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 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 payer/provider relations with efficient reimbursement. The solution integrates with Facets®, QNXT™ and non-TriZetto® core administration systems to aggregate and price bundles in real time during the claims adjudication workflow and to identify quality and efficiency indicators.

Benefits include:

• Automates episode-based payment bundling contracts in any core claims administration system
• Administers both retrospective and prospective bundled payment contracts in real time during the claims adjudication workflow
• Integrates with Facets, QNXT and NetworX Pricer for real-time processing, including prospective bundled payment pricing
• Identifies ROI and contracting opportunities by modeling  proposed episodic contracts with robust analytics 
• Monitors value-based program results in detail
• Includes optional fully outsourced payment bundling management services