TriZetto Plan Data Management assists healthcare organizations in four key areas:

• Minimize operating costs and manage revenues
• Assist in ensuring that plans meet CMS guidelines
• Provide easy-to-use software in order to reduce the need for specialized staff
• Avoid the need to develop and maintain expensive software

TriZetto Plan Data Management solutions for Medicare Advantage and/or Part D healthcare organizations address enrollment administration; HCC revenue management; member reconciliation; and claims data and PDE validation and administration. These solutions are available on an individual basis or as an integrated system covering the full continuum, including enrollment, reconciliation, revenue management and more.

In addition, TriZetto Plan Data Management can assist clients with:

Revenue Management Services: For healthcare organizations that don't have the internal resources to conduct chart reviews to determine if the medical chart reflects claims data, we can assist in the identification of charts for review and review the charts.

Working Aged Survey and Reconciliation: Incorrect status on Working Aged can significantly reduce revenue. We can survey your membership and research whether members should be categorized as Working Aged.

Coordination of Benefits (COB): This service supports the Part D sponsor's need to identify and report on a member's other health insurance coverage for Part D. Sponsors are required to coordinate with State Pharmaceutical Assistance Programs and other providers of prescription drug coverage with respect to payment of premiums and coverage, as well as coverage supplementing benefits available under Part D.

The Plan Data Management portfolio can extend the capabilities of TriZetto Medicare solutions, including Facets® and QNXT™, the leading core administration platforms for healthcare payers; CareAdvance Medicare®, a secure, Web-based communication platform for case, utilization, disease and population management; and the NetworX™ Suite, which supports management of provider networks.

Benefits

• Reduces operating costs
• Helps Medicare Part C and Part D plans manage revenues
• Supports compliance with CMS rules

Information

For more detailed information, please call 1-800-569-1222 or click on the link below. Request more information     Contact a sales rep