To support today’s advanced plan designs, benefits administrators need to connect with multiple provider networks and specialty services vendors. TriZetto offers two complementary solution strategies that enable connectivity and integration with leading industry networks and vendors: 1) the TriZetto ClaimsExchange® Service; and 2) the TriZetto Premier Partnership Program™.
The TriZetto ClaimsExchange service seamlessly connects benefits administrators to a vast network of PPOs—routing claims and re-pricing data electronically through a single point of connectivity. The ClaimsExchange service automates and simplifies the re-pricing process, minimizing paperwork, manual intervention and human errors. The result is a dramatic increase in auto-adjudication rates as well as significantly reduced administrative costs. Additional capabilities provide an automated solution for obtaining discounts on out-of-network claims via a post-adjudication electronic interface with fee negotiators that further reduces adjustments due to ineligible claims.
The exclusive TriZetto Premier Partnership Program provides affordable, integrated access to the same type of high-performance, high-impact solutions that larger organizations have in place—but in a more cost-effective, easy-to-implement package. TriZetto has identified and established partnerships with quality vendors whose innovative, reliable products and services can enable administrators to better manage plan risk. The Premier Partnership Program leverages TriZetto's strength and its share of the self-funded market to secure optimal vendor pricing. These products and services are part of a cohesive strategy to help benefits administrators transform from a singular focus on paying claims to a broader strategy of better managing client risk.
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TriZetto provides leading healthcare information technology for payers and providers. From claims processing and advanced network management to case management solutions and HIPAA Compliance with 5010 implementation, TriZetto healthcare technology management solutions help reduce costs, streamline administration and improve the quality of care. TriZetto’s network management services help payers improve provider network management with tools for contract modeling, claims pricing, payment bundling and more. And TriZetto solutions give healthcare organizations the ability to achieve compliance with ICD-10 and 5010 HIPAA regulations more easily and cost-effectively.