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Maximize your government business potential
From Medicare/Medicaid enrollment through encounter submissions, augment your core administration system with features to automate processing.
Products
TriZetto® Enrollment Administration Manager (EAM), powered by TriZetto® Enrollment Administration Manager Workflow, streamlines Medicare Advantage enrollment while ensuring CMS compliance. It automates eligibility verification, OEC election processing and TRR handling to reduce manual work and improve acceptance rates. EAM integrates with Facets® and QNXT™ for seamless billing, claims and member services. It enables multichannel enrollment changes, enforces CARA legislation and enhances visibility into enrollment workflows.
Its automated work routing, validation and compliance tracking features make it a critical solution for efficient and compliant health plan enrollment management.
TriZetto® Financial Reconciliation Manager (FRM) supports Medicare Parts C and D reconciliation, detects eligibility and payment discrepancies, and enables data corrections via the retroactive processing center. FRM streamlines work assignments, workflow management and discrepancy tracking while ensuring compliance with CMS financial reporting regulations, providing a comprehensive solution for accurate and efficient financial reconciliation.
TriZetto® Encounter Data Manager™ (EDM) and TriZetto® Encounter Data Manager Workflow streamline data submission, ensuring compliance with CMS, commercial exchanges and state agencies. EDM automates error correction, enforces submission rules and enhances data accuracy to reduce overhead costs. It captures data from multiple sources, identifies financial mismatches and optimizes risk scores and revenue. EDM’s automated workflows replace manual processes to improve efficiency, transparency and control. Built-in configurations minimize customization needs, ensuring timely, accurate and compliant encounter submissions while reducing the total cost of ownership.
TriZetto® Risk Score Manager (RSM) analyzes claims and encounter data to calculate expected CMS reimbursement based on submitted diagnoses. It reconciles risk scores against CMS RAPS response files and EDPS submissions to ensure accuracy and enhances visibility into risk scores to improve payment forecasting. RSM also identifies member Hierarchical Condition Categories (HCCs), compares them to CMS data to detect discrepancies, and calculates Parts C and D risk scores using demographics and HCC data. Its detailed risk SCORE and HCC management reports support informed decision-making and compliance.
Take the first step
Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital healthcare solutions is vast and growing. Our expertise in healthcare IT services enables us to integrate cutting-edge technology seamlessly into your operations.
Let’s talk about how digital healthcare IT solutions can work for your business.