Establishing benefit plan parameters that enable computerized systems to accurately calculate payments can be a very challenging task, particularly when the goal is to increase automation for plans with highly complex designs.
Of necessity, the system needs to support interaction between multiple values and rules sets that take into consideration the requirements of deductibles, co-pays and co-pay exceptions, in-network and out-of-network provider utilization, stop loss, coinsurance, out-of-pockets and more. The result is that plan building can be a tedious, time-consuming task that requires working with complex coding structures and cryptic naming conventions.
TriZetto is in the final stages of development for its new GUI PlanBuilder application that is designed to:
- Provide a streamlined plan building process using a graphical user interface (GUI)
- Provide an easier and more intuitive method for the plan building process
- Increase productivity in plan building
The GUI PlanBuilder application is a valuable component of TriZetto's industry-leading QicLink Extended Enterprise core benefits administration application and was highlighted in one of the most well attended workshop sessions during the recent TriZetto Benefits Administration Client Conference.
The QicLink GUI PlanBuilder will allow:
- Use of English language entry values instead of codes or acronyms
- Creation of a 'library' of independent plan provisions which will enable search, selection and insertion to 'create' the plan
- Dynamic updating of the QicLink files, so changes can quickly and easily be put into operation across affected plans, including for ClaimRules toolkit users
This new GUI PlanBuilder program will take advantage of the QicLink Extended Enterprise new relational plan file structure to deliver this functionality, and is scheduled for the QicLink release to be available in December of 2005.
