HHS has confirmed that the Edge Server requirement is not only for health plans that participate in Exchanges, but also for health plans that serve the individual and small group markets. Health plans need to be able to share consolidated, scrubbed and masked information that includes enrollment, medical claims, and pharmacy claims data on a recommended monthly basis.
Pre-integrated with TriZetto’s Facets™ and QNXT™ core administration applications, TriZetto Encounter Data Manager (EDM) for Edge Server provides an interface from the enrollment and claims data sources to generate and edit files submitted through the Edge Server to HHS. The TriZetto Edge Server Solution application helps you scrub, mask, submit and track complete files according to the varying HHS submission and format requirements for delivery to the Edge Server. The solution allows for greater efficiency and supports your compliance efforts with accurate submission files and error fixes to better maximize risk scores and deliver higher reinsurance revenue. EDM for Edge Server can run on premise at your facilities or you can opt to utilize TriZetto’s AMS services to host and support the solution. EDM for Edge Server can be used with other non-TriZetto core administrative platforms.
TriZetto’s Exchange capabilities help clients navigate uncharted waters with a wide range of technical, consulting, training and business management services. Our knowledgeable professionals leverage best practices, repeatable processes and utilize proprietary tools to get support our clients Exchange-readiness needs.
Our Exchange Services Include:
Learn more about TriZetto’s solutions for Exchange [marketplaces], as well as other TriZetto solutions for core administration, healthcare claim processing and more.
Comprehensive Capabilities to Participate in Healthcare Insurance Exchanges
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TriZetto provides leading healthcare IT solutions for payers and providers. TriZetto promotes integrated care management by offering comprehensive solutions for care management software, claims management services, network management solutions and more. With solutions for care management, patient-centered medical home (PCMH) solutions, payment bundling and other innovative models, TriZetto is helping reduce the cost, improve the quality of care and transform the healthcare industry.