TriZetto and Elsevier /MEDai have partnered to offer predictive healthcare analytics solutions for payer organizations. The first offering, TriZetto Clinical AnalytiX Interface™, is an interface to facilitate and reduce integration expenses for those payers seeking clinical analytics in coordination with TriZetto’s core applications – Facets™ and QNXT™. The second offering will be a solution integrated with TriZetto’s CareAdvance Enterprise® application. These solutions can be used effectively for improved chronic care management, superior identification and stratification of populations, identification of cost drivers for high-risk populations, real-time monitoring of member compliance to evidence-based medicine guidelines, and understanding of member motivation for self management. Additionally, the interface and integrated solutions will enhance communication between physicians and consumers to promote improved health status and care coordination.

Sanovia reduces administrative cost and drug spend for health plans by automating the pharmacy prior authorization process. In partnership with TriZetto, Sanovia’s PA-Logic℠ solution delivers the first and only unified platform to manage both medical benefit and pharmacy benefit drugs. With real-time interfaces to Facets® and QNXT®, PA-Logic provides a fully automated workflow with an embedded clinical rules engine that ensures cost-effective, consistent and quality pharmacy prior authorization determinations.

The Optum Claims Editing System*, an integrated partner product, is a powerful adjunct to the Facets 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.
*Ingenix is now OptumInsight, part of Optum™ – a leading health services business.

McKesson ClaimCheck® code audit solution is an integrated partner solution. Healthcare experts define best practices criteria for claims management as: accurate, fast and valid per current coding practices. That is why so many health plans have turned to the McKesson ClaimCheck® and TriZetto® Facets® solutions to help manage their claims operations.

The ClaimCheck® - Facets® integrated solution provides the opportunity for saving administrative dollars, and improving the efficiency of claims operations. ClaimCheck customers have the opportunity to use increasingly granular edits that align with medical policies, thereby increasing auto adjudication and reducing overall administrative expenses. The interface supports both online and batch processing, the full functionality of ClaimCheck, and maps the code auditing recommendations directly back to the claims processing system.

McKesson ClaimsXten. More than ever before, health plans face the challenge of delivering quality care while managing costs. That is why the McKesson and TriZetto® teams built the integration between ClaimsXten™ and Facets®.

The McKesson integration software, the Facets Integration Module (FIM) works to process Facets message-based claims through ClaimsXten™ workflows. The integration offers dynamic real-time communication, supports all the McKesson rules, any payer defined custom rules and the full functionality of ClaimsXten™. Customers have the opportunity to use customized edits to better align their medical policies within the code auditing logic, thereby improving auto adjudication and greatly reducing administrative expenses.

Learn more about McKesson ClaimsXten and how its integration to TriZetto Facets can help pave the way for optimal claims management, view the recorded webinar.

The OPTUM GeoAccess GeoCoder software application, an integrated partner product, provides the most precise analysis of member or employee access to network providers. The easy-to-use system assigns geographic coordinates – longitude and latitude – to street addresses, optimizing the payer’s data in order to provide precise analysis of member or employee access to network providers. GeoNetworks produces presentation-quality maps, graphs, and tabular reports that are widely recognized as the industry’s best for analyzing and communicating network accessibility.
*Ingenix is now OptumInsight, part of Optum™ – a leading health services business.

The Optum Prospective Payment Systems (PPS)* software application, an integrated partner product, maps, groups and prices facility claims to ensure appropriate reimbursement. More than 30 federal-, state- and payer-specific payment systems are available in the PPS applications. The integration of all CMS Prospective Payment Systems (PPS) through a real time interface enables facility claims utilizing the CMS Prospective System (PPS) to be auto-adjudicated with NetworX Pricer for Medicare, Medicaid and commercial lines of business.  The results for payers are streamlined claims-processing workflows, reduce reimbursement errors and improved payment integrity.
*Ingenix is now OptumInsight, part of Optum™ – a leading health services business.

FIS Healthcare Solutions — With the industry’s #1 multi-purse benefit debit card platform tightly integrated with the TriZetto Facets Platform, FIS enables integrated consumer benefit account management of HSA, FSA, HRA and dependent care accounts. By giving them access to their flexible benefit account balances using a convenient debit card, FIS empowers members to better manage their healthcare expenses and to take a more active role in their health and wealth situation.

Partner Information Request

If you'd like to learn more about TriZetto business alliances and suppliers, please call 1-800-569-1222, or email us your company profile and contact information.