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Contain Costs

APPROPRIATELY DETERMINE RISK BASED ON CONTRACTUAL ASSIGNMENT

Align Division of Financial Responsibility (DOFR) payment within QNXT claims adjudication process.

REDUCE GRAY AREAS FOR ASSIGNMENT OF RISK


Easily define and configure individual Division of Financial Responsibility (DOFR) contractual relationships.

Determining which party is financially responsible for services rendered is notoriously time-consuming and complex. The QNXT DOFR Module simplifies this process with a set of tools to easily define and configure individual Division of Financial Responsibility (DOFR) contractual relationships. This means they can be quickly and accurately analyzed and acted on during the claims adjudication process, and that claims can be paid by line of business, based on the DOFR. It also reduces gray areas in defining which party has risk for a specific service. Features include:

  • Allowing users to configure any defined DOFR
  • Permitting intake of the assigned DOFR during the QNXT adjudication process
  • Allowing for DOFR override when authorized by the health plan or medical group
  • Providing high-quality measures, outcomes and reports
  • Supporting cost containment and cost certainty

QNXT MODULAR ADD-ONS

QNXT™ Appeals and Grievance Workflow™

Appeals, grievance and complaint management

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QNXT™ Claims Workflow™

Streamline business processes with greater accuracy and efficiency

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QNXT™ EXtended Integration™ (QXI)

Fast, flexible integration of multiple applications

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QNXT™ DOFR Module

Align Division of Financial Responsibility (DOFR) payment with QNXT

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RELATED THINKING

Solution Summary
TriZetto® QNXT™ DOFR Module

Enabling Division of Financial Responsibility (DOFR) Payment...

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