TriZetto Expands BPO Services to Support Additional Claims Platforms

GREENWOOD VILLAGE, Colo.--(BUSINESS WIRE)-- The TriZetto Group, Inc. today announced that it is broadening its business process outsourcing (BPO) services for a number of additional administration platforms beyond the company’s own enterprise applications. The BPO services available on this broader array of administration platforms include front-end processing, enrollment, billing and claims administration, which can reduce the cost of core administration by as much as 20 to 40 percent, compared to captive, in-house processing. The expanded capabilities leverage new resources and proprietary technology from Tela Sourcing, which the company acquired in August 2010. In addition, the company announced a new on-demand delivery option for these alternate administration platform services to allow more payers to outsource short-term administration projects to TriZetto BPO to quickly and cost-effectively restore normal process balances. All the new services are available immediately.

“This is a critical time for expanding our range of BPO services to help our customers be more strategic in how they meet the compression on budgets that comes with healthcare reform; by decreasing administrative spend, payers are better prepared to meet new medical loss ratio requirements,” said Brij Sharma, TriZetto’s senior vice president of services, and former CEO of Tela Sourcing. “This represents the first of many anticipated new healthcare service offerings that leverage TriZetto and Tela’s strengths and unique assets.”

In Gartner’s September 20, 2010 report, titled Health Insurance BPO Market Evolving Toward Strategic Services, Gartner analyst Maureen O’Neil said, “U.S. health insurers' CIOs are more frequently considering BPO as a strategic option, turning it from largely the exception to a more accepted norm. As health insurers become more sophisticated in their evaluation of BPO providers, they no longer base their selections exclusively on transaction costs; instead, they factor in a provider's industry knowledge, technology base, and ability to meet quick time-to-market goals.”

Expanded BPO Services Provide Flexibility and Cost Savings

Leveraging more than 700 resources, which may be applied in onshore, offshore or blended operating models, TriZetto BPO can now complete front-end processing, enrollment, billing and claims administration services on a variety of vendor platforms. Using professionals with an average of five years of experience, and 70 percent with bachelor’s degrees, TriZetto can adjudicate claims with pend resolution, process adjustments and coordinate benefits, finalize claims, and complete provider and member correspondence in a system-independent environment that decreases claims expenses for specific processes up to 40 percent over in-house handling.

To complete traditional front-end processing more efficiently and less expensively, TriZetto uses a proprietary platform built with advanced OCR technology for translating paper claim submissions into EDI 837 files. The efficient approach of this engine, highly advanced technology coupled with cost-effective resources, may significantly reduce front-end processing costs. It provides a streamlined foundation for front-end BPO services that include mailroom, imaging, data entry, electronic claims processing, member and provider matching, PPO routing, and image storage and retrieval.

Additional TriZetto BPO enrollment and billing services allow payers to focus on their more strategic operations. Services include group setup and member enrollment, premium billing and reconciliation, and provider and member correspondence.

On-Demand services even out payer operations and expenses

TriZetto’s expanded on-demand BPO services give payers flexibility and cost efficiency for accommodating business fluctuations without disrupting service levels to employers, members or care providers. Payers can use TriZetto on-demand services to augment staff on an as-needed basis to even out claims backlog and overflow challenges.

About TriZetto BPO Services

TriZetto was originally founded as a services company and offers a wide range of business processing outsourcing (BPO) services, in addition to I.T. outsourcing. With its acquisition of Tela Sourcing, Inc. in August 2010, TriZetto has expanded its breadth and depth of BPO capabilities, now offering cost-effective offshore, onshore and blended models that can significantly lower administrative costs across areas such as front-end services (mailroom, imaging, OCR/scanning and data processing), claims processing, enrollment, configuration and billing.

About TriZetto

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry, with its technology touching half of the U.S. insured population. TriZetto’s vision for the industry, Integrated Healthcare Management, is the optimized coordination of benefits and care for healthcare consumers to improve the value of every healthcare dollar spent. The company's offerings include enterprise and component software, I.T. outsourcing services, business process outsourcing services and consulting that help payers transform and optimize their operations to enhance revenue growth, to drive administrative efficiency and to improve the cost and quality of care.


The TriZetto Group
Rachel Tanner Lew, 303-495-7022
[email protected]
Schwartz Communications
Davida Dinerman or Pauline Louie, 781-684-0770
[email protected]

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