TriZetto® NetworX Payment Bundling Administration™

  • medium-woman-two-men-jpg-362x246Automate payment bundling for greater efficiency and reduced cost.


    As the industry continues to buzz about “value-based reimbursement”, health plans struggle with how to redefine the relationships with their providers moving from traditional Fee-for-Service (FFS) to the new Fee-for-Value models. Payment bundling can be an initial step to incorporating value-based reimbursement into provider network management strategies. Through payment bundling programs, health plans like yours have already started to transform the payer-provider relationship to build effective partnerships, promote quality and improve the cost of care.

     

    TriZetto NetworX Payment Bundling Administration™—a comprehensive, automated solution.


    Although payment bundling promises to revolutionize the way we deliver and pay for healthcare, it requires automation to make it effective, scalable and cost-efficient. TriZetto NetworX Payment Bundling Administration™ provides a comprehensive software solution with patent-pending functionality that automates the prospective bundling process.

    Here’s how it works. NetworX Payment Bundling Administration:

    • Integrates tightly with your claims processing system, whether that’s a TriZetto solution or third-party application.
    • Evaluates each fee-for-service claim made during the adjudication process to determine whether the claim belongs to an identified episode-of-care bundle.
    • Creates episodes of care prospectively, in real time.
    • Bundles related claims together from multiple clinicians working on a specific episode.
    • Re-prices claims to conform to the agreed total payment for each episode of care.


    Part of the NetworX Suite® of products for managing provider networks, TriZetto’s NetworX Payment Bundling Administration solution is available on a licensed or hosted basis to healthcare payers.

     

    Benefits of TriZetto NetworX Payment Bundling Administration


    With NetworX Payment Bundling Administration, payers can:

    • Automate and scale payment bundling processes as needed.
    • Reduce the cost of claims and increase the predictability of payments.
    • Defers some risk to providers.
    • Promote collaboration among providers to increase the quality of care.
    • Reduce tension with providers regarding what is and is not covered in claims.

     

    Features


    • Transform the existing fee-for-service claims stream into prospective payment bundles at the time of care.
    • Use both prospective and retrospective payment models.
    • Use pre-configured bundles, including common cardiac and orthopedic episodes, developed by nationally recognized entities, including the Centers for Medicare and Medicaid Services, Integrated Healthcare Alliance of California, and Prometheus Payment™.
    • Access additional pre-configured bundles for heart attack, diabetes, pneumonia, stroke, asthma and other chronic conditions, developed by the Health Care Incentives Improvement Institute.
    • Modify existing bundles or create new bundles based on individual and market needs.

     

  • TriZetto Services

    Our world-class services include application hosting and management, business process services, and consulting. TriZetto’s application hosting and management are delivered via cloud technologies to give clients flexible and scalable business services. Our global team of experienced professionals possesses deep knowledge of both the healthcare industry and TriZetto solutions, helping clients solve their unique business challenges and achieve results more quickly.