QNXT 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 - QNXT™ Connector 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 QNXT™ 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
  

  MICRO-DYN MEDICAL SYSTEMS, INC.

  Micro-Dyn Medical Systems, Inc. offerings are integrated partner products. Micro-Dyn specializes in software products for healthcare claim DRG calculation, APC assignment, Medicare reimbursement calculation, data editing, and validation to Medicare specifications. Micro-Dyn’s DRGActive™, APCActive™, and PRICERActive™ software and data editing components integrate seamlessly with QNXT to immediately add data validation, DRG/APC calculation and Medicare reimbursement capability.

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• Cost Management Solutions
  

  CHANGE HEALTHCARE

  Change Healthcare is a key catalyst of a value-based healthcare system—working alongside customers to accelerate the journey towards improved lives and healthier communities. Payment Integrity solutions from Change Healthcare are integrated with the TriZetto Healthcare Products QNXT™ enterprise core administration system. By leveraging the Change Healthcare Intelligent Healthcare Network™—the single largest financial and administrative network in the U.S. healthcare system—these solutions provide the broadest view of billing activity to help identify inappropriate claims before they are paid. Our extensive network enables a multi-payer data set with unparalleled insights, allowing payment accuracy solutions at every stage of the claim lifecycle: pre-submission, pre-payment and post-payment. We deliver an end-to-end suite of solutions and services that combat many of the ways that payers are at risk for paying inappropriate claims.

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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® QNXT™ 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 QNXT™ 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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• Enterprise Document Management
  

  ONBASE® BY HYLAND

  OnBase® by Hyland, an enterprise content management (ECM) solution, integrates with TriZetto® QNXT™ to provide payers with a single point of access for clinical and administrative content. OnBase for TriZetto QNXT gives users access to related content from within QNXT’s native view, meaning adjusters and plan administrators do not need to leave their QNXT window to search for information, speeding claims resolution and increasing member and provider satisfaction.

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• Healthcare Account and Funds Management
  

  WEX HEALTH

  Cognizant and WEX Health have partnered to offer consumer-driven healthcare administration and benefits card solutions for payer organizations. Through the partnership, WEX Health's industry-leading consumer-driven healthcare administration system, WEX Health Cloud, is available to Cognizant TriZetto® QNXT™ enterprise core administration system clients. The partnership agreement includes the WEX Health Payment Card which uses patented technology to achieve the highest auto-substantiation rates in the industry. WEX Health simplifies the business of healthcare through WEX Health Cloud, a cloud-based healthcare financial management platform that drives efficiency for benefit administration technology, consumer engagement, and advanced billing and payments. Our partner organizations enable us to deliver our industry-leading and award-winning solution to 225,000 employers and more than 24 million consumers. Together we take the complexity out of defined contribution, HSAs, HRAs, FSAs, VEBAs, PRAs, premium billing, public and private health insurance exchanges, COBRA, wellness plans, and transit plans. Learn more at www.wexhealthinc.com, and follow WEX Health at @WEXHealthInc.

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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® QNXT, Facets, or QicLink , 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
  

  CHANGE HEALTHCARE

  Change Healthcare is an integrated partner with the QNXT™ enterprise core administration system, providing a single, automated communications and payments platform. The Change Healthcare QNXT interface provides a seamless connection for streamlined implementation; and enables better member engagement with printed and electronic communications across all lines of business, including Commercial, Individual, Medicare, Medicaid, PBM and Dental. Change Healthcare provides significant opportunities for QNXT customers to reduce overall costs, mitigate risk and drive digital adoption associated with regulated and non-regulated member communications and provider payments. Preference-based intelligent payment analytics drives the most cost-effective payment distribution platform. Change Healthcare is the industry’s largest communications vendor dedicated 100% to healthcare, which provides economical and technology-enabled solutions with efficiencies at scale, including savings with participation in the Change Healthcare Health Payers USA cooperative, the nation’s first and largest healthcare postage cooperative. QNXT customers also have better controls with access to a comprehensive web-based virtual mailroom, which provides configurable self-service document management, editing, composition, audit, tracking and reporting.

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  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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