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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 (PBA) 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.

TriZetto NetworX Payment Bundling Administration Analytics

As value-based reimbursement models become more prevalent across commercial- and government-based programs, payers need support to effectively build, manage and evaluate episodes of care to include in bundled-payment arrangements. The NetworX Payment Bundling Administration Analytics (PBAA) solution allows users to evaluate new episode opportunities, review provider performance and manage contracted episodes of care.

Based on bundled claims data generated by the NetworX PBA engine, and leveraging the Tableau Business Intelligence tool for data visualization and report views, payers can:

  • Identify potential episodes of care, with attributing providers and current FFS cost
  • Manage ongoing and completed episodes of care while tracking the program’s overall success
  • Drill down into reports that integrate financial, operational and quality data to deliver value.

TriZetto NetworX PBAA is an integral component of Cognizant’s TriZetto Healthcare Products portfolio of solutions designed to help payers and providers enter into payment bundle arrangements to reduce costs, improve quality and achieve better outcomes.

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Solution Summary
NetworX Payment Bundling Administration

Automated, Flexible and Scalable Payment Bundling

Solution Summary
NetworX Payment Bundling Adm. Analytics

Evaluate and Manage Episodes of Care

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