SERVICE SUMMARY

TRIZETTO
HEALTHCARE PROCESS
AUTOMATION SERVICE
Intelligent Automation for
High Volume, High Value
Claims Processing
For healthcare payers, change is constant. With an aging population, an influx of new members
through Marketplaces, the expansion of Medicaid, and continued growth through traditional
commercial and Medicare populations, payers face significant challenges to their operations.
And administrative efficiency is the name of the game.
Payers who are competing to win know that administrative expense relief can be gained by
outsourcing business processing functions, and relying on partners to help reduce costs and
also to provide increased flexibility and access to specialized skills with reliable outcomes and
predictable costs. Business process outsourcing can run the gamut from occasional claims
overflow services to full outsourcing of many functions.
For payers who seek assistance specifically with claims processing, TriZetto now offers a new
Healthcare Process Automation Service for claims. Whether managing large backlog projects or a
subset of ongoing monthly claims, claims processing is now available as an automated service from
TriZetto, one of the healthcare industrys most trusted partners.

TriZetto Healthcare Process Automation Service for Claims

TriZetto Healthcare Process Automation Service addresses a need that exists between autoadjudication and manual processing in the claims process. It automates and replaces work
performed by a person, such as a claims examiner, on a claims system. The staff replacement
solution service includes a claims systems user interface, without bypassing any key claims system
features or functionality. The result is an efficiently processed claim in a secure environment.
TriZetto Healthcare Process Automation Service is a quickly deployable technology-based staff
replacement solution for clients who need to reassign important resources to more difficult
processes, automating the high-volume, low-to-medium complexity work to the service. The
service offers enormous flexibility and significantly shorter turnaround times as compared to
patches, system changes, or configuration changes.

TriZetto Healthcare
Process Automation
Service
Automated claims
processing service

Immediate impact with quick

implementation
Increased claims processing
productivity
Reduced administrative
expense
Consistent and accurate
Complete logging and auditing

Why TriZetto Healthcare Process Automation Service?

Scale
Just-In-Time Staffing
Faster Processing
Higher Quality

Scales staff to handle any volume of work that a system can handle.
Manages large volume changes, since it can re-allocate resources in seconds.
Processes at least five times faster and up to 30 times faster than a human can. In a high-volume
environment, this means productivity gains!
Executes all instructions with perfect consistency and accuracy. In claims processing, HPA has
typically achieved a 99.97% first-pass financial accuracy metric on a rolling 12-month average.

Instant and Always

Expertise

Has the knowledge of a Subject Matter Expert (SME), and can be replicated to account for volume.
Therefore, there is no learning curve as additional resource is added because HPA never forgets
anything it has learned. In fact, knowledge is compartmentalized in libraries by line-of-business,
process, system, platform, etc., so over time HPAs knowledge base for each discipline continues
to grow.

Consistency

Performs work exactly the same way. There is no interpretation variance, fudging or intuitive
balancing all of which are a major source of inconsistency and error. Simply put, the system will
do exactly what it is taught to do, exactly the same way every time.

Traceability

Logs all work it performs. This includes every decision, every input, every read, every warning/error
message, system diagnostics, environmental diagnostics, and numerous other data points. Every
piece of work performed can be audited and the decision-making logic and corresponding results
can also be audited.

Volume + Value = A Winning Formula

For payers seeking to reduce administrative costs, the TriZetto Healthcare Process Automation
Service provides significant, measurable and clear savings over using human personnel
for straightforward, repetitive claims processing functions based on processing speed.
Simultaneously, it provides quality improvement by reducing financial and processing errors. And
it offers processing capabilities and overall performance that would be difficult or expensive to
perform manually.

About TriZetto
TriZetto, a Cognizant company and business unit within Cognizants healthcare practice, provides
world-class information technology solutions to make better healthcare happen. TriZettos worldclass technology products, in combination with Cognizants consulting, IT and business process
services at scale dramatically simplifies the deployment and adoption of technology and improves
operationshelping to reengineer the business of healthcare today, while reimagining it for
tomorrow.

For more information on how TriZetto Healthcare Process Automation Service can
help you enhance revenue growth, drive administrative efficiency, and improve the
cost and quality of care, call 1-800-569-1222 or visit www.trizetto.com.

TriZetto Corporation
Corporate Office
9655 Maroon Circle
Englewood, CO 80112
1-800-569-1222
www.trizetto.com

Copyright 2014 TriZetto Corporation. All rights reserved. TriZetto and the TriZetto Triangle logo are registered trademarks Corporation or its subsidiaries. Other company and product names may be
trademarks of the respective companies with which they are associated. The mention of such companies and product names is with due recognition and without intent to misappropriate such names or marks.

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