TriZetto 2008 Corporate Template
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Transcript TriZetto 2008 Corporate Template
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Copyright © 2014 TriZetto Corporation
Getting The Most Out Of
Your 5.x Enhancements
Keith Herbert, Director Facets Product Design
Dave Resnick, Manager Facets Product Design
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Copyright © 2014 TriZetto Corporation
Agenda
Release Schedule & Communication
Product Feature Highlights 5.01 through 5.10
Government Programs
Compliance
Client Satisfaction
Usability
Architecture Advancement
Preview of Future Releases
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Copyright © 2014 TriZetto Corporation
Release Schedule &
Communication
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Copyright © 2014 TriZetto Corporation
Release Schedule
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Facets™
5.2
• R1 – November 5, 2014
• R2 – February 4, 2015
Facets™
5.10
• R5 – May 7, 2014
• R6 – August 6, 2014
• R7 – November 12, 2014
Facets™
5.01
• R17 – May 7, 2014
• R18 – August 13, 2014
• R19 – November 12, 2014
Copyright © 2014 TriZetto Corporation
Release Communication
Release Preview
High level view of
Release content
Published post planning
Provides early visibility into content
See the R5 Demos that are posted – Copy/Paste, EHB, HIX
820….more to come!
Release Review Meetings
Client Reviews – pre-release
Review of select fixes
Enhancement review
Session Recording
Data Models and presentations
published
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Release Communication
Upcoming Release reminders
Letter Server support deprecated as of October 2014
5.10 R7 and 5.20 R1 will not have an install for Letter Server
Support for generating letter request data (ATLT) continues through
5.20 release
EDI 4010 and 5010 pre-addenda transactions support ends as of
5.10 R7/5.20 R1
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Product Features,
Government
Programs
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Copyright © 2014 TriZetto Corporation
Medicare-Medicaid (Dual) Eligibles
Process a single claim
for members with both
Medicare and Medicaid
coverage
Enhanced Claims
Adjudication Routine
Stores Claim and
Line Item data for
reporting
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Copyright © 2014 TriZetto Corporation
Medicare-Medicaid (Dual) Eligibles
Class/Plan Definition
Supplementation
applies
Secondary Product
Secondary Network Set
New Secondary Product
application
Limited set of
Components
Establish Variable
Components
New Secondary Plan
Processing Rules
application
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Medicare-Medicaid (Dual) Eligibles
Additional information on Medicare-Medicaid (Dual)
Eligibles can be obtained at “Lessons Learned Around
Participating in Serving the Dual-Eligible Population”
workshop, Tuesday 10:45-11:45.
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Copyright © 2014 TriZetto Corporation
Product Features,
Compliance
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Copyright © 2014 TriZetto Corporation
FSA Partial Rollover
IRS requirement is to
allow for optional partial
rollover of FSA funds
into the next year, with a
maximum amount of
$500
Mutually exclusive to
existing Grace Period
availability
Changes made to FSA
Administrative
Information application
in 5.10R3
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Copyright © 2014 TriZetto Corporation
Reform related enhancements
Cost Sharing Batch
Essential Health Services
Membership changes:
Support Rating of the 3 oldest children
New Applications
Enrollment Channel Description
Exchange ID Description
Exchange Rules Product Component
Subscriber/Family Changes to collect Enrollment
Source, APTC status and Subsidy amounts
Subsidy Billing Changes
APTC Status
Exchange delinquency
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Copyright © 2014 TriZetto Corporation
Reform related enhancements
Further details on Reform related enhancements are
available:
Healthcare Reform Exchange Experience
Workshop
Solutions Center
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Copyright © 2014 TriZetto Corporation
Additional Compliance Enhancements
Core 835 ERT/ERA
2014 Clinical Editing Criteria includes ICD-10
Consumer Friendly Descriptor fields for Procedure
Codes
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Copyright © 2014 TriZetto Corporation
Product Features,
Client Satisfaction
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Copyright © 2014 TriZetto Corporation
Rendering Provider Enhancements
Medical Claims and
Encounters
Claim Level
Hospital Claims and
Encounters
Claim & Line Item
Levels
Propagation
Claim to Line Item
when line level ID is
blank or invalid
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Copyright © 2014 TriZetto Corporation
New Qualifiers for:
DOFR
Supplemental
Conversion Rules
NetworX Pricer
Workflow
ClaimsXTen
Added to:
Customer Service
Web Services
Automatic Copayment Reduction
Provides the option to
limit the line item
copayment amount to a
percentage of the line
item allowable
(medical/hospital only)
Service Rule Definition
modified to provide the
option to Warn or Reduce
when copayment exceeds
the stated percentage
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Copyright © 2014 TriZetto Corporation
Additional Enhancements
MMS Void
HIPAA Gateway Purge and Archive of Transactions
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Copyright © 2014 TriZetto Corporation
Product Features
Usability
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Copyright © 2014 TriZetto Corporation
5x User Interface
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Improved navigation experience
Docking preferences
Resizing & Pinning
Auto-hiding & Fluid re-display
Modernized Look to Tree Control
Scrolling
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Copyright © 2014 TriZetto Corporation
Application Tab Windows
Browser Application
Favorites – frequent use
applications
New Font Style
Securing Sensitive Information
Masking of IDs
Facets Security Config
Partial or Full Masking
TIN, EIN, Medicare ID,
Medicaid ID, Original
Subscriber ID
Applications & Searches
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Copy to Clipboard
Passive Enablement
Security
Application level
Search results display
Availability
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List Grids
Search Results Display
Interaction with masked information
Facets application’s Open Record area,
Formatted Text area, and Dialogs
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Copyright © 2014 TriZetto Corporation
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Copyright © 2014 TriZetto Corporation
Architecture
Advancement
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Copyright © 2014 TriZetto Corporation
TriZetto Upgrade Framework
5.10 R5
Enhance the ability to facilitate and coordinate the execution of
independent upgrade actions when moving from one Facets release
to another
Upgrade Framework
Upgrade multiple Facets
Databases (Core, AR, AU,XC)
Oracle, SQL Server, Sybase
Checks Actions
Verification Scripts
Winter Tech Overview – on CX
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Copyright © 2014 TriZetto Corporation
Major Release Binary Installation – 5.2 R1
Multi-release project to
modify how the Facets
binaries are installed
Sets up the ability to
upgrade to a new major
release without having to
do a full uninstall and install.
5.2 will be the last time that will need to be done.
The changes will provide the ability to upgrade from
5.2 to 5.3 similar to an upgrade from 5.2 R1 to 5.2 R2.
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Workflow – Optional Java Server – 5.2 R1**
New option for java server
implementation - TomEE
No changes required for Facets
Workflow applications
Facets end user experience is not
changed
Impact – Total Cost of Ownership
** introducing in 5.2 R1 for evaluation purposes
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Facets UI – Applying New Technology
5.01 R10 – Introduced the Qualified Health Plan
Definition application
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Built on WPF/C# platform
XAML Presentation Layer
New paradigms
Features developed based on R&D for Claim Search
Copyright © 2014 TriZetto Corporation
Facets™ UI – Applying New Technology
5.10 - 5.20 timeframe – Research & Development
Technology direction
From WPF/C#/XAML to pure web application – HTML
Web Application Proof of Concept – Workflow Routing Rules
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Facets™ R6 – Preview Highlights
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Copyright © 2014 TriZetto Corporation
Facets™ 5.10 R6 Preview (August)
Compliance & Reform
FSA Partial Rollover
Compliance Maps for CMS Edit Parameter
Premium Age Calculation for Exchange Support
Performance
835 Multi-engine performance improvements
Audit Archive – R7 planned delivery (Client Survey item)
Client Satisfaction
Workflow – Group Related Entity qualifiers
iCES Transfer/Added Lines functionality
Facets/TCS Integration – Spell Check
ITS
14.5
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Facets™ 5.10 R6 Preview
Real Time Accumulator Service (5.1R6)
New Offering
Paradigm is shifting due to requirements around a single
deductible or limit
Health Plans need the ability to keep in sync with 3rd party
vendors in a real time manor
Built on ReST architecture
Contact your SAE for more information or to step a meeting
to review the functionality
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Beyond R6…..
Client Satisfaction
Selective application of deductibles to stoploss
Addition of Group ID and Plan ID as NetworXPricer® qualifiers
Display Plan Year for Accumulators
Error when a claim spans subgroup termination
Modification of HRA/FSA COB routine calculation of Maximum
Amount to Pay
Performance
Claim Archive Redesign for Performance
Government Programs
Dual Eligibles recalculation of OOP amounts
Zero Dollar Premium (Exchange)
Subsidy Tolerance (Exchange)
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Questions?
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Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have 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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