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TriZetto acquires Gateway EDI

The TriZetto Group, Inc., announced Tuesday that it has signed an agreement to acquire privately held Gateway EDI, a St. Louis-based healthcare revenue cycle management (RCM) company. Officials said the combination of the companies' platforms will benefit both payers and providers by delivering integrated end-to-end real-time payment information.

TriZetto officials said the company will invest significant resources to integrate both companies' platforms and develop connectivity solutions that strengthen payment processing and care-collaboration programs.

"This acquisition is an industry game-changer and will shape the future of healthcare," explained Trace Devanny, TriZetto's chief executive officer. "Our combined solutions will transform today's payment processing from batch to real-time communications, dramatically reducing expenses for both payers and providers. Connecting the providers who deliver care, in real time, with the health plans that pay for the care will help eliminate the remaining waste, paperwork and phone traffic inherent in today's fragmented system."

Officials said the new payer-provider connectivity will drive enhanced work-flow processes and cost reduction across the industry. The combined platforms of the two companies will give providers direct real-time access to payment information for almost half of the insured U.S. population, which is served by TriZetto systems.

[See also: New TriZetto portal to link providers with payers]

"In 2009, the healthcare industry spent $150 billion on billing and insurance-related administrative costs. By increasing collaboration and communications between providers and payers, we can decrease inefficiencies that lead to such high costs, resulting in more resources to deliver high-quality care and better value to patients," said Timothy Fogerty, Gateway EDI's chief executive officer. "We are excited to be able to offer this new capability to our more than 300 practice management system and electronic health record partners."

TriZetto's current Provider POS Direct application presents an immediate opportunity for payer organizations, offering unique real-time claims estimation and adjudication at the point of service in practitioners' offices. Integrated, expanded solutions will follow over the next year, initially in markets where the two companies have a critical mass of payer and provider customers, said officials.

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Stephen Furia, TriZetto's vice president of provider strategy, stressed that expanded payer-provider connectivity is key both to TriZetto's vision of Integrated Healthcare Management and to improving U.S. healthcare. "The integrated capabilities of our two companies will help bridge what has been a fragmented healthcare system and improve efficiency in coordinating benefits and care to deliver greater value for every healthcare dollar spent," he said. "It's a win-win strategy, reducing payment and collection expenses for payers and providers and enabling them to collaborate in support of the deployment of promising new models such as accountable care organizations and patient-centered medical home."

TriZetto intends to operate Gateway EDI as an independent subsidiary, with Gateway EDI's current leadership team continuing to run its operations, officials said.

"In combining resources with TriZetto, Gateway EDI can give providers instant access to the most accurate benefits and patient payment responsibility information. As a result, patients will know exactly how much they owe at the time of their visit," said Charlotte Martin, Gateway EDI president and COO. "In a best-case scenario, the current claims-processing cycle takes four days to get from provider to payer and back to provider for patient billing. The combination of our two companies will enable a process that happens in seconds."

Terms of the deal were not disclosed.