Pended claims are a painful reality leaving payers with the ongoing struggle of growing claims backlogs, dissatisfied providers and potential regulatory non-compliance. For many payers, the only option for mitigation is to rely on manual processes which are both inefficient and costly.
The introduction of the QNXT Workflow for claims application into your existing QNXT™ environment will help you reduce costs, improve efficiency and increase the productivity of your end users. QNXT Workflow for claims is designed specifically to help manage your claim inventory more efficiently. The new workflow capabilities for claims will help prioritize, triage and reduce pended and exception claims resulting in in improved administrative efficiency and performance.
Designed to help plans manage the inventory and priority of claims to be worked, QNXT Workflow capabilities include:
QNXT Workflow for claims streamlines the delivery of work to users by automatically routing claims in real-time to user work queues based on configured routing rules. Prioritized and routed claims are resolved and then reintroduced to the QNXT adjudication process. QNXT users then quickly and efficiently move on to the next work item in their workflow queue.
Reducing healthcare costs and improving quality through TriZetto technology-enabled solutions. Read the impressive results.
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TriZetto is a leading provider of healthcare technology for payers and providers. TriZetto facilitates integrated healthcare management with comprehensive solutions for core administration, health insurance claims processing, care management, IT hosting services, Medicare solutions and more. TriZetto’s innovative claims processing software streamlines claims administration to reduce costs and improve revenue cycle management.