Transcript TriZetto 2014 Health Conference - Optimization

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Optimization for Fun and Profit: Robots
and More
Sal Novin, Director of Product Development, TriZetto
David Weathington, Sr Director,
Business Service Operations, Cigna HealthSpring
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An Established Partnership
 Five-year relationship with Cigna HealthSpring
(through TriZetto acquisition of HPA Services)
 Automated multiple claim systems (EZCAP, MHC, and QNXT)
 Interface with supporting systems (APC/DRG Calculators, iHealth, CCMS, etc.,)
 HPA Services has developed over 50 workflows across all systems, including daily
and special projects.
 Recently moved all business to QNXT and sunset EZCAP and MHC.
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Business Background
 David Weathington - Senior Director, Business
Service Operations
 Healthcare Process Automation in place four years:
 Medicare
 Medicaid
 Managed care operations experience:
 Health Services
 Customer Service
 Claims
 Over 1,000,000 claims per month processed, exceeding
$250,000,000 in value
 Currently implementing new Medicare-Medicaid Financial
Alignment Initiative
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Healthcare Process Automation Service –
What Is It?
Overview:
An automation service specifically designed for
healthcare reimbursement.
Quickly and accurately manually processes claims, following
the same procedures that a human does, on the same system
Result of HPA Service Robot is indistinguishable from work
performed by a person.
Technical term for this is type of system is Autonomic
Computing, (Artificial Intelligence, Machine Learning, etc.,)
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Healthcare Process Automation Service –
Value Differentiators
Value Differentiators:
Fewer Errors
Faster
Processing
Consistent
Results
Up to 5 - 30X
faster than a
human.
Zero variance on
an ANOVA Gauge
R&R
Scalable
Traceability
Immediate ROI
Access to unlimited
staff.
Traceable,
auditable
processing.
Fast
implementations,
3-6 weeks to
savings.
Timeliness
Compliance
Lower TCO
Reduce regulatory
penalties & fines.
Reduce
settlements and
legal costs.
Lower operations
costs. Predictable
pricing.
Over 99% first
pass Financial
Accuracy.
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More Information
 TriZetto Advantage Services area Healthcare
Process Automation
 Beat The Robot – Win prizes and literally compete
against the robot on QNXT and Facets.
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What’s Inside Every Robot?
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Session Survey
We would like to extend you an
opportunity to provide candid feedback.
During the workshop you should’ve received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time, we would
greatly value your feedback. For your convenience, the survey will be
available throughout the remainder of the conference should you not
be able to complete immediately.
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Thank You!
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