TriZetto Buys Gateway EDI Medical Claim and Payment Company-More Medical Financial Algorithms Adding Power to the Payers

I have covered TriZetto, which is somewhat of a competitor of Ingenix when it comes to analytics and providing the least cost routing in healthcare. We all still question and should whether or not this represents the best care. I have included a few links from the recent past and TriZetto is run by the former CEO of Cerner.

CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management

Trizetto also has a high focus with marketing to employers too so this acquisition of Tela Sourcing might give them an edge on providing cheaper pricing for the companies they solicit for their business. You can also read from prior posts this is profit driven by private equity firms.

Trizetto Group (Wholly Owned Subsidiary of Apax Partners London Based Private Equity Firm) Says Their Study Indicates the US Healthcare System is Ready to Adopt Value Based Insurance Designs – Marketing At Its Best

In doing this blog I see all kinds of stuff out there and back about a year ago they produced this study of well informed consumers that said they were ready to adapt PHRs and so on, and I asked and still ask, where are those patients since it seemed to indicate a large group. The link above will fill in the blanks there. I certainly can’t find them. In addition they have the capabilities to outsource to India and other locations through subsidiary acquisitions.

TriZetto (Owned by Apax Partners PE Firm) Buys Tela Sourcing And Gains IT Resources to Outsource Claim and Other Transactions To India With US Medical Billing

We do need a smarter Congress and to help them out with some of the complicated law processes today and to create financial laws that have teeth, we almost do need a “Department of Algorithms” as I started talking about 2 years ago. When we start to see conglomerates running extreme data and business intelligence, we need a government that is also in tune to what is occurring. As mentioned too they could easily send “Watson” over to Congress to help them out too. They need it. BD

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

So with this acquisition, more algorithms and data system integration and someone has to pay for all of this, who, the customers of course, so pretty much what you have here from what I am reading is a clearinghouse service for sale. Certainly claims need to be scrubbed for accuracy but the payers should pay for this since they benefit and the service should be free for providers and hospitals

What is the real value of a payment algorithm today I sometimes ponder? BD

ST. LOUIS – The TriZetto Group, Inc., announced Tuesday that it has signed an agreement to acquire privately held Gateway EDI, a St. Louis-based healthcare revenue cycle management (RCM) company. Officials said the combination of the companies' platforms will benefit both payers and providers by delivering integrated end-to-end real-time payment information.

TriZetto officials said the company will invest significant resources to integrate both companies' platforms and develop connectivity solutions that strengthen payment processing and care-collaboration programs.