The TriZetto Group, Inc. today announced the upcoming launch of CareAdvance Provider™, the newest component of CareAdvance Enterprise®, TriZetto’s care management suite comprised of the Clinical CareAdvance®, Personal CareAdvance®, and now CareAdvance Provider applications. An automated authorization portal for healthcare practitioners, the CareAdvance Provider system will improve utilization management and administrative efficiencies for practitioners and payers through enhanced provider engagement and automation. The increase in information sharing between practitioners and health insurers will improve clinical care management processes, and result in improved health outcomes for consumers. The CareAdvance Provider system is scheduled to be available in December 2010.
The CareAdvance Provider solution enables direct communication between payers and providers, to better automate healthcare service requests through payer web portals that care providers already use. When a provider submits an authorization request through the portal, the CareAdvance Provider solution automatically generates a pre-determined set of questions that is sent back to the practitioner for answers. Those answers are then reviewed by the software, generating a score based on the member’s benefit plan and its associated medical policy. The request is automatically approved, rejected, or filed for additional review. By automating the authorization workflow, the process is expected to be significantly faster and more efficient for both payers and providers.
“The CareAdvance Provider system continues TriZetto’s focus on delivering solutions to improve administrative efficiency and the cost and quality of care,” said Dr. Jeff Rideout, TriZetto’s chief medical officer and senior vice president of cost and care management. “By automating healthcare service requests using the pre-determined rules each payer creates and maintains, payers and practitioners can reduce unwarranted variations in care as well as administrative headaches. Additionally, by giving practitioners more access to clinical information and standardizing the authorization process, parties likely will see improvements in the consistency and efficiency of utilization management, as well as care management overall.”
In addition to the automated authorization, providers will have access to a member-specific clinical profile, the Medical Clinical Profile, every time they enter the CareAdvance Provider portal.
This profile—similar to an electronic medical record and populated with data from the Clinical CareAdvance application—can alert the practitioner using the portal to patient medications, claims history, and other elements that impact the quality of care being provided.
“The power of the CareAdvance Provider software lies in the provider self-service, which can greatly reduce the lengthy and costly process practitioners often face when seeking pre-authorization for a medical service,” Rideout continued. “With this new solution, practitioners’ workflow is automated with two-way communication regarding the authorization request-for-services without the need for phone calls or manual processes, like mailing or faxing forms. The information they need to enhance their workflow, including the Member Clinical Profile, will be available in the CareAdvance Provider system. By giving practitioners greater participation in the authorization process, this new solution can help control cost to support reform mandates, enable patient-centered medical home programs and reduce the administrative burden of many over-taxed provider offices.”
Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry, with its technology touching half of the U.S. insured population. TriZetto’s vision for the industry, Integrated Healthcare Management, is the optimized coordination of benefits and care for healthcare consumers to improve the value of every healthcare dollar spent. The company’s offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.
The TriZetto Group
Rachel Tanner Lew
Davida Dinerman or Pauline Louie