TriZetto and its Payer Solutions-V

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.