TriZetto Expands End-to-End ICD-10 Support With New Solution That Helps Payers Maintain Financial Neutrality Between ICD-9

GREENWOOD VILLAGE, Colo.--(BUSINESS WIRE)-- The TriZetto Group, Inc. today announced the availability of its TriZetto Advantage 10 Payment AnalytiXTM solution, a SaaS offering that can help healthcare payer organizations maintain financial neutrality between claims coded in ICD-9 or ICD-10. This capability makes TriZetto the first company to provide end-to-end ICD-10 solutions that cover the technical, business and clinical impacts needed to comply with and leverage the ICD-10 code mandate by October 2013. TriZetto’s end-to-end ICD-10 solutions include ICD-10-ready applications for core administration, care management and web portals; applications that complete the ICD-9 to ICD-10 translation; and services that help payers migrate and leverage ICD-10 data.

“This new solution can minimize a health plan’s risk of migrating to ICD-10 and the impact ICD-10 can have on its financials, as well as provider relationships,” explained Scott Hampel, vice president of product management at TriZetto. “The TriZetto Advantage 10 Payment AnalytiX solution can be extremely beneficial to payers in helping ensure that they experience minimal variance in what they pay for claims coded in ICD-10 versus ICD-9. Without this analysis, payers risk an increase or decrease in claims payments to providers, a provider-satisfaction problem and greater administrative costs because more claims payments could fail to process automatically.”

The new solution integrates code mapping, a translation tool, modeling and analytic tools, along with services, to enable health plans to identify the ICD-9 codes they pay against currently, and determine how those payments will be affected by the expanded coding of ICD-10.

The TriZetto Advantage 10 Payment AnalytiX solution allows payers to begin with data analysis and move easily through mapping, pricing and iterative analysis. The integrated solution allows stakeholders throughout payer organizations to make informed decisions about how to minimize the impacts of the new codes across their claims-reimbursement processes, provider-negotiation strategies and medical policies.

“This capability can help health plans reduce the scope and therefore cost of their ICD-10 migrations significantly by determining which of the tens of thousands of available codes they use most frequently and which of those have the largest impact on their bottom line,” Hampel said. “Further, because this capability is available in a SaaS model, payers will pay for the service only as long as they need it, minimizing the overall expense of the project.”

Hampel added that “true, comprehensive” ICD-10 migration should include updates to technology, business and clinical systems, programs and processes enterprise-wide. TriZetto’s complete, end-to-end ICD-10 solution, TriZetto Advantage 10 ServicesTM, can help healthcare payers leverage HIPAA 5010 and ICD-10 data to power healthcare reform initiatives that increase operational efficiency while improving the cost and quality of care. The process integrates the patent-pending TriZetto Advantage Framework and includes six stages of service that can help health plans translate ICD-10 goals into actionable project plans; complete the mapping crosswalk and system readiness; and leverage the data to build value-based benefit plans, more targeted care programs and collaborative provider relationships that leverage HIPAA 5010 and ICD-10 data.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions, including patented and patent-pending innovations, that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto’s solutions touch half of the U.S. insured population and reach more than 21,000 physician practices representing more than 75,000 practitioners. The company’s payer offerings include enterprise and component software, application hosting and management, business process outsourcing services and consulting that help transform and optimize operations. TriZetto’s provider offerings through Gateway EDI, a wholly owned subsidiary, include advanced tools and proactive services to monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable the deployment of promising new models of post-reform healthcare. TriZetto is committed to the integration and convergence of technology systems that enable its vision of Integrated Healthcare Management, the coordination of benefits and healthcare to drive more value from every healthcare dollar spent. For more information, visit


The TriZetto Group
Loren Finkelstein, 303-542-2460
[email protected]
Schwartz Communications
Davida Dinerman/Pauline Louie, 781-684-0770
[email protected]

KEYWORDS:   United States  North America  Colorado

INDUSTRY KEYWORDS:   Technology  Data Management  Software  Practice Management  Health  Professional Services  Insurance  General Health



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