DENVER – The TriZetto Group, Inc., today announced that Johns Hopkins HealthCare, which serves more than 300,000 members, including approximately 212,000 managed Medicaid beneficiaries, successfully reduced a substantial backlog of medical claims, reduced claims-operational expenses and resolved other administrative issues with the help of TriZetto’s business management services.
JHHC elected to use front-end services delivered by TriZetto’s services team. Front-end services include mailroom functions such as opening and sorting paper-based claims; converting paper claims to electronic format and transferring these to the core administrative system; image storage and retrieval; workflow management and more.
“The backlog was quickly eliminated, provider complaints declined and processing times improved,” Lees said, adding that TriZetto “consistently met our requirements for accuracy and turnaround time.”
JHHC was so pleased with TriZetto’s performance that, several months later, when Medicaid enrollments surged, the organization elected to send a portion of pended claims—those not processed automatically by the core administrative platform—to TriZetto’s claims administration services team, to process manually.
As TriZetto’s role at JHHC has increased, claims-operational expenses have decreased by approximately 20 percent, Lees said, noting that total annual savings are $300,000. The relationship with TriZetto has freed JHHC’s administrative staff to focus on strategic priorities; for example, employees now have time to proactively contact providers, helping them make the transition from paper-based claims to EDI. This has led to further cost-savings, and paper-based claims have declined from 75 percent to 7 percent of total claims.
TriZetto has delivered other critical services to JHHC, including software development and provider maintenance and credentialing. “TriZetto can pretty much do anything we ask,” Lees said. “If we need resources quickly and cost-effectively, we call TriZetto.”
Many healthcare organizations are turning to business management services as a way to reduce administrative costs and improve quality, according to Thomas Rekart, TriZetto’s senior vice president of business management services. “Demand is increasing as health plans seek effective ways to meet the challenges of healthcare reform legislation,” he said. “Plans that serve the managed Medicaid market are particularly focused on reducing administrative spend, as state budgets are constrained while Medicaid enrollments are likely to surge in the coming two to five years.”
Providing front-end, enrollment, billing, claims, benefit configuration and customer service for more than 75 customers annually on a variety of claims administration platforms, TriZetto has the experience, best practices and results to help healthcare organizations meet short- and long-term needs. With more than 1,200 professional resources working in onshore and offshore locations, TriZetto has consistently delivered high-quality results, with customers experiencing typical savings of 20 percent.
While best known for its industry-leading software portfolio, TriZetto also offers a robust set of business services. In addition to business management services, TriZetto offers application management and consulting services. TriZetto’s comprehensive services solutions can help healthcare organizations improve efficiency, control costs and accelerate speed to market, while potentially reducing risk. TriZetto’s business services are delivered by a closely aligned global workforce of 1,500 professionals who are uniquely well-trained and experienced in delivering TriZetto and third-party applications.
About Johns Hopkins HealthCare
Jointly owned by the Johns Hopkins Health System and the Johns Hopkins University School of Medicine in Baltimore, Md., Johns Hopkins HealthCare (JHHC) develops and manages medical care contracts with organizations, government programs, and healthcare providers for more than 300,000 plan members. Approximately 212,000 of these are managed Medicaid members.
About TriZetto
TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component software, application management services, business management services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.
