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One of the most important, and historically most difficult, roles in a successful claims operation is that of plan builder. Usually a behind the scenes individual with a gift for logical thinking, the plan builder is responsible for converting the final text of a contracted benefit plan into parameters that a claims administration system will use to adjudicate claims according to the plan design. Because of the complexities typically involved in the plan building process, good plan builders are hard to find and oftentimes overworked. They can also be expensive to retain.
TriZetto is changing all that with a new, GUI-based plan building application that incorporates a re-usable benefit plan provision library for its industry-leading QicLink Extended Enterprise application. The library enables the plan administrator to build templates for their most frequently used benefit plan provision combinations. These templates provide for consistency across plans and make it easier for newer, more inexperienced personnel to build plans within the system, applying proven design structures to load new contract parameters.
This can be particularly helpful when implementing contracts that incorporate High Deductible Health Plans (HDHPs). By law, HDHPs require a set minimum deductible, as well as a maximum out-of-pocket amount. With the new QicLink GUI-based PlanBuilder, clients can build these and other parameters once and copy them into any plans to which they may apply.
Templates are created quickly and easily via any of three ways:
- On the fly, while building a plan
- As an independent unit, to be applied when appropriate
- Automatically, via a "Build Templates" utility to read existing records and create one
template for each unique set of criteria it finds.
The PlanBuilder functionality has an intuitive GUI-based design to facilitate ease of use and is set up to enable the user to access the plan and all components in a single, tabbed view, eliminating the need to branch between programs. English descriptions built into the selectable data values further enhance the user-friendliness of the program - making it an ideal tool for new or less experienced plan builders.
Incorporated into the standard QicLinkTM Extended Enterprise 4.0 Release, the new PlanBuilder function is scheduled for field testing in November, with general availability in Q1 of 2007. Current clients will not need to rebuild plans to take advantage of this exciting new standard program, thanks to the new "Build Templates" utility. In addition, clients utilizing the ClaimRules Toolkit, with its pre-built claim logic matrix, will find that the PlanBuilder will save them time and effort by eliminating the need for extract and re-loading of data - increasing the value and efficiency of the ClaimRules application, as well.
Clients and prospects can get preview demonstrations of this
valuable new functionality by contacting Ted.tamul@trizetto.com or call 630/428-5326.
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