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To achieve high levels of automation in claim processing, your organization needs a logic matrix that supports procedure-driven adjudication, efficient plan building, and ease of maintenance. TriZetto® has developed ClaimRules to deliver a logic matrix based on our years of experience in the medical and insurance industries. This solution enables your organization to achieve the advantages associated with the use of a comprehensive logic matrix while you avoid the costs and hassles of creating your own.
With ClaimRules, your organization can quickly implement a procedure-driven plan and improve the consistency and efficiency of claims payment. ClaimRules utilizes a universal decision matrix (UDM) that contains comprehensive claim rules. It also provides a universal plan that uses the same benefit-coding structure as the UDM. A plan-building toolkit is provided as well, to help you define an efficient plan-building methodology. After completing ClaimRules training, your staff will be able to implement your UDM within three weeks. And with the toolkit, a new plan generally can be built in 2.5 days.
Benefits
- Increases automation and accuracy in claim processing
- Drives significant cost-savings by reducing implementation time and cost
- Helps ensure consistent and efficient claim payments
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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