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Automates the processing of bundled payments using clinical logic to identify and reprice claims based on their role in an episode of care.

Value-based reimbursement models are rapidly gaining prominence as payers look to reward the value, not volume of care delivered. Bundling payments based on episodes of care can help reduce unwarranted variations and more accurately predict medical costs. However, transforming existing Fee-for-Service (FFS) claims into episodic-based payments, can add significant administrative burden and cost. 

NetworX Payment Bundling Administration solution enables payers to develop and administer highly automated prospective and retrospective payment-bundling programs that can help improve the cost and quality of care, while enhancing provider experience through efficiencies in reimbursement. The solution integrates with Facets™, QNXT™ and non-TriZetto core administration systems to aggregate and price bundles, and identify quality and efficiency indicators while adjudication occurs.

Benefits include:

  • Automates and scale payment bundling processes as needed.
  • Reduces the cost of claims and increase the predictability of payments.
  • Defers some risk to providers.
  • Promotes collaboration among providers to increase the quality of care.
  • Reduces tension with providers regarding what is and is not covered in claims.

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Solution Summary
TriZetto® NetworX Payment Bundling...

Automated, Fexible and Scalable Payment Bundling

Solution Summary
TriZetto® NetworX Payment Bundling...

Evaluate and Manage Episodes of Care

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