TriZetto 2008 Corporate Template
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Transcript TriZetto 2008 Corporate Template
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Copyright © 2014 TriZetto Corporation
Implementation Means
Collaboration
Chris Rugg – Blue Cross and Blue Shield of MN
Manager – Network Pricing Methodology & Provider Pricing
Jim Hall –TriZetto
Senior Product Manager
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Agenda
About Blue Cross and Blue Shield of Minnesota
NetworX™ Implementation Overview
Implementation Story
What we did
Enhancements & Innovations
Lessons Learned
NetworX in our Business
How we use NetworX
How we manage NetworX
Collaboration with TriZetto
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About Blue Cross Blue Shield of Minnesota
Minnesota’s market leader
Nearly 2.7 million members
One in three Minnesotans is covered
by Blue Cross
Largest health plan in the state
More than 98 percent of all hospitals
and physicians
National scope
Access to the largest provider network
in the U.S., including more than 90
percent of hospitals and 80 percent of
physicians
Covering over 99 million people
379 of the top 500 U.S. companies
count on the Blues*
*Each local Blue Cross and Blue Shield plan is an independent licensee of the Blue Cross and Blue Shield Association
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Implementation
Story
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NetworX™ Implementation Overview
Blue Cross and Blue Shield of MN (Blue Cross) purchased
stand-alone NetworX Pricer and Modeler in 2009
Installation and implementation work completed in 2010
SIT and BAT testing completed during the first-half of 2011
Pricer go-live in July 2011 with all commercial providers
moved to Pricer by August 2011
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Implementation Story
Dedicated team of business and IT staff
Each business analyst was a subject matter expect (SME)
TriZetto consultant was on-site and part of the business team
Multiple project managers based on key deliverables
Established a dedicated “war room”
Created full inventory of contracts to be transitioned
Created reporting to inventory all provider contracts
Analysts researched and categorized each contract to identify
requirements
“Gaps” identified early and enhancements requested
Identified all components needed for go-live
(i.e. Fee Schedules, Calc beans, Code Groups, etc.)
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Implementation Story
IT staff worked with TriZetto on install and configuration
Work included establishing application environments, claim system
modifications, etc.
Dedicated team established to populate Modeler database
Loaded three-years worth of claims
Data mapping process was lengthy
Built and tested each Modeler rate sheet template
Started by building required code groups, schedules, and rate sheet
templates
Extensive testing done for each template to ensure all components
worked appropriately
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Implementation Story
Built all Modeler Rate Sheets
Initially built around 1,000 rate sheets that mirrored our current
commercial pricing
Each rate sheet was audited to ensure correct rates
All commercial contracts transitioned at Go-Live
Training for all staff completed “just in time” to help with retention
Automated program scripts updated provider demographic system
Transitioned all providers at once
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Implementation Story – Enhancements & Innovations
Created Global Rate Sheets
Allows for universal changes to default pricing
3M APR-DRGs and EAPG
Commercially-based groupers for hospital pricing
Currently being rolled out to all of our hospitals
Streamlined process for updating contract rates
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Implementation Story – Lessons Learned
Optum Medicare Payment Groupers
Commercial claims can cause errors with groupers due to having
inconsistent claims information
Claim System Integration w/ Stand-Alone NetworX Pricer
Each Pricer calculation needs to be tested to ensure compatibility with
claims system
Pricer / Modeler reporting
Reporting from these applications is complicated and requires skilled
programmers
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NetworX ™
in our
Business
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How We Use NetworX™
Modeler is our “source of record” for all NetworX Rate Sheets
Tight controls on Rate Sheet creation
Follow approved templates
Created by Finance Analysts in Modeler
Tested and approved by Pricer Administration team
Approved Rate Sheets transferred to NetworX Pricer for adjudication
process
Approximately 3,600 rate sheets have been built to date
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How We Manage NetworX™
Business Pricer / Modeler Administrative Support
Ongoing maintenance of payment methodologies, default pricing,
tables updates
Development of business processes
Business testing of all application and grouper upgrades
Audits of TriZetto rate sheets that will be used for pricing claims
Day-to-day research and issue resolution
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How We Manage NetworX™
Business Financial Analysts
Build rate sheets for negotiated contracts
Financial modeling
Network Implementation
Setup our provider demographic system to use updated Pricer rate sheets
IT Pricer / Modeler Support
Dedicated internal and external resources
Work with various areas of Blue Cross to coordinate updates and testing
Database management
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Collaboration
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Collaboration with TriZetto
Regular meetings with TriZetto Team
Product Management / Development / Support
Discuss open issues
Discuss new opportunities / enhancements
Regular communication with our Account Executives
Keep informed of overall performance and satisfaction
Collaborate on initiatives and strategy
Product Enhancement Overviews
Learn more about enhancements / fixes for upcoming TriZetto releases
Client Engagement Reviews
Product Roadmap
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Copyright © 2014 TriZetto Corporation
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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Copyright © 2014 TriZetto Corporation
Thank You!
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Copyright © 2014 TriZetto Corporation