TriZetto said that its integrated software solution has already enabled Capital BlueCross to increase claims auto-adjudication rate and reduce pended-claims inventory (claims in line for processing) and its claim days on hand (time for processing).
The enhancements to the claims process follow other solutions offered to Capital BlueCross by TriZetto that have helped to automate member enrollment, premium billing, claims administration and customer service; streamline the delivery of work to users, improving business processes while reducing manual labor and errors; and automate critical aspects of disease management so Capital BlueCross can use its care management staff most effectively and cost-efficiently.
Commenting on the implementation, Capital BlueCross executive vice president and COO, Deb Cohen, said: "We are fortunate to have a business partner like TriZetto to help us bring advanced solutions to the work we do on behalf of our customers."
TriZetto Blue Cross and Blue Shield market segment president, Sal Gentile, said: "Our network management system has helped Capital BlueCross rebuild and restructure its provider contracts. Our care management platform has streamlined the administration of helpful disease management programs that support plan members in its central Pennsylvania and Lehigh Valley service area."
"In the months and years ahead, TriZetto stands ready to assist with upgrade, customization and integration projects that can further enhance Capital BlueCross’ business processes and administrative efficiencies," Gentile said.