The TriZetto Group, Inc., today announced that El Paso First Health Plans, Inc., a non-profit community healthcare organization serving 95,000 people in the El Paso, Tex., area, has used an integrated set of TriZetto’s software and services to improve efficiency and support compliance with complex federal healthcare regulations.
“With the support of TriZetto’s consulting services team, El Paso First has fully grasped what to do, what the next steps are, and where we need to place strategic emphasis,” said Sharon Perkins, director of information systems at El Paso First. “TriZetto helped develop a strategic plan for execution, which was reviewed and approved by the State of Texas with no edits. That was amazing.”
Over a period of three weeks, TriZetto’s consulting services team researched and designed a compliance strategy and plan, identifying El Paso First’s needs, defining next-steps, and determining how to collaborate with group practices and medical facilities to ensure financial neutrality in claims administration. El Paso submitted the plan and received state approval. The CEO of El Paso First then used the strategic roadmap to guide the organization’s “go-live” plan for both 5010 and ICD-10 compliance.
“HIPAA 5010 and ICD-10 requirements figure prominently in planning by healthcare organizations around IT infrastructure and business processes,” explained Jake Sorg, TriZetto’s senior vice president of consulting services. “The most proactive, forward-looking health plans such as El Paso First are doing two things. They’re replacing or making major upgrades to their core administrative systems, and they’re coordinating with providers to secure financial neutrality in benefits administration and care delivery.”
The 5010 regulations establish new standards for electronic transactions, while ICD-10 coding provides more specific, granular diagnosis and treatment information in patient care than does the current ICD-9 code set. Although compliance deadlines are in flux, Sorg said the opportunity for operational improvement presents health plans with a compelling reason to move forward with transitions sooner than later. “El Paso First, for example, has turned the challenge of compliance into an opportunity to further improve its administrative efficiency,” he said.
An earlier version of TriZetto’s enterprise core administration solution, the QNXT™system, helped El Paso First improve its auto-adjudication rate for claims from 50 percent to 83 percent. Its average claim turnaround time declined from 30 days to eight to 10 days, and provider complaints decreased 20 percent, while provider satisfaction rose nearly 30 percent. El Paso First then tapped TriZetto’s consulting services group to upgrade the system to the latest version, which is both 5010- and ICD-10-ready. Perkins expects the newest version of the system to help drive further administrative efficiencies, while providing the IT foundation for 5010 and ICD-10 compliance.
“We are extremely confident that we’re going to meet the requirements that the state and federal government have set,” she said. “We’re headed in the right direction, thanks in no small part to TriZetto, and we’re equipped with the correct and proper tools to get us there.”
About El Paso First Health Plans
Established in 1999, El Paso First Health Plans was created for the sole purpose of providing affordable healthcare for the community. As a local, not-for-profit organization, El Paso First provides healthcare coverage to approximately 95,000 people. El Paso First Health Plans promotes community health by providing access to quality healthcare for children, families and individuals who need it most. Thousands of El Paso, Tex., families and Medicaid recipients are receiving quality healthcare and improving their lives because of the company’s programs. For information, visit www.epfirst.com.
TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 100,000 care providers. TriZetto helps healthcare organizations achieve compliance; enhance administrative efficiency; improve the cost, quality and delivery of care; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance and claims editing and revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.
The TriZetto Group
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