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Ds-Syn Networx Pricer QNXT 0515
Ds-Syn Networx Pricer QNXT 0515
Ds-Syn Networx Pricer QNXT 0515
TM
Whether the goal is to better administer Medical Loss Requirements (MLR), better
optimize the delivery of care, or manage new reimbursement standards for programs like
Medicare and Medicaid, payers are increasingly changing their relationship with providers
through new contract terms and pricing methodologies. New contract arrangements can
introduce higher levels of complexity to administer claims. As a result, Payers need to
be able to leverage and extend their existing technology resources to achieve greater
flexibility and administrative efficiency relative to their providers. Now health plans who
leverage the QNXT application have access to the advanced capabilities of TriZettos
NetworX Pricer solution to efficiently and reliably manage new pricing methodologies and
highly complex claims.
Provider
Match
Benefits and
Adjudication
Editing
Claim Data w/
Rate Sheet ID
Claim
Claim Data w/
Pricing Details
Remit
NetworX Pricer
Results that NetworX Pricer
Customers Have Reported:
Improved Pricing
automation exceeding
98%
Drove labor savings of as
much as 30%
Reduced contractconfiguration time by
as much as 75% claims
adjudication process
By giving payers a pricing platform with enhanced functionality that allows them to:
Create new negotiated rates in QNXT with greater flexibility, more functionality and less
maintenance
Reduce configuration complexity with NetworX Pricer rate sheets, a single view of provider
pricing configuration rules.
Leverage a QNXT and NetworX Pricer hybrid configuration approach - use existing QNXT
Provider Contract Reimbursement functionality while adding NetworX Pricer enhanced
functionality to create greater claims payment accuracy and automation.
Expand Medicare Pricing & Reimbursement Capabilities with OptumEasy Group & 3M
for higher claim adjudication rates and better payment accuracy, with a central pricing
engine for multiple production environments, multi-tenant deployment, and hierarchy fee
schedules.
Drive efficient computations and calculations to manage effective cost containment of
reimbursements and risk through enhanced pricing methodologies:
TriZetto Headquarters
Corporate Office
9655 Maroon Circle
Englewood, CO 80112 USA
Toll Free: +1 800 569 1222
www.trizetto.com
Email: salesinfo@trizetto.com
Copyright 2015, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic,
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trademarks mentioned herein are the property of their respective owners.
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