Click to learn more about our products and services:To learn more or schedule a customized demo contact us. revenueEnd-to-end submission We have the solutions you need to extend functionality of your core system, fully integrated and immediately effective.Initiate new enrollments, PBP changes, disenrollments and member changes from multiple channels including batch, web service and user entry.Leverage comprehensive validations of enrollment and member change transactions to streamline enrollment processes to maximize acceptance rates and minimize unnecessary manual work.Automate member eligibility verification directly with CMS Batch Eligibility Query (BEQ).Meet Part C and Part D enrollment reporting requirements including robust processing of daily and special Transaction Reply Reports (TRR) in applying member updates.Gain a clear view of daily enrollment work in progress.Automate the routing and assignment of work items based on specific roles, queues and priorities for issue enrollment and resolution.Integrate enrollment data with QNXT, Facets or other third party core administration applications for billing, claims processing and member services.Use one system for Medicare Part C and Part D payment reconciliation by member or Plan/PBP.Identify eligibility, member demographic, special status, low income, out of area and payment discrepancies.Correct your plan’s internal data system and submit corrections to CMS via the Retroactive Processing Center.Assist the management of work assignments, workflow management and discrepancy aging.Ensure that your organization has the tools to remain in compliance with CMS regulations for financial reporting.Reduce costs associated with inaccurate or incomplete data by providing quick and timely resolution of submission errors.Gauge potential financial mismatches and potential loss of revenue from CMS, Commercial Exchange or state agencies.Reduce the need for complex customization and state-specific solutions with built-in client configuration.Access aggregated and detailed encounter management information.Enhance business processes and provide transparency in the encounter life-cycle.Create batch files for Palmetto Customer Service and Support Centre (CSSC).Identify member Hierarchical Condition Category (HCC) and Rx HCC by payment year and data collection.Compare HCC information to CMS information to identify discrepancies.Calculate Part C and Part D risk scores using plan, CMS demographics and HCC data.Determine claim/diagnosis level RAPS in cases when CMS is missing accepted HCCs/Rx HCCs.Provide detailed risk score and HCC-related management reports.Utilize the RAPS response files and EDPS MAO-004 reports to compare the latest disposition of diagnosis codes at the member level.Automate key processes from assessment of member data through creation of reports that support RADV audits.Identify potential diagnoses by combining claims, pharmacy and demographic data.Manage the workflow related to organizing prospective candidates for adjusted risk scores and requesting changes.Track chart audit results on both Medicare Part C and Part D risk scores.Conduct assessments on members by evaluating their health prior to claims submission.Increase the quality and accuracy of data submitted to CMS.Identify clinical suspects for risk review and coding resolution.Support regulatory compliance and timely submission of data to the EDGE server.Detect issues for resolution and restitution prior to a RADV audit.Allow suspect data comparisons at medical group, IPA and physician levels to identify provider education opportunities.Pre-screen records format and content per CMS edit criteria.Create a CMS PDE file format for record submission. We will always look for new ways to help you improve revenue and increase cash flow. Learn more about TriZetto's core administration and other features today. We will stay ahead of regulatory changes so your office will never struggle to keep up. Please Enter a Valid Email Address help optimize medicare EDM provides a configurable and scalable encounter management solution that produces agency compliant encounter transactions, while enforcing submission rules to help prevent non-compliant transactions from being submitted to CMS, Commercial Exchange or state agencies.TriZetto® Claims Data Manager (CDM) streamlines and simplifies your health plan’s requirement for submitting timely RAPS data for Medicare Advantage members. With RSM, your health plan gains visibility into risk scores, which allows you to better forecast payments from CMS. Every feature that I use from TriZetto Provider Solutions products I enjoy. With that information, your health plan can take action if additional diagnoses have been made by providers. Thank you for the customer service and personal attention our office has received from TriZetto.
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