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 QNXT™ 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. More than ever before, health plans face the challenge of ensuring that members receive quality care while managing costs. That is why 20 QNXT customers have turned to an integrated ClaimCheck® and QNXT™ solution to help manage their claims operations. The McKesson – TriZetto co-developed solution improves claims payment efficiencies and productivity. The long standing relationship, the collaborative development, and a stringent certification process ensure the reliability and quality of the interface prior to each release. Expert services and support from the McKesson Service Capability and Performance Standards (SCP) certified team provides continued value for customers.

The ClaimCheck® - QNXT™ interface enables customers to more accurately reflect their medical policies by creating and applying user-defined customized edits. This capability streamlines and improves auto adjudication and greatly reduces administrative expenses. In addition, ClaimCheck improves workflow as recommendations are cross-walked to QNXT remark codes with configurable audit messages.

Emdeon is the healthcare industry’s leading provider of a complete suite of business process outsourcing services with the ability to deliver print and mail services to your healthcare constituents.

Emdeon’s Management solutions, an integrated partner solution, provides cost savings and improved efficiencies for paper payment and remittance documents.

Micro-Dyn Medical Systems, Inc. offerings are integrated partner products. Micro-Dyn specializes in software products for healthcare claim DRG calculation, APC assignment, Medicare reimbursement calculation, data editing, and validation to Medicare specifications. Micro-Dyn’s DRGActive™, APCActive™, and PRICERActive™ software and data editing components integrate seamlessly with QNXT to immediately add data validation, DRG/APC calculation and Medicare reimbursement capability.

OPTUM provides organizations with the ability to keep pace and ensure compliance with constantly changing codes and code rules for ICD-9-CM, CPT®, HCPCS Level II and ICD-10-CM.
*Ingenix is now OptumInsight, part of Optum™ – a leading health services business.

Convey's comprehensive Web-based and desktop solutions provide value to institutions engaged in banking and wealth management and tax information reporting. Convey offers several solutions in tax reporting, beginning with its desktop offering, 1099Convey. 1099Convey prepares year-end wage and payment information returns electronically, magnetically or in print, supporting 1098, 5498, W-2, W-2G and all 1099 versions and correction forms. Network and high-volume licenses are available. Convey also offers Taxport Managed Services, a Web-based service solution that encompasses state reporting, TIN Compliance, 1042-S filing and many service options, including print services.

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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.