This really is not rocket science as there has to be a carrot for programmers and companies to keep creating methodologies for payment expedition. It is no secret 
today that the payers and those outside the clinical side of healthcare are the financial beneficiaries; however learning new software techniques and having yet one more place to go takes time. I wonder why the folks that keep dishing out more applications and portals don’t recognize this fact. Software in itself is not going to be the cure all for care but it does generate faster profits if the providers us it. This portal could even make it easier to facilitate the possibility of moving some of this functionality overseas as the company purchased another company that does this.
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
Even some of the folks who have been on the medical record side of the business are crossing over to the payer side as the ex CEO of Cerner is now in charge over here. A while back, another data intense algorithmic software company, Ingenix who is part of United Healthcare made some efforts to purchase TriZetto.
Ex Cerner President Hired by Trizetto as CEO – More Money on This Side As Payment Algorithms Are Not Certified and Held Accountable as is EHR Software
Granted, using a portal is more efficient that reams of paper and faxes but it also makes the processes easier for outsourcing here so we get a double edge sword of sorts and again the third parties here with supplying all types of software and algorithms are the ones who cash in big time with profits as those transaction fees just keep on growing. As a patient, is this just not wonderful to know that you are yet one more number here with a “score” that is assisting in determining what care you will get, makes one fee like just one more “score” or “brick” in the wall. The purpose of looking at all angles here is to hopefully create an awareness for the patients to create a greater understanding of the processes that work in the background that they may or may not be aware of as they run 24/7 and as humans we still need to sleep.
As you can see from this article, this process is making it easier to “score” the patient with a risk assessment to let the provider know, based on new algorithmic formulas on whether or not authorizations will be approved. As a patient you are scored right and left these days to see if your health and needs can fit into the formulas they have determined to be authorized with the algorithms set forth. All profits here eventually go to the parent company, a private equity firm in the UK so it’s a good idea to see who owns and manages who these days at with new contracts and acquisitions, it changes quickly. BD
GREENWOOD VILLAGE, CO – One of the pain points in the payment of healthcare bills is the process of gaining approval from insurers for medical procedures. The TriZetto Group is looking to ease that pain by introducing a better means of communication between providers and payers.
The Greenwood Village, Colo.-based developer of healthcare IT solutions last week announced the upcoming launch of CareAdvance Provider, the newest component of its CareAdvance Enterprise care management suite. The new automated authorization portal is designed to enable direct communication between providers and payers through Web portals that providers already use, allowing them to determine more quickly which treatments will be covered by the patient’s health plan.
According to TriZetto officials, when a provider submits an authorization request through the new portal, a CareAdvance Provider solution replies with a pre-determined set of questions. The provider’s answers to those questions generate a score based on the patient’s benefit plan, enabling the provider to determine whether the authorization will be approved, denied or filed for additional review.
New TriZetto portal to link providers with payers | Healthcare Finance News
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