TriZetto’s Rob Scavo Available for Comment

NEWPORT BEACH, Calif. - December 4, 2008 - The effort has been compared to rewriting a health plan’s DNA.1 One study said it will be the most significant healthcare information overhaul since the advent of computers.2 Others liken the effort to planning and preparing for Y2K.

The initiative is the transition by healthcare payer organizations to ICD-10 diagnosis codes and ANSI X12 version 5010 HIPAA transaction codes. A white paper released today by The TriZetto Group, Inc. is the first of several resources the company will offer health plans to help them adopt these new, more extensive codes successfully.

TriZetto provides software and IT services that help payers drive integrated healthcare management: the convergence of benefits administration, care management and constituent engagement to improve U.S. healthcare.

“This is so much more than simply expanding the length of a database field,” explained Rob Scavo, senior vice president of core administration solutions at TriZetto. “Our white paper discusses the people, processes and technology that can help payers take a more holistic approach across their organizations to adopting this greatly expanded coding schema, which will have a widespread rippling effect on virtually all of the key functions of payers. The upgrade by payers will require massive system reviews, new medical coding and extensive updates to information systems that administer benefits and care. We are working hard to stay ahead of these changes to ensure that TriZetto is there with software and implementation expertise to guide our customers through adoption.”

TriZetto’s white paper, “ICD-10 Adoption: A Strategic Opportunity for the Entire Payer Organization,” is the first of a series of communications to guide health plans in planning and executing the following adaptive changes throughout their business cycle:

• Product development – Evaluate and reconfigure benefit plan structures to identify the changes in coinsurance, co-pays, deductibles or other plan elements that are more specific to discreet diagnosis codes.
• Revenue generation – Implement new premium billing strategies that take into account the detailed clinical information soon to be available from ICD-10 codes.
• Customer service – Review the look-up and search routines to identify potential modifications for new claims process and new medical coding.
• Reimbursement management – Evaluate the entire claims business process to prepare to accept ICD-10 codes. Manage the coding transition to minimize fraud, double billings and double payments.
• Finance and administration – Evaluate financial functions to determine how ICD-10 implementation will affect business decision analytics, and how the “crosswalk” from old to new codes can be managed optimally.
• Care management – Evaluate every process for determining medical necessity, appropriateness of care, referrals, utilization, authorization and certification. Consider implementation of advanced clinical guidelines based on the expanded codes.
• Network management – Address “code-readiness” of providers during recontracting. Develop and implement new pricing and reimbursement structures, including fee schedules, and hospital and ancillary pricing scenarios that could take into account greater diagnosis specificity.
• Risk management – Evaluate and adapt rating, underwriting and actuarial policies and guidelines to account for the greater granularity of the new code systems.

TriZetto’s new ICD-10 white paper is available at www.trizetto.com/icd-10. Requests by news media for interviews with Scavo may be directed to Schwartz Communications at 781-684-0770 or trizetto@schwartz-pr.com.

About ICD-10

When seeing a patient, a doctor collects historical and physical information and recommends steps to improve health and perhaps certain medical procedures. All of this is coded using a diagnostic taxonomy, the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The codes are used to track morbidity and mortality data and for health claim reimbursement. In 2011, health plans and providers must move from ICD-9 coding to ICD-10, a more complex scheme of classifying diseases that reflects recent advances in disease detection and treatment and that is used by all other countries in the industrialized world.

About TriZetto

TriZetto is Powering Integrated Healthcare Management™. With its technology touching more than half of the U.S. insured population, TriZetto is uniquely positioned to drive the convergence of health benefit administration, care management and constituent engagement. The company provides premier information technology solutions that enable payers and other constituents in the healthcare supply chain to improve the coordination of benefits and care for healthcare consumers. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company’s payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at www.trizetto.com.

1Roma, Paul and Graves, Casey, Deloitte Consulting LLP, “Intersections: Where Technology and Business Meet to Help Transform Health Plans, 2008.

2Workgroup for Electronic Data Interchange Subcommittee on ICD-10, “Issues Surrounding the Proposed Implementation of ICD-10 Adoption,” report to WEDI, 2000.

CONTACTS:

Government Relations Contact::
The TriZetto Group, Inc.
Brad Samson
949-719-2220
brad.samson@trizetto.com

Media Contact:
Schwartz Communications
Melissa Bruno
781-684-0770
trizetto@schwartz-pr.com