The OPTUM™ Prospective Payment Systems (PPS)* application, maps, groups and prices facility claims to ensure appropriate reimbursement. OPTUM™’s ECMPro™ application integrates with TriZetto®’s NetworX Suite® solution to manage grouping, pricing, editing and mapping for Federal (DRG, APC, ASC, IRF, SNF, CAH, LTCH, IPF, Physician) Prospective Payment Systems (PPS) and more than 20 state and payer specific PPS. Facility (inpatient and outpatient) and professional Medicare PPS, and a number of Medicaid PPS are integrated with NetworX Pricer® to support auto-adjudicated claims processing. Users can also apply the supported Medicare and/or Medicaid PPS to their commercial business processing. The integrated solutions streamline claims-processing workflows to reduce reimbursement errors and improve payment integrity.
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As a provider of innovative healthcare IT solutions, TriZetto offers business process outsourcing services (BPO services) and healthcare business consulting services that enable healthcare organizations to improve competitiveness and focus on core capabilities. TriZetto’s business process outsourcing and strategic IT outsourcing services help increase flexibility and reduce costs. TriZetto’s consulting services help clients improve performance and value of solutions. And as a hosting services provider, TriZetto enables healthcare organizations to reduce costs, improve availability and address HIPAA compliance.