NEWPORT BEACH, Calif. - May 4, 2009 - Premera Blue Cross is making real-time calculation of patients' share of costs available at the point of service. Premera has gone live with the Provider POS DirectTM system, a web-based application from The TriZetto Group, Inc. that enables medical practices to determine patient financial liability in real-time, helps members make financial decisions about their healthcare and allows doctors and other providers to submit paperless claims in real-time and be paid more quickly for their services. Health plans covering more than 6 million lives have purchased the Provider POS Direct platform, and patents are pending on TriZetto's system.

"Our implementation of TriZetto's application went smoothly, and we're pleased with how well the system has functioned from the get-go," said Dave Young, Premera's vice president of IT strategies and business services. "The Provider POS Direct application is easy to configure, use and upgrade. Our goals in making this system available to our providers are to improve transparency for healthcare consumers and payment efficiency for network providers. Early reviews of the platform by our contracted providers have been very positive."

"Real-time liability estimation is a great point of differentiation for Premera in the eyes of providers," noted Dave Pinkert, senior vice president of network management and Constituent Web Solutions at TriZetto. "For members covered by Premera, doctors now can calculate financial liability accurately and adjudicate claims at any point in their workflow through the use of real-time information and transaction processing. The front-office staff can tell a patient how much he or she owes in full for a medical service and either collect payment at that time or set up a payment plan before the person leaves the office."

TriZetto's Provider POS Direct system is one of the company's suite of applications that improve information sharing between the health plan, patients and providers, which is crucial to enabling Integrated Healthcare Management, a systematic approach to optimizing health benefits and care delivery to promote quality care while reducing costs.

For patients with insurance plans that do not have the Provider POS Direct platform, doctors must wait until they receive insurance payments to finalize patients' bills and seek collection. This, said Pinkert, can cause confusion for patients and long delays for providers in settling accounts.

Although some vendors and health plans offer estimation tools that can be used when a patient checks out, only TriZetto's Provider POS Direct system produces real-time, accurate calculations of patient financial liability before, during or after care. The application provides functionality both for estimation and full submission of medical claims.

Healthcare consumers want to know what they owe at all points of service, from scheduling to check-out. Accuracy is essential, as patients struggle to manage rising out-of-pocket expenses for care. In addition, pricing-transparency laws in many states now require providers and payers to offer timely, accurate information about patient liability.

Surveys suggest that without real-time information at the point of service, such as that produced by TriZetto's Provider POS Direct application, physicians on average begin to collect unpaid deductibles and coinsurance 40 days after the service date. Roughly 30 percent of these charges are never collected, resulting in bad debt, according to a January 2007 article in Health Industry Insights.

How TriZetto's Provider POS Direct System Works

The application appears on Premera's website in a secure area of the provider portal. A patient arrives at the doctor's office for treatment. The physician or staff enters the patient's information and service details, such as procedure and diagnosis codes. TriZetto's Provider POS system uses data such as the doctor's fee schedule and the patient's benefit plan, remaining deductible, copay, coinsurance and out-of-pocket maximum to calculate the individual's financial liability. This calculation occurs in real-time, and the system's response is delivered in seconds.

The doctor or office staff can print out the calculation to show the patient how much he or she owes. The calculation includes the total charge, fee adjustment (i.e., the negotiated provider discount), costs not covered, what the member's plan will pay, the deductible, copay and coinsurance. The balance owed by the patient appears at the base of the calculation. The consumer either pays the balance at that time, by credit card for example, or through a payment plan. The doctor and patient also can use TriZetto's Provider POS Direct application in advance to consider various treatment options and choose a course of action.

About Premera Blue Cross

Our mission is to provide peace of mind to our members about their healthcare coverage. We provide healthcare coverage and related services to 1.5 million people in Washington and Alaska. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1952. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Wash., that provide health, life, vision, dental, and long-term care insurance, and other related services. In the J. D. Power 2007 National Health Insurance Plan Satisfaction Study, Premera Blue Cross ranked highest in member satisfaction among health plans (regional and national companies) serving the western U.S. 2007 was the first time J. D. Power surveyed consumers about health plans.

About TriZetto

Founded in 1997, TriZetto is a privately held healthcare information technology company. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management™. TriZetto provides information technology solutions that enable health insurance payers and other constituents in the healthcare supply chain to improve the coordination of benefits and care for healthcare consumers. The company's offerings include enterprise and component software, hosting and business process outsourcing services, and consulting.

CONTACTS:

Government Relations Contact:
Brad Samson
The TriZetto Group
949-719-2220
brad.samson@trizetto.com

Media Contact:
Melissa Bruno
Schwartz Communications
781-684-0770
trizetto@schwartz-pr.com