TriZetto Reviews & Pricing

Key Features

• Claims Processing: Automatically verify insurance and sweep claims, scrubbing them of any mistakes or coding errors, which often lead to denials or delayed reimbursement. This speeds up the process of submitting claims while helping improve first-time acceptance rates.  
• Claims Reconciliation: Automate claims tracking throughout the reimbursement cycle. Monitor and convert EOB information into 835 remittance files to reduce errors and time spent reconciling claims. 
• Rejection Prevention: Apply coding edits to insurance claims prior to submission. Receive error messages to identify rejections before they happen, reducing claims rejections. 
• Eligibility Checks: Directly connect to insurance providers for real-time validation of patient eligibility. Integrate with practice management systems to seamlessly update patient insurance information. 
• Patient Responsibility Estimation: Generate patient cost estimates in real time to improve client satisfaction and likelihood of payment. 
• Prior Authorization: Automatically send prior authorization requests for treatment to patient insurance providers. Communicate with payers and track authorization requests within the provider portal. 
• Patient Payments: Provide patients with a selection of payment options, including credit card processing, a payment portal and text-to-pay processing, to improve patient experiences. 
• Denials Management: Receive claims denial notifications, along with causes and potential for appeal. Monitor error, edit and payer trends to reduce future denials. 
• Contract Management: Audit payments against contractual agreements with payers. Automatically generate documents and track efforts to dispute underpaid obligations. 
• RCM and Coding Services: Outsource revenue cycle management and coding processes, such as billing, patient statements, registration and insurance claims coding, to focus more on patient care and less on administrative tasks. 
• Credentialing: Check and manage employee credentials against payer requirements to ensure maximum reimbursement. Store employee documentation to remain up-to-date on expired credentials. 

Approach to Common Challenges

• Workflow Disruptions: TriZetto offers customizable EHR solutions that integrate smoothly into existing workflows, minimizing disruptions and optimizing operational efficiency.
• Data Security and Privacy: TriZetto implements robust security measures and compliance protocols within its EHR solutions, ensuring data privacy and mitigating security risks.
• Regulatory Compliance: TriZetto is designed to support regulatory compliance, facilitating reporting and documentation to meet industry standards and avoid penalties.

Cost Of Ownership

Limitations

• Significant initial investment.
• Inactive customer support.
• Limited customization options for open-source platforms.
• Glitchy integrations.

Training Resources

• Resource Library: Addresses common challenges faced by healthcare organizations through practical tips, case studies and expert advice shared through white papers, blogs and webinars.

FAQs