TriZetto Corporation announced today an agreement with Washington, D.C. based-Gorman Health Group, LLC, to enable healthcare payer organizations to successfully participate in federal and state-based Health Insurance Exchanges. Gorman Health Group’s web-based software Valencia integrates with the TriZetto core administrative platforms, Facets™ and QNXT™, and extends the existing Exchange functionality to perform the complex reconciliation of membership and payments.
“Health plans face administrative complexities as individuals purchasing insurance through the Exchanges may be eligible to receive tax credit subsidies based on a variety of factors including family size, employment and income levels,” said Dan Skari, solution general manager for Healthcare Reform at TriZetto. “With more than 50 TriZetto clients in 30 states planning to participate in the Exchanges in October, and millions of individuals projected to purchase insurance through the newly formed Exchanges, health plans face the daunting task of reconciling individual and federal government payments based on their individual subsidy level.
Health plans may receive multiple payments on a monthly basis for each individual. This can fluctuate as these individuals’ circumstances change (i.e. income level, family status). As a result, the more complex payment reconciliation process can decrease administrative efficiency and contribute to potentially increasing costs.
TriZetto has engaged another strategic partner, Syntel, to develop a custom interface that integrates Valencia with TriZetto’s systems as part of the entire solution. The interface, powered by Syntel, supplies the Valencia solution with data from TriZetto’s Facets or QNXT core administration systems to complete this end-to-end marketplace solution.
According to Syntel Chief Operating Officer Rakesh Khanna, TriZetto’s end-to-end product portfolio is proactively improving significant portions of the healthcare technology ecosystem. “Health Insurance Exchanges present a challenge to the industry and underscore the need to integrate solutions like Facets or QNXT and Valencia to provide measurable value to health plans,” said Khanna. “Syntel is proud to partner with TriZetto and Gorman Health Group to enable this integration.”
The combination of TriZetto’s core administrative platforms with Valencia gives health plans the reconciliation capabilities plans require to analyze data quickly and efficiently. It provides real-time transparency into the status of each individual member and helps minimize payment shortfalls by identifying membership and revenue gaps between the Exchange and the health plan.
Other benefits include:
- Improved workflow to drive and resolve payment discrepancies through a health plan’s existing process.
- A real-time view into the status of an member’s payment status
- Reduced risk through utilization of an integrated solution.
The integrated TriZetto, Gorman Health Group and Syntel solution creates a powerful combination that allows health plans in this growth market to better realize speed to value and the ability to compete to win. TriZetto also provides deep healthcare experience through consulting services and training programs, along with reliable tools to help plans to better meet their goals.
About Gorman Health Group, LLC.
Gorman Health Group (GHG) is a national health care professional services and software company staffed by subject matter experts, former health plan executives and seasoned regulators. For more than 16 years, hundreds of clients serving millions of health care consumers have leveraged GHG’s strategic counsel and technology solutions to achieve growth objectives, maintain compliant operations, improve market position, advance profitability and serve beneficiaries. Gorman Health Group’s clients have one-stop access to expert advice, guidance and support in every strategic and operational area in government-sponsored health care and receive the highest levels of service available today. Our mission is to improve the quality of health care offered to the nation’s consumers.
Syntel (Nasdaq:SYNT) is a leading global provider of integrated information technology and Knowledge Process Outsourcing (KPO) solutions spanning the entire lifecycle of business and information systems and processes. The Company is driven by its mission to create new opportunities for clients by harnessing the passion, talent and innovation of Syntel employees worldwide. Syntel leverages dedicated Centers of Excellence, a flexible Global Delivery Model, and a strong track record of building collaborative client partnerships to create sustainable business advantage for Global 2000 organizations. Syntel is assessed at SEI CMMi Level 5, and is ISO 27001 and ISO 9001:2008 certified. As of June 30, 2013, Syntel employed more than 22,000 people worldwide. To learn more, visit us at: www.syntelinc.com.
About TriZetto Corporation
TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 200,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.
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