QNXT Partner Solutions

  • Claims Editing and Auditing

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    OPTUM™

    The OPTUM™ Claims Editing System, an integrated partner product, is a powerful adjunct to the QNXT™ enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant KnowledgeBase of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.

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    McKesson

    McKesson’s ClaimCheck® code audit solution is an integrated partner product. The ClaimCheck® - QNXT™ interface enables customers to more accurately reflect their medical policies by creating and applying user-defined customized edits. This capability streamlines and improves auto adjudication and greatly reduces administrative expenses. In addition, ClaimCheck improves workflow as recommendations are cross-walked to QNXT remark codes with configurable audit messages. The long standing relationship, the collaborative development, and a stringent certification process ensures the reliability and quality of the interface prior to each release. 

    Claims Grouping and Pricing

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    Micro-Dyn Medical Systems, Inc.

    Micro-Dyn Medical Systems, Inc. offerings are integrated partner products. Micro-Dyn specializes in software products for healthcare claim DRG calculation, APC assignment, Medicare reimbursement calculation, data editing, and validation to Medicare specifications. Micro-Dyn’s DRGActive™, APCActive™, and PRICERActive™ software and data editing components integrate seamlessly with QNXT to immediately add data validation, DRG/APC calculation and Medicare reimbursement capability.

    Cost Management Solutions

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    Change Healthcare

    Change Healthcare is a key catalyst of a value-based healthcare system – working alongside customers to accelerate the journey towards improved lives and healthier communities. Payment Integrity solutions from Change Healthcare are currently being integrated with the TriZetto® QNXT™ enterprise core administration system. By leveraging the Change Healthcare Intelligent Healthcare Network™ – the single largest financial and administrative network in the U.S. healthcare system – these solutions provide the broadest view of billing activity to help identify inappropriate claims before they are paid. Our extensive network enables a multi-payer data set with unparalleled insights, allowing payment accuracy solutions at every stage of the claim lifecycle: pre-submission, pre-payment and post-payment. We deliver an end-to-end suite of solutions and services that combat many of the ways that payers are at risk for paying inappropriate claims.

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    Zelis Claims Integrity

    Zelis™ Healthcare delivers measurable value through our unparalleled claim integrity solutions, operational excellence, and healthcare intelligence. Our integrated multiple products and solutions ensure that our clients are obtaining the highest level of savings on each claim through our robust technology and precise processes, enhanced with human expertise. Through our partnership with Cognizant for a near real-time interface to TriZetto’s® QNXT™ core administration platform, we ensure that your daily claim process is kept intact, operation rule consistency automation is achieved, and most importantly, near real-time capabilities reduce turnaround time from days/hours to seconds. With the QNXT™ interface to Zelis Claims Integrity services, you will also see reduction of loss ratio and increased operational transparency, all of which can lead to substantial savings.

    Enterprise Document Management

    OnBase

    OnBase by Hyland

    OnBase by Hyland, an enterprise content management (ECM) solution, integrates with TriZetto® QNXT™ to provide payers with a single point of access for clinical and administrative content. OnBase for TriZetto QNXT gives users access to related content from within QNXT’s native view, meaning adjusters and plan administrators do not need to leave their QNXT window to search for information, speeding claims resolution and increasing member and provider satisfaction. For more information, please visit OnBase.com/TriZetto

    Healthcare Account And Funds Management

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    WEX Health

    Cognizant and WEX Health have partnered to offer consumer-driven healthcare administration and benefits card solutions for payer organizations. Through the partnership, WEX Health's industry-leading consumer-driven healthcare administration system, WEX Health Cloud, is available to Cognizant TriZetto® QNXT™ enterprise core administration system clients. The partnership agreement includes the WEX Health Payment Card which uses patented technology to achieve the highest auto-substantiation rates in the industry. WEX Health simplifies the business of healthcare through WEX Health Cloud, a cloud-based healthcare financial management platform that drives efficiency for benefit administration technology, consumer engagement, and advanced billing and payments. Our partner organizations enable us to deliver our industry-leading and award-winning solution to 225,000 employers and more than 24 million consumers. Together we take the complexity out of defined contribution, HSAs, HRAs, FSAs, VEBAs, PRAs, premium billing, public and private health insurance exchanges, COBRA, wellness plans, and transit plans. Learn more at www.wexhealthinc.com, and follow WEX Health at @WEXHealthInc.

    Healthcare Payments Technology

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    Zelis Payments

    Zelis™ Payments is a leading healthcare payments technology company dedicated to delivering value via exceptional client experiences. Our solutions facilitate regulatory compliance and streamline the transfer of healthcare payments and data. Through our proprietary integration with Cognizant’s TriZetto® QNXT, Facets, or QicLink , Zelis Payment’s technology becomes a part of your daily workflow to create a seamless payment process, which improves accuracy and reduces process complexity for significantly improved cost control. To ensure provider satisfaction and reduce noise, we employ a unique, provider-centric enrollment and support model, which encourages electronic adoption and network retention.

    Outbound Printing and Fulfillment

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    Change Healthcare

    Change Healthcare is an integrated partner product with the QNXT™ enterprise core administration system, providing advanced payment processing technology with a wide range of printed and electronic payment options available through a single platform. These solutions can reduce administrative costs by maximizing adoption of electronic payments, and reduce print and mail costs for print-related payments by consolidating printing and correspondence. Participation in the Change Healthcare HealthPayers USA Postage cooperative - the nation’s first and largest healthcare postage co-op -- offers significant postage and operational savings. Full-color printed or electronic EOBs, omni-channel communications, and monthly or episodic consolidation options help to reduce administrative costs and differentiate your consumer experience. Preference-based intelligent payment analytics can determine the most cost-effective payment distribution channel.

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    RedCard

    RedCard delivers reliable, client branded, enhanced design and production of critical customer communications including healthcare checks, Explanation of Payments (EOPs), Explanation of Benefits (EOBs), Healthcare (ID) cards, enrollment-related correspondence, and letters delivered in the mail or via the Web. RedCard enables clients, through an integrated set of Web-based self-service management tools, the ability to redesign its member and provider communication utilizing the latest four-color technology. Based upon client-specific needs, it will also enhance communication time frames using its industry first, healthcare episode-based claim bundling option. This integrated system creates new cost savings while changing the frequency, look, and feel of the communications, allowing for fewer customer service calls and an overall better experience.

    Subrogation and Claim Recovery Services

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    The Phia Group

    The Phia Group is a provider of services designed to control costs and protect plan assets; including subrogation & overpayment recovery, document drafting, compliance and consultation. The Phia Group’s mission is to reduce the cost of health benefit plans through the use of innovative technologies, legal expertise, and focused, flexible customer service.

    Tax Compliance

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    Sovos Compliance

    Sovos Compliance designs technology solutions to help businesses meet the demands of their unique tax, compliance and reporting obligations. The company enables over 4,000 clients to operate with the confidence to efficiently navigate today's dynamic regulatory environment. Sovos Compliance utilizes a unique ability to turn knowledge into highly functional, scalable software that seamlessly integrates with a wide-array of applications and information technologies used by businesses today. Sovos Compliance gives clients peace of mind by simplifying tax compliance, providing greater control and visibility, and mitigating compliance risk.