FACETS PARTNERS

• Claims Editing and Auditing
  

  CLAIMSXTEN™

  ClaimsXten is an integrated partner product of Change Healthcare that provides a clinically-based claims payment software solution for payers that want to create and deploy flexible, automated rules to help improve payment accuracy, reduce appeals, and realize medical and administrative savings. The ClaimsXten - Facets® Adapter helps increase administrative efficiency and enables customers the flexibility to process each claim under the specific terms and conditions of each benefit plan.

  By correcting inappropriately billed claims, ClaimsXten has saved billions of dollars for the industry¹. It:

  • Automates billing policies sourced from the American Medical Association, Centers for Medicare and Medicaid Services (CMS), specialty societies and a health plan’s unique payment and medical policies
  • Increases claim auto-adjudication rates, typically by more than 4%
  • Processes over a million claims a day; offers clinically defensible, transparent coding information for payers and providers. 

  
  Beyond auditing, ClaimsXten helps claims get paid correctly the first time with automated, customizable rules that catch wasteful, abusive or claims errors and reduce post-pay resources.

  ¹ Change Healthcare internal data for all ClaimsXten customers over a 12 month period.
  

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  OPTUM® CLAIMS EDITING SYSTEM

  The OPTUM Claims Editing System, an integrated partner product, is a powerful adjunct to the Facets enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant Knowledge base of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.

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• Claims Grouping and Pricing
  

  OPTUM®

  The OPTUM® Prospective Payment Systems (PPS) software application, an integrated partner product, maps, groups and prices facility claims to ensure appropriate reimbursement. OPTUM®’s ECMPro™ application integrates with TriZetto®’s NetworX Suite® solution to manage grouping, pricing, editing and mapping for Federal (DRG, APC, ASC, IRF, SNF, CAH, LTCH, IPF, Physician) Prospective Payment Systems (PPS) and more than 20 state and payer specific PPS. Facility (inpatient and outpatient) and professional Medicare PPS, and a number of Medicaid PPS are integrated with NetworX Pricer® to support auto-adjudicated claims processing. Users can also apply the supported Medicare and/or Medicaid PPS to their commercial business processing. The integrated solutions streamline claims-processing workflows to reduce reimbursement errors and improve payment integrity.

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• Cost Management Solutions
  

  Avalon Healthcare Solutions 

  Avalon Healthcare Solutions is a healthcare information technology and clinical specialty benefit management company focused on laboratory testing. Avalon provides a comprehensive program to facilitate management of outpatient laboratory services across all providers: independent, physician office, and hospital-based laboratories. Using an independent Clinical Advisory Board, we have developed a suite of science-based laboratory policies, including high-volume, low-cost routine testing which are reviewed, adapted, and adopted by the health plan. Policy enforcement is administered through Avalon’s proprietary, automated technology, providing health plans with significant savings on outpatient laboratory spend.

  Through our partnership with Cognizant, Facets clients can rapidly realize these savings by leveraging a real-time integration from Cognizant’s TriZetto® Facets® core administration platform to Avalon.

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  ZELIS™ HEALTHCARE

  Zelis™ Healthcare delivers measurable value through our unparalleled claim integrity solutions, operational excellence and healthcare intelligence. Our integrated multiple products and solutions ensure that our clients are obtaining the highest level of savings on each claim through our robust technology and precise processes, enhanced with human expertise. Through our partnership with Cognizant for a near real-time interface to TriZetto’s® Facets™ core administration platform, we ensure that your daily claim process is kept intact, operation rule consistency automation is achieved, and most importantly, near real-time capabilities reduce turnaround time from days/hours to seconds. With the Facets™ interface to Zelis Payment Integrity services, you will also see reduction of loss ratio and increased operational transparency, all of which can lead to substantial savings.

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• Healthcare Account and Funds Management
  

  ALEGEUS 

  With the industry’s #1 multi-purse benefit debit card platform tightly integrated with the TriZetto Healthcare Products Facets platform, Alegeus enables integrated consumer benefit account management of HSA, FSA, HRA and dependent care accounts. By giving them access to their flexible benefit account balances using a convenient debit card, Alegeus empowers members to better manage their healthcare expenses and to take a more active role in their health and wealth situation.

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• Healthcare Payments Technology
  

  ZELIS™ PAYMENTS

  Zelis™ Payments is a leading healthcare payments technology company dedicated to delivering value via exceptional client experiences. Our solutions facilitate regulatory compliance and streamline the transfer of healthcare payments and data. Through our proprietary integration with Cognizant’s TriZetto® Facets, Zelis Payment’s technology becomes a part of your daily workflow to create a seamless payment process, which improves accuracy and reduces process complexity for significantly improved cost control. To ensure provider satisfaction and reduce noise, we employ a unique, provider-centric enrollment and support model, which encourages electronic adoption and network retention.

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• Outbound Printing and Fulfillment
  

  REDCARD

  RedCard delivers reliable, client branded, enhanced design and production of critical customer communications including healthcare checks, explanation of payments (EOPs), explanation of benefits (EOBs), healthcare (ID) cards, enrollment-related correspondence, and letters delivered in the mail or via the Web. RedCard enables clients, through an integrated set of web-based self-service management tools, the ability to redesign its member and provider communication utilizing the latest four-color technology. Based on client-specific needs, it will also enhance communication time frames using its industry first, healthcare episode-based claim bundling option. This integrated system creates new cost savings while changing the frequency, look, and feel of the communications, allowing for fewer customer service calls and an overall better experience.

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