Efficiency, accuracy and accountability to help you capture your share of the Medicare Advantage market—and profit from it.
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When it comes to increasing your share of the Medicare Advantage market, you’ll find an excellent partner in TriZetto. With solutions that already serve more than 30 percent of people qualifying for Medicare Advantage and Part D, TriZetto gives you the tools to manage your Medicare business well. TriZetto can help you reduce costs, increase revenue opportunities and streamline compliance with CMS requirements.TriZetto’s solutions include:
Automating the process of managing transactions between your plan and CMS is necessary to be successful in managing a Medicare Advantage plan. Our TriZetto Medicare Solutions deliver capabilities for all key areas of Medicare management including Enrollment Administration, Claims Data submission, Financial Reconciliation, and HCC
Revenue Cycle Management.
TriZetto's Facets and QNXT platforms are the leading core administrative systems for healthcare payers in the managed Medicare market. Both systems automate business processes, enhance efficiency and provide the flexibility to administer diverse plan designs. TriZetto's solutions integrate with third-party solutions and adapt easily to a rapidly changing business and regulatory environment.
The CareAdvance Enterprise application is a secure, Web-based communication platform that automatically identifies members who should be included in care management programs, and monitors their health status while effectively engaging members in their own care. The solution supports utilization, case, disease and population health management and helps payers meet federal and state requirements for quality initiatives and care improvement.
Our comprehensive network management solutions helps enhance the value of your provider networks, negotiate more favorable contracts and reduce administrative costs. The NetworX Pricer® application automates claims pricing so you can administer provider contracts more quickly and accurately. The NetworX Modeler® application helps you model and evaluate the financial implications of proposed rates and contractual terms. The NetworX Modeler with Analytics™ solution lets you dive deeper into "what if" scenarios when analyzing provider contracts. The NetworX Payment Bundling Administration™ solution automates episode-of-care reimbursement, prospectively aggregating claims into bundles for processing and payment.
With solutions in core administration, care and provider network management, TriZetto is a comprehensive Medicare partner that can help you drive efficiency, enhance revenue and improve the quality of care.
Our TriZetto Star Rating Analytics solution accelerates the understanding of your health plan’s quality and performance rating in each domain, as well as provides detailed information about specific measures. This insight gives you the information you need to improve your ratings and ultimately increase payments. Get details.
TriZetto’s Sales and Marketing Automation solution provides CRM capabilities, enabling comprehensive marketing automation, campaign management and segmentation. The solution provides sales support through all channels, using online, direct or mobile communications. Our solution also helps health plans streamline their Medicare open enrollment process with advanced, compliant marketing and workflow automation. Learn more.
While TriZetto’s Medicare solutions can help you achieve dramatic results, you’ll see results faster when you combine these solutions with TriZetto Advantage Services®. That’s because no one has more experience managing and implementing TriZetto applications than TriZetto itself. With TriZetto Advantage Services, you’ll experience easier implementations and integrations, smoother process transitions and faster business transformation. That translates to measurable results and a competitive edge. Learn more about TriZetto Advantage Services now.
In this podcast, Gary Jacobs, senior vice president of corporate development at Universal American, discusses the future of healthcare and Medicare and suggests steps that Medicare plans can take today to help ensure future success.
RAPS, Encounter and PDE Data Validation and Submission Solutions from TriZetto®.
The HCC Risk Adjustment Manager helps Medicare payers better optimize revenue through improved data collection, which generates more accurate risk scores and, therefore, more accurate payments.
Hear from innovative healthcare leaders about succeeding in a time of unprecedented healthcare change.
Why Stars Matter
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TriZetto provides leading healthcare information technology for payers and providers. From claims processing and advanced network management to case management solutions and HIPAA Compliance with 5010 implementation, TriZetto healthcare technology management solutions help reduce costs, streamline administration and improve the quality of care. TriZetto’s network management services help payers improve provider network management with tools for contract modeling, claims pricing, payment bundling and more. And TriZetto solutions give healthcare organizations the ability to achieve compliance with ICD-10 and 5010 HIPAA regulations more easily and cost-effectively.