DENVER, Colo.- November 30, 2011 – The TriZetto Group, Inc. today announced customer reports of significant improvements in administrative efficiency and speed to market as these organizations maneuver to meet the demands of healthcare reform legislation and compete more effectively. TriZetto’s customers also said that its solutions have helped them quickly configure and launch new products and lines of business that meet changing market and regulatory demands.

Cox HealthPlans, a 40,000-member, provider-owned health plan in Springfield, Mo., said it has reduced administrative costs 17 percent in three years and expects to achieve additional reductions. Blue Cross & Blue Shield of Rhode Island reported further increases in its auto-adjudication of claims and accuracy of claims payment. And Blue Cross Blue Shield of Louisiana has accelerated the launch of new benefit products and new lines of business and now can implement a new group, with a custom benefit plan, in less than one-third the time it took previously.

“We’ve been able to strategically lower our administration expenses since we started using TriZetto solutions,” said Jeff Bond, president and CEO of Cox HealthPlans. “We were already pretty low. Back in 2005, we were around 9.5 percent administration expense as a percent of premium. But we’ve been able to aggressively move our administration expense down even further. Today, we’re at 7.9 percent. That’s about a 17-percent reduction over three years, and we’re working to reduce it further.”

“Claims are adjudicated now much more automatically than they had been before,” said Virginia Levi, associate vice president and executive program manager at Blue Cross & Blue Shield of Rhode Island. “And our first-pass rates are very, very high – well over 90 percent. On the IT side, we’ve been able to improve dramatically the way we configure the application. It used to take days or weeks to make a small change in our legacy application, but now, with TriZetto’s solutions, it takes us a matter of hours or days to make those same kinds of changes.”

Blue Cross & Blue Shield of Rhode Island, with approximately 600,000 members, wanted to bring innovative products to market quickly while also reducing administrative expenses. With the help of TriZetto, the independent Blues organization has achieved both objectives.

Blue Cross Blue Shield of Louisiana, which serves more than 1.3 million members, implemented TriZetto solutions to help improve both administrative efficiency and speed to market.

“TriZetto’s solutions have enabled us to build benefit plans much faster,” said Gina Laird, vice president of business engineering at Blue Cross Blue Shield of Louisiana. “We reduced our average time to implement a new group, with a custom benefit plan, from about 10 weeks to three weeks, and that includes all build and testing. Our groups and our brokers are much happier. They sometimes make decisions at the last minute, and there’s very little time from the moment they make decisions to when they need ID cards in their hands. TriZetto’s solutions have improved our ability to satisfy our brokers and employer groups.”

Blue Cross Blue Shield of Louisiana also increased its first-pass rate for claims to 83 percent to 85 percent, up from 66 percent the first year following the implementation. The first-pass rate measures the extent to which the core system auto-adjudicates healthcare claims on the first try. As the rate increases, the need for costly manual processing of claims decreases, as do errors and delays.

“Healthcare organizations are facing some of the greatest challenges they have ever faced,” said Jude Dieterman, TriZetto’s executive vice president and payer markets president. “Demands for increased administrative efficiency and accelerated speed to market are just two of the challenges we are helping payers meet. TriZetto is also helping payers communicate and collaborate with healthcare providers, improve the cost and quality of care, and drive greater value for every healthcare premium dollar spent.

“It’s clear that we’re helping our customers turn the challenges of reform and the changing marketplace into opportunities,” Dieterman said. “Our customers are winning new membership in a very competitive environment. They enjoy a distinct advantage in terms of administrative efficiency and delivering affordable, quality care. We look forward to continuing to deliver innovative solutions as a trusted, strategic partner to these organizations as they face new challenges – and new opportunities – in the years ahead.”

This has been a watershed year for TriZetto customers and for the U.S. healthcare industry as a whole. The year brought a new requirement, under healthcare reform, that large-group insurers spend at least 85 percent of premium revenue on medical services and quality improvement. Individual and small-group insurers must spend at least 80 percent in those areas. This limits the amount that insurers can spend on health plan administration. In addition, health plans’ premiums must pass muster with federal and state regulators by the end of the year, and payers are now required to offer free preventive services.

To meet these challenges and remain competitive, many payer organizations are using TriZetto’s technology-enabled solutions not only to improve administrative efficiency and bring new products to market more quickly, but also to increase collaboration with healthcare providers, improve management of member care, and heighten engagement of members in care and decision-making.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.

Media Contacts:

The TriZetto Group
Loren Finkelstein
303-542-2460
loren.finkelstein@trizetto.com

Schwartz MSL
Davida Dinerman
781-684-0770
trizetto@schwartzcomm.com