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Claim pricing is a time-consuming and costly administrative process that adds to healthcare costs. TriZetto's ClaimsExchange™ service interfaces with any claims system and provides both dial-up and Internet-based connectivity and information exchange among the payer and preferred provider organization communities. ClaimsExchange dramatically reduces costs and improves service.
As the first repricing solution available over the Internet, ClaimsExchange seamlessly connects payers and PPOs and eliminates numerous manual and paper-based processes.
PPOs participate through Internet access and EDI interface to their re-pricing systems.
Payers participate using the ClaimsExchange router, which interfaces with the claims system, verifies plan-member eligibility and PPO access, then automatically routes, manages and tracks eligible claims prior to the adjudication process.
Benefits
- For Payers:
- Simplifies administrative tasks and reduces costs
- Streamlines relationships with multiple PPOs within a single workflow and interface
- Maximizes client/plan savings
- Drives superior client and claim turnaround
- For PPOs:
- Standardizes and automates delivery of HIPAA-compliant claims transactions
- Simplifies administration
- Provides quality and utilization reporting
- Delivers access to additional payer customers
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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