides a comprehensive software solution with patent-pending functionality that automates the prospective bundling process. Here’s how it works:

Ø  Integrates tightly with payers' claims processing system, whether that’s a TriZetto solution or third-party application.

Ø  Evaluates each fee-for-service claim made during the adjudication process to determine whether the claim belongs to an identified episode-of-care bundle.

Ø  Creates episodes of care prospectively, in real time.

Ø  Bundles related claims together from multiple clinicians working on a specific episode.

Ø  Re-prices claims to conform to the agreed total payment for each episode of care.

Part of the NetworX Suite of products for managing provider networks, TriZetto’s NetworX Payment Bundling Administration solution is available on a licensed or hosted basis to healthcare payers.

6. Portal Technology Solutions under Payer Solutions

Portal Technology Solutions consist of Member portal, Employer & Broker Solutions and Provider Solutions.

6.i: Member Portal

This portal consists of Member Service application, Treatment Cost Navigator solution and Member Benefit Profile

6.i(a): Member Service application

TriZetto’s Member Service application helps health plans meet the demand of members for high levels of client service while also helping to keep administrative costs low. Using the effective Web-based self-service tools that Member Service provides, health plan members can look up information and perform routine transactions at any time of day or night, from any location, without the help of a client service representative.

6.i(b):Treatment Cost Navigator solution

With self-service capabilities from TriZetto’s Treatment Cost Navigator solution, members can:

Ø  Estimate likely out-of-pocket costs for particular treatments.

Ø  Review eligibility for specific treatments.

Ø  Compare costs with accumulated deductible amounts and/or out-of-pocket maximums.

6.i(c): Member Benefit Profile

With TriZetto’s Member Benefit Profile™ application, insurance companies can give their health plan’s members an easy-to-read, well-organized and comprehensive view of their benefits, funds and healthcare utilization.

6.ii:  Employer & Broker

This portal consists of Employer & Broker Enrollment solution, Employer & Broker Bill solution and Employer & Broker Service solution

6.ii(a): Employer & Broker Enrollment solution

TriZetto’s Employer & Broker Service application provides easy-to-use self-service tools for employers and brokers who wish to perform transactions on behalf of members. The Service application not only can help payers improve satisfaction levels, but it also can help them reduce costly telephone calls and paper-based transactions.

6.ii(b): Employer & Broker Bill solution

The TriZetto Employer & Broker Enrollment solution enables employers and brokers to enroll new or open members, conduct all enrollment transactions, and send messages to members. Easy-to-use online tools guide users through enrollment transactions, increasing accuracy while helping you improve efficiency.

6.ii(c): Employer & Broker Service solution

With TriZetto’s Employer & Broker Bill solution, employers and brokers can view the bill, make roster adjustments based on a current invoice, view estimated impact of adjustments, and make a single payment or establish routine payments.

6.iii: Employer & Broker:

Provider  solution consists of Provider POS Direct solution and Provider Service application.

6.iii(a): Provider POS Direct solution

The TriZetto Provider POS Direct solution calculates patient financial liability and adjudicates claims at the point of service. With this valuable tool, providers can collect full payment at the time services are rendered—or, in some cases, even before the  patient’s visit—rather than days or weeks later. That means providers get immediate payment and members get no surprise costs.

6.iii(b):  Provider Service application

TriZetto’s Provider Service application enables providers to conduct a wide range of self-service transactions and inquiries in a secure online environment. For providers, that means getting faster and easier access to the information they need. For payers, it means increasing provider satisfaction, improving accuracy for higher first-pass rates, and reducing calls to payers' client service staff—all of which can help reduce cost and improve the quality of care.