At the heart of every successful healthcare organization is a powerful software engine that automates administrative processes, improves efficiency, and provides the flexibility to integrate with other systems. TriZetto's software portfolio includes two market-leading systems: Facets for health plans and QicLink for benefits administrators. TriZetto’s CareAdvance Enterprise system automates the full spectrum of care management, allowing health plans to better manage medical costs while delivering the highest quality care. All enterprise software can be licensed for installation at the customer site, or hosted in a TriZetto data center.
Facets Extended Enterprise™ — Also known as Facets e2, Facets Extended Enterprise is an enterprise-wide administrative system that offers extensive new functionality. The software can manage consumer-oriented products, such as defined-contribution plans and healthcare spending accounts. It also includes deeply integrated HIPAA and e-business capabilities, business intelligence functionality, and a scaleable architecture that can expand as the health plan grows. Some of the nation's largest health plans use Facets®, including one-third of all Blue Cross and Blue Shield plans.
CareAdvance Enterprise - Enterprise software that allows health plans to automate utilization, case, disease and population management, and to extend a personal health record and personal health management tools to their members. The system includes two modules: Personal CareAdvance and Clinical CareAdvance, which integrate with the health plan’s core information systems, aggregating the member’s personal claims and diagnosis history, current prescriptions, and laboratory data into a single data repository.
QicLink™ — Used to process more than 140 million medical claims annually, QicLink enterprise software has the largest share of the third-party administrator market. QicLink’s new functionality will support health reimbursement arrangements and give health plan members direct access to the plan administrator’s back-office information via the Internet. TriZetto is also updating the look of QicLink with Windows-based displays and a Web-based browser, which are intuitive and easy to navigate.
Facts™ — This application is used for the essential administrative transactions of indemnity insurers, such as enrollment, rating, premium calculation, claims processing, and billing.
HealthWeb® eBusiness Suite — HealthWeb’s comprehensive suite of e-business applications allow health plans to exchange information and conduct business online with members, physicians, employers, and brokers. The suite includes eService, eEnroll, eBill, and eQuote. Together, these modules cross all key business cycles, extending the entire enterprise to the Internet. Your complex business processes, from member acquisition and retention, to enrollment, billing and customer service, can be performed quicker and more efficiently by giving your constituents access to real-time information, 24 hours a day. HealthWeb is the standard Internet platform for TriZetto's proprietary software, Facets and QicLink, and it can work with virtually any back-end system or Web application.
HIPAA Suite — This software suite includes TriZetto HIPAA Gateway™ and TriZetto HIPAA Privacy System, applications that help health plans meet the complex regulatory requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPPA). HIPAA Gateway translates electronic data into a HIPAA-compliant format, and HIPAA Privacy allows health plans to track, manage and disclose member information in keeping with the government privacy guidelines.
NetworX Pricer — The NetworX™ claims pricing system for healthcare payers and preferred provider organizations is the only software that fully automates complex provider contracts. The application can cut in half the time it takes an organization to set up and maintain in its system the terms for physician, hospital and other provider services.
NetworX Modeler - Standalone software that predicts the financial impact of new or revised provider contracts, and can be used with any core administrative system. NetworX Modeler uses a health plan’s real claims data to forecast costs against proposed provider rates and terms, making it easier to negotiate contracts and manage costs. This information can help health plans structure the most strategic pricing arrangements with doctors and hospitals. Health plans can maximize speed and cost savings by using NetworX Modeler in conjunction with NetworX Pricer, which automates the pricing of claims: Contracts can be moved electronically between the pricing engine and the modeler system, without being rebuilt.
ClaimsExchange™ — This TriZetto service allows payers and benefits administrators to electronically transmit and receive claim information to/from external preferred provider organizations (PPOs). This vastly improves the speed and accuracy of the claims pricing process and also eliminates the need for payers to maintain PPO provider lists and contract terms within their core systems.
The goal of information technology is to make businesses more efficient, competitive, and profitable. But healthcare organizations, in particular, find it difficult to realize the promise of IT due to the complexity of the business and limited capital. For many health plans, outsourcing can be the solution. TriZetto’s outsourced services – software hosting and management, transaction processing, and IT operations management – reduce or eliminate upfront capital costs and significantly increase return on investment. When a customer combines all three types of outsourcing, the organization can reap the full benefit of TriZetto's comprehensive solutions.
Software Hosting and Management — TriZetto was the first and, according to a 2002 report by IDC Research, the leading hosted applications provider dedicated to the healthcare industry. More than just providing hardware for hosting, TriZetto’s team of IT experts actually manages the applications, to deliver optimal efficiency, productivity and return on investment for our customers. For a predictable monthly fee, customers can access advanced IT, without the up-front and ongoing expense of owning, upgrading and maintaining their own systems. The applications are pre-tested, come with guaranteed service levels, and can be a fast and easy path to HIPAA compliance.
Transaction Processing — Also called business process outsourcing, this type of outsourcing includes back-office functions. Companies can outsource all or part of their business processes to TriZetto, to address their expenditure, revenue, customer service and care management business cycles. This results in further efficiency and savings, and allows organizations to focus on their core business. These services can be performed at the customer site or at TriZetto, with guaranteed service levels.
IT Operations Management — TriZetto employs experienced staff to run all or part of a customer's IT operation. These services can involve management of the customer’s entire IT infrastructure, including data center operations, networks, desktops, help desk support, disaster recovery, and security.
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