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Payment bundling platform uses clinical logic to identify and reprice claims based on episodes of care

Value-based reimbursement models are rapidly gaining prominence as payers look to reward the value, not the 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. 
Our TriZetto® bundled payments solution addresses these challenges. NetworX Payment Bundling Administration (PBA) is value-based reimbursement software that enables payers to develop and administer highly automated prospective and retrospective payment bundling programs. It 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 used in value-based contracting. Working in real time, during the claims adjudication workflow, and the solution also identifies quality and efficiency indicators.
Key capabilities:
  • Automates episode-based payment bundling contracts in any core claims administration system
  • Administers both prospective and retrospective bundled payment contracts in real time, during the claims adjudication workflow
  • Speeds implementation and lowers the cost of upkeep through pre-integration 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

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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