QNXT™ Optimization Software Products
With Claim Test Pro, you can test claims data efficiently and cost effectively and verify with confidence that correct claim totals are being paid. The solution greatly reduces the need for manual creation of test cases, automates the management and reconciliation of results, tracks and documents test projects and cases, and electronically converts system data to applicable testing data sets to create a robust and applicable testing environment.
In addition, the Claim Test Pro application provides a comprehensive set of testing suites that provide for more diverse testing schemas, enabling testing of a multitude of provider reimbursement scenarios. The solution automates many processes that previously were done manually, helping plans increase administrative efficiencies by reducing the resources needed to manage these initiatives. An added benefit of the Claim Test Pro solution is that it provides management tools that track and report progress.
Plans that do not have a strategy for testing and validating claims data may be at risk. Claim Test Pro can help you:
- Reduce overpayments to providers. Data that has been thoroughly vetted helps ensure that your plan is paying its contracted providers the correct amounts.
- Lower administrative costs. Reducing errors in provider payments reduces manual rework, helping drive down costs.
- Trim test cycle time. Automation can help you save hundreds of hours building and documenting test cases.
- Reduce critical defects introduced to production. The application is virtually self-documenting, automatically summarizing what you have tested and reconciled.
Implementing QNXT is an effective way to improve claims processing, group administration, case management and pre-authorizations, to name a few of the many benefits; but ensuring that QNXT continues to satisfy all of your needs and requirements sometimes requires system configuration changes and any changes to be promoted between environments. In some cases, this process can be complicated and time-consuming. The Configuration Solution for QNXT is a combination of tools and services that automate, optimize and help maintain QNXT configurations and promotions. When combined with integration, the solution facilitates a robust configuration data change management process.
Configuration Solution for QNXT allows healthcare organizations to:
- Track modifications using process-driven automation
- Compare configuration differences between any environments
- Migrate configuration changes to any region or environment
- Ensure adherence to change procedures and approval processes
- Reduce demands on database administrators during change promotions
- Perform targeted component migrations of desired configurations
- Reduce testing demands and rework
When making and managing system configuration changes, it is critical that payers continually test in order to validate the integrity of the changes and to ensure that new configuration items are production-ready. This task becomes more complex when multiple, simultaneous changes are involved.
The Configuration Migration Utility for QNXT helps control, manage and successfully execute configuration promotions. It gives non-healthcare IT personnel the ability to migrate specific aspects of configuration changes from environment to environment in a manner that is controlled, workflow-integrated and audit-capable. With this tool, you can:
- Eliminate wholesale environment copies. Perform targeted component migrations of desired configurations.
- Reduce demand of specialty healthcare IT resources. Reduce the demands on database administrators during change promotions.
- Ensure adherence to change procedures and approval processes. Enforce a rigorous workflow process while distributing the execution work efforts.
- Reduce testing demands and rework. Test only the migrated component instead of re-executing wholesale test cycles.
Before adding new functions, changing system configurations or design, it is important to test them in a way that keeps health information fully protected. Test Data Generator creates non-production data sets of both transactional and configuration data, allowing healthcare organizations to test possible changes before implementing them. The tool ensures that protected health information (PHI) remains fully secure by stripping the data of personal identifying information and creating key word files with all new identity information. The result is size-controlled data sets of randomized non-production data.
Using Test Data Generator for QNXT, healthcare organizations can:
- Reduce the risk of exposing PHI that occurs when production data is simply copied into non-production data bases for testing.
- Create multiple specialized test databases and control their size and composition.
- Reduce non-targeted environment copies.
- Decrease demands on specialty IT resources.
- Improve security.
TriZetto® Testing Automation Suite is a licensed software solution that automates the validation and testing of health plan software product implementations. It can be used to automate data-driven testing such as benefit configuration data, batch processes, API integrations, upgrade and regression testing scenarios and EDI-type transaction processing. Testing Automation Suite can reduce cost and alleviate staffing pressure by automating much of the test execution process.