TriZetto Improves Efficiency for CareOregon

By Anuradha Shukla

TMCnet Contributor

 

TriZetto (News - Alert) has delivered its technology-enabled solution to CareOregon, a not-for-profit health plan serving low-income Oregonians.

The solution from the TriZetto Group (News - Alert) has enabled CareOregon to meet critical deadlines, grow its business and improve administrative efficiency.

CareOregon has been able to cut administrative costs through increased automation of core processes across multiple lines of business. Its managers can now easily access real-time information to stratify population health and support members with case management interventions, treatment plans and medical-service authorizations.

TriZetto's comprehensive administrative solution for CareOregon also enables electronic exchanges of HIPAA-compliant transactions between CareOregon and its trading partners, and streamlines accounts-receivable processes and work flows.

"We are thrilled about the efficiencies we've gained from TriZetto's solution," said Colleen Crace, system coordinator supervisor at CareOregon. "It's quite gratifying that the more we've used it, the more we've discovered it can do. We strive for continuous improvement, and there hasn't been a month in which we've been unable to leverage TriZetto's system to improve cost and quality."

Prior to implementing TriZetto's solution, CareOregon used the services of a TPA vendor that processed Medicaid claims manually. Thanks to TriZetto, the first-pass auto-adjudication rate for professional claims has increased from 0 percent to 66 percent.

The rate for facility claims has also increased from zero to 63 percent, and claims received from EDI have risen from 59 percent to 82 percent.

"One might expect administrative costs to rise with growth, but TriZetto's solution has helped CareOregon spend proportionately less while investing proportionately more on delivering patient care," said Rob Scavo, TriZetto's regional market president.