DENVER--(EON: Enhanced Online News)--TriZetto Corporation today announced it has achieved National Committee for Quality Assurance (NCQA) Disease Management (DM) Systems Certification for seven of its disease management programs supported by TriZetto’s CareAdvance Enterprise® solution, an application that streamlines disease management, case management and utilization management (UM) to better manage and coordinate member care.
“Passing this rigorous review of our clinical information systems to support a number of DM programs further communicates TriZetto’s continued commitment to helping clients meet their cost and quality goals pertaining to care management.”
To earn NCQA’s DM Systems Certification, TriZetto has met select requirements in four categories of high NCQA disease management standards: Patient Service, Care Coordination, Measurement and Quality Improvement and Program Operation. These certification standards are purposefully set high to encourage organizations to continuously enhance their quality. The measures are developed with input from researchers in the field, the Disease Management Advisory Council (DMAC), standing committees, employers, purchasers and operators of disease management programs, state and federal regulators and other experts.
“We’re very excited to have achieved this NCQA DM Systems Certification,” says Lesley Brown, senior vice president, Care Solutions at TriZetto. “Passing this rigorous review of our clinical information systems to support a number of DM programs further communicates TriZetto’s continued commitment to helping clients meet their cost and quality goals pertaining to care management.”
The CareAdvance Enterprise solution captures member information from many sources, including a member-facing web portal enabling secure bi-directional communications, to create more complete care plans from which targeted interventions can be launched. The solution also provides payers and physicians’ staff with automated, two-way communications regarding UM authorization requests without the need for phone calls, faxes or other manual processes.
TriZetto’s care management contracts range from 5,500 to more than 12 million lives per client, serving a variety of client types with nearly 40 million contracted lives combined. The company’s core administration solutions (FacetsTM and QNXTTM) enable claims processing for more than 142 million lives.
The CareAdvance Enterprise solution is integrated with TriZetto core claims administration systems, allowing for real-time retrieval and review of member claims and uniformity in authorization rules and dashboard reporting. The current release of CareAdvance Enterprise (Version 5.0) features built-in ICD-10 regulatory capabilities, simplified, yet sophisticated analytics and web-enabled member access to important care information.
“Our clients may be eligible to receive ‘automatic credit’ for meeting specific standards covered by our Certification, helping to make the NCQA accreditation process less burdensome for them,” Brown points out. “It’s one more way for TriZetto to demonstrate to payers how we can be relied upon as a partner helping them solve their business problems and reach their goals.”
TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch more than half the U.S. insured population and reach more than 200,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of healthcare organization. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.
NCQA has reviewed and certified TriZetto Corporation’s Systems capability. For complete details on the scope of this review, visit www.trizetto.com.