Provider Solutions

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  • Build stronger relationships with providers by offering access to valuable tools

    Providers today face many of the same pressures as payers. To better manage their business, they need to reduce costs, increase efficiency and improve the quality of care. When payers help providers achieve these goals, they build strong positive relationships with providers—and achieve their own goals of reducing costs and improving efficiency.
    TriZetto Provider Solutions give your providers tools to run their practices more efficiently and effectively, and give you tools to improve provider satisfaction. TriZetto Provider Solutions include the Provider POS Direct™ and Provider Service applications.

    Provider POS Direct. Enabling providers to adjudicate claims at the point of service.

    As members take on greater financial responsibility for healthcare, providers face greater financial risk. Providers need to be able to bill patients and collect payment at the point of service, not weeks later. The TriZetto Provider POS Direct solution calculates patient financial liability and adjudicates claims at the point of service. Providers can collect full payment at the time services are rendered—or, in some cases, even before the patient’s visit—rather than days or weeks later. That means providers get immediate payment and members get no surprise costs.

    The solution gives providers online access to the payer's core administrative system in order to update, submit or view relevant data. The provider's staff can use the application to submit transactions in real time when scheduling appointments or when the patient is checking in/out. This can be done via standard Web browser or EDI.

    Provider Service. Online access to key information and self-service tools.

    Provider offices are busy places, and the staff needs to be able to get basic information about patients and their coverage and perform business transactions quickly and efficiently. TriZetto’s Provider Service application enables providers to conduct a wide range of self-service transactions and inquiries in a secure online environment. For providers, that means getting faster, easier access to the information they need. For payers, it means increasing provider satisfaction, improving accuracy for higher first-pass rates, and reducing calls to the client service staff—all of which can help reduce cost and improve the quality of care.

    The Provider Service application’s self-service capabilities enable providers to check member eligibility; review benefit summaries and product details; review claim status; submit referrals; log pre-authorization for inpatient/outpatient services; and submit medical claims.


  • 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.