GREENWOOD VILLAGE, Colo.- September 01, 2011 –The TriZetto Group, Inc. today announced a partnership with Three Rivers Provider Network (TRPN) that gives TriZetto’s benefits-administrator customers pre-negotiated discounts as high as 25 percent and preferred pricing for out-of-network services obtained by members. This discounted pricing can help third-party administrators (TPAs) reduce plan costs and improve overall plan savings for their employer groups, while creating additional revenue streams.

California-based TRPN is the nation’s largest proprietary supplemental provider-discount network, with some 600,000 providers nationwide, including more than 5,000 hospitals and 70,000 ancillary facilities. TRPN is the latest addition to the TriZetto Premier Partnership Program™. The program leverages the large customer base of TriZetto’s QicLink Extended Enterprise™ core administration system to provide optimal pricing of innovative, integrated vendor products and services that can help TPAs and their self-funded employer customers manage the cost and quality of care.

“With employers looking for greater sophistication and flexibility to effectively manage plan costs, this solution provides benefits administrators with a more competitive offering through the deployment of a best-in-class out-of-network management system,” said Rob Scavo, president of the emerging market and benefits administration business units at TriZetto. “It enables TPA customers of TriZetto to offer the value-add of network cost-containment in addition to their core service of administering claim payments.”

“Our alliance gives benefits administrators an easy, affordable and automated way to efficiently select and route out-of-network claims to TRPN for rapid identification, discount pricing and resolution of claim payments through direct, compliant contracting practices unfound in today’s marketplace,” said David Roth, chief marketing officer of TRPN. “TriZetto’s TPA customers now can offer employer groups even more competitive cost-management strategies and potentially greater savings.”

TriZetto uses its ClaimsExchange^® electronic connectivity service to integrate TRPN’s out-of-network cost-management solution with its QicLink system. With this integration, benefits administrators can streamline and simplify out-of-network claims processing and reduce the paperwork, manual intervention and errors historically associated with the work flow.

TriZetto QicLink system customers that subscribe to TRPN’s services can benefit from:

• Complete integration between the QicLink and ClaimsExchange applications and TRPN.
• Data exchange to create disruption reports for quoting new and renewing cases.
• Automatic routing of non-network claims from the QicLink system, after adjudication but before check creation, for re-pricing by TRPN; two-hour-or-less standard re-pricing turnaround time and faster provider-dispute resolution.
• Automatic re-adjudication of claims in the QicLink platform after TRPN re-pricing.
• TriZetto Premier Partnership Program pricing, which is based on the aggregate buying power of TriZetto’s QicLink system customer base.
• TRPN reports documenting savings on non-network claim re-pricing.

About Three Rivers Provider Network

TRPN was founded in 1996 as a company that was contracted to provide services for several major auto clients. At that time, clients needed a network that would grant PPO-type discounts without incurring balance-billing risks for their members. Over time, TRPN was prompted by other companies that focused on group health and workers compensation to perform similar type services for them. TRPN contracts were uniquely designed for group health, workers compensation and auto-liability claims, expanding existing coverage and significantly reducing out-of-network expense. Since then, TRPN has evolved into the largest and fastest-growing proprietary PPO network in the United States. The TRPN network includes some 600,000 total providers, including more than 5,000 hospitals and 70,000 ancillary facilities. Through our clients, approximately 10 million lives now have access to the TRPN PPO network.

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 www.trizetto.com.

 

Media Contacts:

The TriZetto Group
Loren Finkelstein
303-542-2460
loren.finkelstein@trizetto.com

Schwartz Communications
Davida Dinerman
781-684-0770
trizetto@schwartzcomm.com