Identify and reprice claims based on episodes of care

Use clinical logic to identify and reprice claims based on episodes of care

Our TriZetto® NetworX Payment Bundling Administration (PBA) solution effectively addresses value-based reimbursement challenges. A comprehensive software that enables payers to develop and administer highly automated prospective and retrospective payment bundling programs, PBA can help improve the cost and quality of care while enhancing payer/provider relations through efficient reimbursement. The solution seamlessly integrates with Facets®, QNXT™ and non-TriZetto core administration systems to aggregate and price bundles used in value-based contracting. Working in real time during the claims adjudication workflow, the solution also identifies quality and efficiency indicators.

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. Our TriZetto 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 PBAA 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 fee-for-service costs
• 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