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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® EngageProvider® delivers real-time access to transaction health plan information to providers and their staff from core administrative systems. Through this real-time data access, providers can create more efficient practice management processes and support member care decisions to improve outcomes and lower costs.
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.