A leading HealthCare Payer is responsible for managing and processing a large volume of healthcare claims daily. They needed a comprehensive claims processing platform that could handle the complexity of processing claims from a variety of providers (P2), including hospitals, clinics, IPAs, and physician practices, while ensuring compliance with industry regulations and timely processing of claims.
The Payer faced several challenges related to claims processing, including the need to streamline the process of receiving and processing claims, the need to automate claims adjudication and payment processing, and the need to improve the accuracy and efficiency of claims processing to reduce costs.
The Payer engaged GHIT Digital to implement and integrate the Trizetto Facets Claims Platform, a comprehensive claims processing system designed specifically for healthcare payers (P1). The Facets Claims Platform (P4) includes several modules, each designed to address a specific aspect of claims processing. The implementation, configuration and upgrade steps included but not limited to:
Planning and Design: GHIT consultants worked with the Payer's business and technical teams to develop a detailed project implementation, integration and testing plan, including identifying the specific Trizetto Facets modules needed, such as the Claims Adjudication, Provider Data Management, Enrollment, Premium Billing, and Finance modules, and developing a deployment strategy.
Deployment and Configuration: GHIT Digital deployed and configured the Trizetto Facets Claims Platform according to the agreed-upon plan, integrating it with the Payer's existing systems and applications.
Testing and Validation: Team GHIT conducted thorough testing and validation of the Trizetto Facets Claims Platform to ensure it is functioning properly and providing the expected level of claims processing accuracy and efficiency.
Training and Support: GHIT Digital provided training to the Payer's staff on how to use and maintain the Trizetto Facets Claims Platform and provides ongoing support to address any issues or concerns.
With the Trizetto Facets Claims Platform implemented and integrated by GHIT Digital, the HealthCare Payer was able to streamline their claims processing, automate claims adjudication and payment processing, and improve the accuracy and efficiency of claims processing, reducing costs and improving customer satisfaction. The Payer also achieved compliance with industry regulations and gained greater control over the claims processing process.
GHIT Digital ( https://ghit.digital/) is a domain focused, future ready, boutique IT Services & Digital Transformation firm. We are Minority and Women Owned (MWOB) small business from New Jersey, USA. Diversity, Inclusion, and Growth is our Mantra. Team GHIT works on strategic IT Projects for Government (G); HealthCare (H); Insurance (I); and Technology (T) clients, thus the brand GHIT. We are nimble, scalable and sell & deliver with Platform Partners & Delivery Partners. Out niche capabilities include Agile Project Management, Infrastructure Services, Data Services, Cloud native Data and Apps Implementation, Integration, Migration, Security & Optimization.
MonMass, Inc. (the legal name of GHIT Digital) will work on your strategic IT Projects or tactical Staffing & Consulting requirements (NAICS codes 541511 / 541512 / 541330 / 541618). Feel free to call 201.792.8924 or write to us at Contact@GHIT.digital for no obligation discovery conversation. You are welcome to share your RFPs/RPQs for us to review and respond on time.
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