Transcript TriZetto 2008 Corporate Template

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Copyright © 2014 TriZetto Corporation
Maximizing Collaboration
Through Deeper Payer-Provider
Integration
Allen Latham – Associate Vice President
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Copyright © 2014 TriZetto Corporation
Agenda
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Examples of Payer-Provider Collaboration
Driving out administrative cost
Example of ROI
Additional services to drive out cost and increase
efficiencies
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Copyright © 2014 TriZetto Corporation
The TriZetto Healthcare Community
TriZetto is the industry leader in delivering innovative
solutions that drive improved efficiency, connectivity
and industry collaboration to help our clients succeed.
230K+
Providers
400+
PM / EMR System
Connections
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Copyright © 2014 TriZetto Corporation
180M
Consumers
1.8B+
Transactions/Yr.
360+
Payer Organizations
50+
Exchange-Ready Clients
Enabling Healthcare Collaboration
Payer
Provider
Solutions
Solutions
Eligibility
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Claims
Gaps in Care
Customer Service
Financial
Streamlining real-time transactions between payers and providers
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Copyright © 2014 TriZetto Corporation
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TriZetto Provider Solutions
Supporting Reduced Administrative Burden And
New Models Of Care And Payment
TriZetto acquired Gateway EDI in 2011 to deliver integrated realtime payer-provider connectivity:
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Removing friction and administrative burden
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Preparing for payment reform and changes to Revenue Cycle
Management
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Enhancing Integration and Connectivity to support payer - provider
collaboration and new models of care delivery
Copyright © 2014 TriZetto Corporation
Extensive Capabilities to Drive Change
Provider
Revenue Cycle
Management
Patient Liability
& Eligibility
Connectivity &
Collaboration
Core Extended
Integration
Patient Access
Post Claim
Payment
Analytics
Denial
Management
400+
EMR/EHR
Integrations
Payer
Benefit
Management
Workflow
Customer Service
Enrollment &
Billing
Consumer Directed
Claims Adjud
& Management
Medicare
Dental
Long Term Care
Medicaid
Vision
Behavioral Health
Dual Eligibles
Disability
Individual &
Private HIX
Employer Group
Trusts, Unions,
FEP
Public HIX
Utilization & Case
Management
Referrals and
Advanced Auth
Capitation
Disease
Management
Contract Pricing
Payment Bundling
Population Health
Management
Contract Modeling
& Analytics
Contract Analytics
Implementation
Consulting
Services
Performance
Insight
Optimization
Advisory Services
Upgrade
Compliance
Advisory Services
Training
App. Mgmt.
Services
Application
Hosting
On-Demand
Environments
Security, Disaster
Recovery
Configuration
Front-End
Billing &
Reconciliation
Claims
Administration
Enrollment
Customer Service
Core
Platform
APIs
Self- Service/
Engagement
Lines of
Business
Point of
Service
Cost
Transparency
BCBS Plan
Connectivity
Clinical
Integration
Advanced
Eligibility
Care and
Network
Mgmt.
Trading
Partner
Business
Mgmt.
Services
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Copyright © 2014 TriZetto Corporation
TriZetto Provider Solutions
Business Partners
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Directly contracted with 230,000+ providers
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20,000+ physician practices in all 50 states
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Strong partnerships with 400+ PM/EHR vendors
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3,484 Payer connections
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25 contracted clearinghouses
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Over 1 billion transactions processed annually
Confidential
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Copyright © 2014 TriZetto Corporation
Current EDI Process
TP2
TP3
TP4
TP1
TP5
Relevant
Transactions
FHG
S/MFT
(files) & RT
Facets
Batch:
· 837x / 835
· 999 / 277CA
· 278
Real-time:
· 270 / 271
· 276 / 277
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Copyright © 2014 TriZetto Corporation
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Copyright © 2014 TriZetto Corporation
TriZetto Trading Partner Services
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Trizetto Provider Solutions will act as the sole electronic point of entry and exit for all
health plans’ core systems for the following provider HIPAA X12 transactions version
5010 or greater:
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Claim transactions: 837i, 837p, & 837d
Remittance Advice: 835
Eligibility inquiry and response: 270/271
Claim Status: 276/277CA
Referral and Authorizations: 278
Acknowledgements: 999
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Establish the trading partner technical platform that enables connectivity between any
Trading Partner and the health plan.
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Maintain health plan payer specific rules, transaction edits, and configurations.
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Monitor all inbound and outbound transactions between Trizetto Provider Solutions
and all associated processing system(s).
Confidential
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Copyright © 2014 TriZetto Corporation
Slide title
Compliance and
regulation
requirements
Provider Enrollment
Reporting,
Monitoring and Help
Desk
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Patient Protection and
Affordable Care Act
(PPACA)
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TriZetto will take ownership
of enrollment process –
paperwork, signatures, help
get “systems” in place
Applicable regulations
implemented by the U.S.
Department of Health
and Human Services
(HHS)
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CORE CAQH mandated
operating rules
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EHNAC Accreditation
Standards
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Copyright © 2014 TriZetto Corporation
Prepare and distribute
trading partner standard
reports
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Monitoring Services Monitor inbound and
outbound transactions
(including real time
transactions) between
TriZetto and trading
partners.
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Help Desk Services Provide help desk
support to customer
plans and trading
partners.
TriZetto Trading Partner Services
Reduce Clearing House transaction fees
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PMPM includes all Clearing Houses and unlimited Transaction volumes
230,000 direct connections with providers
Proactive Customer Service
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Cleaner Claims
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- Reducing call volumes and increases Auto Adjudication Rates
TriZetto works with providers to create specific edits which enhance1st pass rates
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TTPS 1st pass error rate Less than 5%
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TTPS payer rejection rate less than 3%
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TTPS work directly with Clearing house or Practice Management system to correct error prior to
hitting adjudication system
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Reduce Paper Claims – TTPS works with providers to offer alternative options to paper process
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Developing Portals to allow providers the ability to process and monitor real time transactions
Copyright © 2014 TriZetto Corporation
Examples of TTPS Cost Savings
Facets client – 500,000 members
$335,160 $450,000
$374,822
Clearing House
Fees
Internal Support
$1,465,174
$5,535,950
Paper Claims
Reductions
1st Pass Rate
Complance & Testing
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Client Total Cost
$ 8,161,106
TTPS Cost
$ 6,361,300
Net Five Year
Annual Savings
$ 1,799,806
$ 359,961
Confidential
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Copyright © 2014 TriZetto Corporation
Examples of TTPS Cost Savings
Plans internal cost average, on blended rate, $.13 - $.25 per transaction – TTPS
cost are in range of $.07 - $.14 per transaction
$537,600
487,257
$376,200
302,146
$243,684
$171,000
$108,000
$70,680
QicLink
250K Members
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Copyright © 2014 TriZetto Corporation
QNXT
140K Memebers
Facets
75K Members
QNXT
15K Memebers
Other Services
 Hosted Real Time Eligibility
 Member Provider Matching
 Paper Claims Processing
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Copyright © 2014 TriZetto Corporation
Thank You!
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Copyright © 2014 TriZetto Corporation