Integration of Leading Payer and Provider Systems will Benefit Practitioners and Health Plans with Improved Operational Efficiency and Care Delivery
GREENWOOD VILLAGE, Colo. & ST. LOUIS--(BUSINESS WIRE)-- The TriZetto Group today announced it has signed an agreement to acquire privately held Gateway EDI, a St. Louis-based healthcare revenue cycle management (RCM) company that gives more than 70,000 physicians solutions for getting paid efficiently and accurately. Terms of the transaction were not disclosed. The CEOs of both companies said the deal is historic for providers and health plans alike because it brings together two industry leaders in providing healthcare IT software and services to deliver integrated end-to-end real-time payment information. This new payer-provider connectivity will drive enhanced work-flow processes and cost reduction across the industry. The combined platforms of the two companies will give providers direct real-time access to payment information for almost half of the insured U.S. population, which is served by TriZetto systems.
“This acquisition is an industry game-changer and will shape the future of healthcare,” explained Trace Devanny, TriZetto’s chief executive officer. “Our combined solutions will transform today’s payment processing from batch to real-time communications, dramatically reducing expenses for both payers and providers. Connecting the providers who deliver care, in real time, with the health plans that pay for the care will help eliminate the remaining waste, paperwork and phone traffic inherent in today’s fragmented system.”
“In 2009, the healthcare industry spent $150 billion on billing and insurance-related administrative costs. By increasing collaboration and communications between providers and payers, we can decrease inefficiencies that lead to such high costs, resulting in more resources to deliver high-quality care and better value to patients,” said Timothy Fogerty, Gateway EDI’s chief executive officer. “We are excited to be able to offer this new capability to our more than 300 practice management system and electronic health record partners.”
Stephen Furia, TriZetto’s vice president of provider strategy, stressed that expanded payer-provider connectivity is key both to TriZetto’s vision of Integrated Healthcare Management and to improving U.S. healthcare. “The integrated capabilities of our two companies will help bridge what has been a fragmented healthcare system and improve efficiency in coordinating benefits and care to deliver greater value for every healthcare dollar spent,” he said. “It’s a win-win strategy, reducing payment and collection expenses for payers and providers and enabling them to collaborate in support of the deployment of promising new models such as accountable care organizations and patient-centered medical home.”
“In combining resources with TriZetto, Gateway EDI can give providers instant access to the most accurate benefits and patient payment responsibility information. As a result, patients will know exactly how much they owe at the time of their visit,” said Charlotte Martin, Gateway EDI president and COO. “In a best-case scenario, the current claims-processing cycle takes four days to get from provider to payer and back to provider for patient billing. The combination of our two companies will enable a process that happens in seconds.”
TriZetto will invest significant resources to integrate the two companies’ platforms and develop connectivity solutions that strengthen payment processing and care-collaboration programs. TriZetto’s current Provider POS DirectTM application presents an immediate opportunity for payer organizations, offering unique real-time claims estimation and adjudication at the point of service in practitioners’ offices. Integrated, expanded solutions will follow over the next year, initially in markets where the two companies have a critical mass of payer and provider customers.
TriZetto intends to operate Gateway EDI as an independent subsidiary, with Gateway EDI’s current leadership team continuing to run its operations.
About Gateway EDI
Healthcare providers trust Gateway EDI’s complete support system of people and tools to maximize their revenue and increase cash flow. Based in St. Louis, Gateway EDI was founded almost 30 years ago by a physician who was unsatisfied with the claims processing tools available at the time and created new solutions focused on better managing the revenue cycle for medical practices. Today, more than 70,000 physicians continue to count on Gateway EDI’s fully integrated suite of advanced tools and proactive service team to monitor, catch and fix claims issues before they can impact a practice. As a result, Gateway EDI’s clients’ average claims rejection rate is more than 20 percent below the industry average. For more information, visit www.gatewayedi.com.
Founded in 1997, TriZetto is focused on world-class software and service solutions to help customers win in an era of reform and transform the industry with increased payer and provider collaboration and connectivity. Integrated Healthcare Management, TriZetto’s vision for the industry, is the coordination of benefits and healthcare to drive more value from every healthcare dollar spent. With its technology touching half of the U.S. insured population, the company’s offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting that help customers 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
Loren Finkelstein, 303-542-2460
Pauline Louie, 781-684-0770
For Gateway EDI
Maria Tonge, 314-469-3500
KEYWORDS: United States North America Colorado Missouri
INDUSTRY KEYWORDS: Technology Data Management Software Practice Management Health Professional Services Insurance General Health