Transcript Key Integrations for QNXT™ in 2014

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Copyright © 2014 TriZetto Corporation
QNXT™ - TriZetto Integrations
Scott Johnson, AVP T3 Architecture
Derrick Drewry, Dir. QNXT GM
Anne Neal, Dir. QNXT Product Owners
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Key Integrations for QNXT™ in 2014
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TriZetto
Workflow
NetworX Pricer™
& PBA
TriZetto
Communication
System (TCS)
 Initial focus is
QNXT Workflow
– Claims
 Supplemental
to QNXT Pricing
Methodologies
 Manages
constituent
communication
 Beta release
August 2014
 Beta release
August 2914
 Initial features
release in R6
 GA release
November 2014
 GA release
November 2014
 Continued
development in
R7
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TriZetto Workflow
Integration
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What is TriZetto Workflow?
 Streamlines delivery of work (e.g. claims) to users
 Prioritizes and routes tasks based on business rules
defined by health plan
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Workflow Success Story
Boston Medical Center (BMC) HealthNet Plan is a not-for-profit
managed care organization serving more than 275,000 members.
CHALLENGE
No simple way to capture and measure claim adjudicators’
productivity. Labor intensive, time consuming & inaccurate.
SOLUTION
Preferred method to calculate adjudicator productivity was to use
generate reports using TriZetto Workflow data.
RESULT
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
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Improved accuracy in measuring claim processing time.
Trackability of employee productivity by user, role, “gap” time etc.
Less time gathering data, more time analyzing data.
Overall increase in quality, efficiency and performance
management.
TriZetto Workflow Architecture
High-Level Constraints




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Re-Use Successful Domain Model
Modernize services offering
Provide responsive, web-based user interface
Standards / WebProfile compliant
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Workflow Engine – Component View
Sourced From Facets
Workflow
Re-Engineered
Component
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Workflow Engine – Consuming Modules
• Crisp Boundaries between User
Interfaces and Engine APIs
• Pluggable security model
• SPA-style user interfaces drove
API definition
HTTP(S) / REST
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QNXT™ Workflow for Claims Architectural Overview
Integrations
Custom
Code
QNXT UI
QNXT
Business
Domain
Unit
Tests
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Data
Storage
QNXT™ Workflow for Claims Architecture
 Domain Driven Design
 All business related logic and decisions centralized into Domain
 Business rules, processes and procedures
 Business and technology experts collaborate throughout the
Domain building process
 Technological decisions can reside outside of core Domain logic
 Changing a UI to a different platform
 Changing the data storage to another vendor
 RESTful Web Services
 Extensibility layer that exposes Domain logic
 Follows HTTP web standards to ease integrations
 New QNXT UI, other software integrations and custom code
 Lightweight transport options for better performance and
scalability
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QNXT™ Claims UI Overview
Browser Z
Browser X
Patient:
Provider:
Browser Y
Save
Patient:
Provider:
Save
Patient:
Provider:
From Date:
To Date:
Save
Content
Server
Web API
Server
Domain
Logic
Server
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Database
Server
QNXT™ Claims UI
 Angular JS
 Future proof JavaScript Library provided by Google
 Set to support current and future web technologies
 Enforces strict decoupling of business logic from UI logic
 Minimizes future maintenance complexities
 Supports Unit Testing
 Build robust, flexible code base that can withstand change
 Bootstrap
 Create flexible, cross browser user experience
 Support for Responsive Design
 Built-in support for mobile platforms including tablets and
phones
 Reacts to changes to browser window size on desktop
platforms
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QNXT™ Workflow for Claims Development Strategy
 TZG Workflow Features
 Select Queued Item
 Set Aside
 Take Break
 Claim Features
 Search
 Entry
 Mass Adjudication
 Authorization, Authentication & Licensing
 Installer
 Documentation
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TriZetto
Communication
Systems (TCS)
Integration
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TriZetto Communication Systems (TCS)
 What is TCS?
 Delivered as part of Foundation Run Time (IHMF)
 Common & integrated solution for all constituent communication
 Provides customizable document generation utilizing MS Word
for template authoring
 Tracks all outbound communication
 Supports delivery of communication across all industry standard
formats (print, email, IVR etc.)
 Key System Component – Template Builder
 Utilizes Microsoft Word & Visual Studio Template Builder plug-in
 Generates templates containing static text, images, tables,
content controls and custom data (XML) etc.,
 Capable of including or excluding content based on conditional
operators from the core system, such as member demographics.
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TCS Architecture
 QNXT™ will interact with TCS via WCF
 Foundation Component database is the primary data
storage
 Templates, XML, Merge Instructions etc.
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TCS Overview
TCS Template Builder Overview
QNXT to TCS Integration Overview
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TriZetto Communication System (TCS)
 Starting development in R6
 Generate XML structure to populate TCS template
(placeholder XML)
 Future Development
 Access TCS directly from QNXT™
 Full/complete integration to TCS build services to;
 Return available templates
 Create communication based on available templates
 Create single fulfillment of communication
 Create batch fulfillment of “queued” communication
 Return communication already sent to constituents
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NetworX® Integration
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NetworX® Integration
 Complete in R5
 Select to price through NetworX Pricer & map to NetworX
Rate Sheet
 Future development
 2015 1st quarter - Pricer
 2015 2nd quarter - PBA
 NetworX Integration Break-out Session will cover
more details!
 “This session will provide an engaging discussion on the
integration of the NetworX suite (Pricer, Modeler & Payment
Bundling Administration) with QNXT.”
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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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