Payer organizations want to maintain strong relationships with the providers who are supporting their members. Provider Solutions applications give physicians access to a wide range of self-service transactions and inquiry capabilities that enhance provider satisfaction while reducing administrative expense. Member eligibility can be verified, referrals and authorizations can be submitted and claims status can be checked. Providers can also be given access to tools that let them determine patient out-of-pocket costs prior to services delivery—giving their patients cost transparency into the expenses they will incur for the healthcare they will be receiving.
TriZetto® Provider Service provides web-based tools that streamline provider administrative processes. Providers can conduct a wide range of self-service transactions and inquiries in a secure online environment. Capabilities include: checking member eligibility, reviewing benefit summaries and product details, reviewing claim status and submitting referrals, and logging pre-authorization for inpatient and outpatient services. The application is integrated with both the TriZetto® Facets™ and TriZetto® QNXT™ core administration platforms to give providers direct access to the most current information available.
TriZetto® Provider POS Direct® is a web-based solution that accurately calculates patient financial liability and adjudicates claims at the point of service. This application offers real-time, accurate calculations of patient financial liability before, during or after care to address the cost transparency needs of both providers and consumers. Patient liability inquiries return results in seconds and support healthcare services delivered in physician offices, clinics and hospital outpatient settings. This solution is pre-integrated with TriZetto® Facets™ and TriZetto® QNXT™ core administration platforms and may also be integrated with existing legacy systems.