Transcript Document

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Confidential
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Copyright © 2014 TriZetto Corporation
What’s New and Coming
in NetworX
Tonia Burns, AVP Product Management
Deb Nelson, VP NetworX Development
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Confidential
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Copyright © 2014 TriZetto Corporation
What have you done for me lately?
A trip down memory lane
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Copyright © 2014 TriZetto Corporation
Additional ICD-10 Processing Logic
 Additional logic for ICD-10 Processing
 Option to use the “ICD-10 Date” for Qualifier Group check only
 Option to use the “ICD-10 Date” for Qualifier Group check and
claim/line qualifying and pricing
 Drive logic by System Property “Qualify on ICD-10 Date”
 “Y” claim pricing should be based on ICD-9/ICD-10 code in
qualifier group (on or after ICD-10 Date, use 10, before, use
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 “N” claim pricing should be based on the submitted code
(ICD-9/ICD-10) regardless of the date
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Global Rate Sheet/Agreement
 Provides the ability to create “standard” terms to be used in multiple
Agreements/Rate sheets
 Create as many Global Rate Sheet/Agreements as needed, limited by
Agreement/Rate Sheet section
 Make changes/add new terms in Global Rate Sheet/Agreement
 Any Rate Sheet/Agreement using the Global Rate Sheet/Agreement inherits the
change
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RESTful service in Stand Alone Pricer
 Clients have an option to use RESTful or standard
(WSDL) for processing electronic claims in Stand
Alone NetworX Pricer
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New Optum™ Prospective Payment
System (PPS) available
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Outpatient Group/Price Only
TRICARE (Inpatient and Outpatient)
Texas Medicaid (Inpatient – APR-DRG)
Medicare Physician
Illinois Medicaid (Inpatient)
Georgia Medicaid (Inpatient)
Michigan Medicaid (Inpatient)
Washington Medicaid (Inpatient)
Kansas Medicaid (Inpatient)
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Copyright © 2014 TriZetto Corporation
Web UI in Stand Alone Pricer
 Pricer functionality in Web UI
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Rate Sheets
Global Rate Sheet
Qualifier Groups
Codes
Calculation Categories
Schedules
Test Price
Copyright © 2014 TriZetto Corporation
New Qualifiers
 Provide the ability to qualify based on Rendering
Provider information
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NPI
Taxonomy
Type
Specialty (Primary and Secondary)
Tax ID
ID
 Patient Reason For Visit Qualifier
 ICD-9
 ICD-10
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New Calculations
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Stop Loss Lesser of Allowed or Per Diem
DRG with Base Rate and Med-Ed Rate
DRG with Base Rate and Length of Stay Inlier
Manual Stop Loss and Outlier – Retain Prior Pricing
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Copyright © 2014 TriZetto Corporation
Upgrades to Optum™ V1303 Web
Services
 Support for ICD-10, including the new Code Class input field
 Support for 64-bit
 Ability to update Optum™ rate files without performing an IIS
reset
 New NY Medicaid APR-DRG and Medicare ESRD pricing
worksheets
 New external data file for Return Code labels and other labels
(outpatient only)
 New input fields for inpatient claims only, including:
 Line-level National Drug Code (NDC)
 Used for Medicare Acute Care claims new technology reimbursement
 Admission Date
 Used to calculate claim length of stay taking into consideration the new
72 hour rule for billing outpatient services on an inpatient claim
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Copyright © 2014 TriZetto Corporation
3M™ Grouper Plus System (GPS)
 Users can access 3M™ GPS through new NetworX
calculations
 Claims submitted through service to 3M™ GPS
 Calculation, claim data and term data “tell” GPS what process
and provide data
 Claim returned to NetworX via the service with appropriate data
(DRG code, edits, pricing, etc., based on process performed)
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Perform Edit/Group functionality
 Enter value for type of grouping to perform
(currently, MS-DRG and APR-DRG available)
 Enter User Key 1 (required) and User Key 2
(optional) values matching records in GPS
 For Medicare DRG, select to apply/not apply
POA/HAC Processing
 Process will return the appropriate DRG to use for
other processing
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Perform Edit/Group for Outpatient
Processes
 Enter value for type of grouping to perform
(currently EAPG available)
 Enter User Key 1 (required) and User Key 2
(optional) values matching records in GPS
 Select editing option
 Process will return appropriate outpatient value for
claim lines
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EAPG Edit/Group/Price
 Enter value for EAPG Edit/Group/Price to perform
(currently Wellmark and Virginia available)
 Enter User Key 1 (required) and User Key 2
(optional) values matching records in GPS
 Select editing option
 Process will apply appropriate edits, EAPG code and
Pricing
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Enhanced PBA (5.10.004.000 and up)
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Updated technology
 Remove dependency on IHMF
 Improved UI- .Net to Java
HCI3 Prometheus
 New optional package– 23 episodes supported
Patient Bundles
 Filters
 Total Episode Price, Budget, Variance and break out by NonComplications and Complications
 Additional patient bundle details visible when patient bundle is open
Episodes & Episode Definition
 Filters
 Publish capability
 Improved usability
Test Price
 New tool available to price claims and see bundling results immediately.
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Copyright © 2014 TriZetto Corporation
Enhanced PBA (5.10.004.000 and up)
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Test Price
 New tool available to price claims and see bundling results immediately.
Claim Re-Evaluation (Facets integration)
Codes
 Cancel Reason Codes
 Category Codes
Administration
 Subscriber Configuration
 Data Import
Security
 Roles/Users
Configuration & Processing
 Improved usability
 Line level processing
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Copyright © 2014 TriZetto Corporation
The Small Print…
 The development release and timing of any features or
functionality described for our products remains at TriZetto’s sole
discretion.
 This information is intended to outline our general product
direction and it should not be relied on in making a purchasing
decision.
 This information is not a commitment, promise or legal obligation
to deliver any material, code, or functionality.
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NetworX Roadmap
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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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