HIPAA News

Two BlueCross BlueShield Plans Select TriZetto's Software to Determine Patient Liability and Adjudicate Claims in Real-Time

(June 25, 2008)-- The TriZetto Group announced two new customers for the company’s real-time patient liability and point-of-service claims adjudication software, Provider POS Direct.

Blue Cross and Blue Shield of Kansas City (BCBSKC) and Blue Cross and Blue Shield of Rhode Island (BCBSRI) are the latest health plans embracing the value of real-time claims adjudication by selecting TriZetto’s Provider POS Direct application. BCBSKC has nearly 900,000 members and 4,000 network providers; BCBSRI has more than 680,000 members and nearly 3,900 network providers. Additionally, BlueCross BlueShield of Tennessee last year incorporated the software to serve 2.3 million members and the 75,000 providers in its network.The Provider POS Direct application will be hosted for BCBSRI in a TriZetto data center.

The Provider POS Direct software helps payers improve the cost of care with an application that supports providers’ financial operations and improves cost transparency. By automating the delivery of accurate, real-time information to providers, the Provider POS Direct application helps increase payer administrative efficiency and improve member, provider and employer satisfaction.

TriZetto’s Provider POS Direct software determines the patient’s financial liability, the provider’s negotiated charge and the health plan’s expected payment at any time -- before, during or after care, enabling providers to collect the patient’s liability when the appointment is scheduled, at check-in or at check-out. The Provider POS Direct application helps improve cash collections, reduce unnecessary billings and minimize bad debt because the application enables real-time and direct access to accurate billing information much earlier in the revenue cycle between the member, provider and payer.

“BCBSKC and BCBSRI are shining examples of health plans forging long-term quality relationships with providers,” said Dan Spirek, executive vice president and chief solutions officer for TriZetto. “They are progressive for identifying and implementing software that enables real-time patient liability determination and claims processing.”

The Provider POS Direct software can be integrated with provider information systems and core payer administrative systems. The software is built on service-oriented architecture, with Internet browser capability, Web services for HIPAA compliance and ease of interoperability with legacy applications. For more details, visit  www.trizetto.com.

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