“Our network management system has helped Capital BlueCross rebuild and restructure its provider contracts. Our care management platform has streamlined the administration of helpful disease management programs that support plan members in its central Pennsylvania and Lehigh Valley service area.”
Leveraging TriZetto’s core, care and network management solutions and consulting services has helped Harrisburg, Pa.-based Capital BlueCross reduce its pended-claims inventory (claims in line for processing) and its claim days on hand (time for processing), while further increasing its claims auto-adjudication rate (systematic processing).
The enhancements to the claims process follow other solutions offered to Capital BlueCross by TriZetto that have helped to automate member enrollment, premium billing, claims administration and customer service; streamline the delivery of work to users, improving business processes while reducing manual labor and errors; and automate critical aspects of disease management so Capital BlueCross can use its highly skilled care management staff most effectively and cost-efficiently.
“We already have a strong reputation for efficient and timely claims processing, but we are always looking for ways to further differentiate our leading-edge capabilities,” said Deb Cohen, Capital BlueCross executive vice president and COO. “We are fortunate to have a business partner like TriZetto to help us bring advanced solutions to the work we do on behalf of our customers.”
Capital BlueCross has a long history of delivering innovative solutions and resources such as TriZetto’s to its customers to help reduce cost, increase quality and improve satisfaction.
“TriZetto’s comprehensive solution set has supported other improvements, as well,” said Sal Gentile, president of TriZetto’s Blue Cross and Blue Shield market segment. “Our network management system has helped Capital BlueCross rebuild and restructure its provider contracts. Our care management platform has streamlined the administration of helpful disease management programs that support plan members in its central Pennsylvania and Lehigh Valley service area.”
TriZetto’s strong consulting services team provided planning and project management support; implementation execution, data conversion and development services; and the implementation of extensions and interfaces. “In the months and years ahead, TriZetto stands ready to assist with upgrade, customization and integration projects that can further enhance Capital BlueCross’ business processes and administrative efficiencies,” Gentile said.
“TriZetto’s consulting services team knows TriZetto software better than anyone,” said Cohen. “They’re best positioned to help Capital BlueCross derive the greatest value enterprise-wide.”
During the last eight years, TriZetto has spent more than $100 million to refine world-class processes, architecture and tools that are used by its consulting group in serving healthcare clients.
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About Capital BlueCross
In 2013, Capital BlueCross is celebrating 75 years of serving central Pennsylvania and Lehigh Valley residents and businesses as the region’s leading health insurer. Through community partnerships and by collaborating with area health care providers, Capital BlueCross brings innovative services and clinical solutions to the marketplace, while expanding and diversifying its comprehensive product portfolio. Committed to delivering medical value to its communities, Capital BlueCross focuses on improving patient satisfaction, enhancing quality of care and reducing costs. The company continues to lead the change in the industry by meeting the evolving health needs of its customers, most recently by entering the retail market and building a first-of-its-kind health and wellness store in the Lehigh Valley called Capital Blue. Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association, employing more than 1,800 people. More information about Capital BlueCross, its family of businesses and its offerings for individuals and employers can be found at capbluecross.com.
TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and collaboratively to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help health plans and TPAs increase administrative efficiency, improve the cost and quality of care, and succeed in the retail healthcare market. Its solutions help physicians and health systems simplify business processes and execute strategies for population health management and accountable care. TriZetto’s healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. For more information, visit www.trizetto.com.