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TriZetto Announces General Availability of EDGE Server Solution That Helps Health Plans Meet Reform Requirements

July 7, 2014

DENVER--(BUSINESS WIRE)-- TriZetto Corporation today announced the general availability of its EDGE Server solution for healthcare payer organizations.

In 2012, CMS introduced the External Data Gathering Environment (EDGE) server concept as the standard distributed data collection method. TriZetto’s technology and services solution enables health plans to securely capture and provide enrollment, medical claims and pharmacy claims data to the U.S. Department of Health and Human Services (HHS). This data is required of all healthcare payers participating in state and federal health Exchanges, as well as individual and small-group markets.

TriZetto’s Encounter Data Manager for EDGE Server application is pre-mapped to the company’s FacetsTM and QNXTTM core administration systems. These systems are used by more than 50 health plans in Exchanges and more than 60 payers in the individual and small-group markets. The Encounter Data Manager for EDGE Server application also integrates with non-TriZetto administrative systems that must comply with the encounter data requirements.

“For more than a decade, TriZetto has helped managed Medicare and Medicaid plans submit encounter data to federal and state agencies,” said Diana Benli, TriZetto’s vice president of product management, government payer solutions. “We securely manage such data for plans covering nearly 30 percent Medicare and 50 percent Medicaid recipients. TriZetto brings the requisite experience and know-how.”

HHS, through the Centers for Medicare & Medicaid, recently updated EDGE server requirements for health plans. By the end of the summer, payers must choose to use a cloud server through Amazon Web ServicesTM or an on-premise server. TriZetto’s solution supports both choices, consolidating, scrubbing, masking and feeding encounter data to either server option. This flexibility will enable health plans to move swiftly to meet the looming deadline.

“These updated requirements and new ones down the road require an experienced, steady hand, and that’s where our services team comes in,” said Dan Skari, solution general manager, healthcare reform, at TriZetto. “In addition to the encounter data application, TriZetto’s EDGE Server solution includes consulting, business management and application management services. Informed by years of experience in encounter data management, our team will help healthcare payers speed implementations, oftentimes in as little as 10 to 12 weeks1 and respond nimbly to changing, evolving regulations and compliance mandates.”

TriZetto’s Encounter Data Manager for EDGE Server application currently used by health plans in 36 states for Medicaid and Medicare, includes data scrubs; flexible data maps; formats that support compliance for populating medical encounter, pharmacy claims and enrollment data in servers; and both licensed and hosted delivery models.

About TriZetto Corporation

TriZetto Corporation provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 230,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.

1 Individual client implementation time may vary.



TriZetto Corporation

Wesley Bryant-King, 303-542-2571

wesley.bryant-king@trizetto.com

Source: TriZetto Corporation


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