At a glance
Industry
Healthcare
Challenge
Improving pricing data and contract modeling
Products and services
NetworX Pricer
NetworX Modeler
NetworX Modeler Analytics
Success Highlights
Streamlined pricing and contract negotiation processes by:
- Automating provider contract pricing
- Reducing time to build and configure contract pricing from multiple days to approximately one hour
- Decreasing configuration time for rate sheet by approximately 25%
Our approach
Our consultants recommended the TriZetto® NetworX Suite® which integrates seamlessly with Facets to automate provider pricing and contract modeling. The client’s first priority was to upload commercial contracts into NetworX Pricer®, a solution which automates provider contract pricing for complex situations, regulatory requirements or different contract approaches, enabling core claims systems to use accurate, allowable amounts for claims adjudication.
We then worked with our client to implement NetworX Modeler® and NetworX Modeler® Analytics. Now the source of truth for all our client’s configurations, NetworX Modeler helps to streamline pricing negotiations with provider facilities by enabling our client to get very granular in pricing terms. The solution refines questions and even complex scenarios in a fraction of the time previously required. Some simple models only take an hour to complete compared to the days it often took our client using spreadsheets and data sets.
Our client can now use any subset of actual claims from Facets and test them against new payment methodologies set up in Modeler. The client may then create new rate sheets and test them all within the same application, enabling it to reduce configuration time by approximately 25%.
NetworX Modeler also speeds updates while ensuring their accuracy. The organization completes and audits all updates in the Modeler Development region before they are broadcast to its other Modeler regions and NetworX Pricer production.
Business outcomes
NetworX Modeler supports new processes our client needs to compete successfully in the changing healthcare landscape while also enabling efficient compliance with government mandates. Its provider contract teams can swiftly model pricing methodologies using data from actual claims to make well-informed pricing decisions for more effective negotiations. Then our client can quickly process provider agreements through Modeler for accurate rates and fewer adjustments.
NetworX Modeler also speeds updates while ensuring their accuracy. The organization completes and audits all updates in the Modeler Development region before they are broadcast to its other Modeler regions and NetworX Pricer production.
The automation in the NetworX solutions saved the client significant processing time by:
- Eliminating manual updates
- Decreasing configuration time for rate sheets by approximately 25%
- Improving search functionality for rate sheets, qualifier groups and fee schedules
- Reducing time to build and configure contract pricing from multiple days to approximately one hour
- Enabling new testing methodologies within the same application