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 33 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:
TriZetto® Medicare Solutions
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 Management.
Core Administration
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.
Care Management
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 management and helps payers meet federal and state requirements for quality initiatives and care improvement.
Network Management
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 network management, TriZetto is a comprehensive Medicare partner that can help you drive efficiency, enhance revenue and improve the quality of care.