TriZetto Acquires Medical Data Express to Help Medicare Advantage and Medicaid Payers Manage Encounter Data

DENVER--(BUSINESS WIRE)-- The TriZetto Group, Inc. today announced the acquisition of Medical Data Express (MDE), continuing the expansion of TriZetto’s managed Medicare and managed Medicaid solutions that currently serve more than 14 million Medicare Advantage and Part D members and over 12 million Medicaid members. Health plans use MDE’s technology and services to meet federal and state mandates for claim submissions that require medical encounter data formats. Plans also leverage MDE for automated end-user claims-testing technology to complete system upgrades, migrations and configuration changes, helping to ensure accuracy and reduce costs.

Aligned with the overall vision of health reform, the use of encounter data supports the development of better quality measures for managing Medicare beneficiaries and building more accurate risk adjustment models. Encounter data includes diagnosis and treatment information for all medical or behavioral services obtained by a patient. Through the analysis of encounter data, the Centers for Medicare & Medicaid Services (CMS) and states can take important steps toward achieving their triple-aim objective of improved beneficiary care, better overall health and reduced healthcare costs.

“By acquiring MDE, TriZetto is cementing its ability to offer customers a proven, comprehensive and reliable solution that helps payer organizations meet federal and state requirements for medical encounter data processing,” said Trace Devanny, chairman and CEO of TriZetto. “We are committed to continuing to enhance our suite of solutions helping Medicare and Medicaid plans leverage the efficiencies they gain for strategic advantage while maintaining compliance.”

A proven, established TriZetto partner, MDE supports Medicaid and Medicare plan customers that submit encounter data to more than 35 Medicaid state organizations and is positioned to meet the timelines established by CMS for Medicare Advantage plans.

“We are thrilled to join a recognized healthcare IT industry leader to launch this new solution,” said Dave Abraham, managing partner of MDE. “Combining MDE’s encounter data knowledge with TriZetto’s technology-enabled solutions and industry experience will provide payers with a powerful tool for submitting encounter data in an accurate, streamlined and timely manner. In addition to customer on-site implementations, MDE’s automated claims testing tool will be bundled with TriZetto services for smooth migrations and upgrades to TriZetto’s world-class enterprise administration systems.”

TriZetto will continue to make its Claims Data Manager application available to Medicare Advantage plans to process RAPs, or risk-adjustment processing, data submissions until the RAPs data requirement sunsets. CMS requires plans to submit both RAPs and encounter data beginning in 2012.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component software, application management services, business management services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit


The TriZetto Group
Loren Finkelstein, 303-542-2460
[email protected]
Schwartz MSL Boston
Davida Dinerman/Nicole Solera, 781-684-0770
[email protected]

KEYWORDS:   United States  North America  Colorado

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