Address payment problems with

TriZetto Provider Solutions®

ICD-10 IconWe can help make your ICD-10 transition as painless as possible.
Even though we’ve officially made the switch to ICD-10, the work is far from over. We know these next few months may be challenging, and we are here to help.  Learn More:

Improve the health of your organization.

Smart healthcare organizations know that optimizing billing and payment processes can be vital to a healthy bottom line. That’s why they rely on TriZetto Provider Solutions. With our revenue management solutions, you’ll not only get paid quickly and accurately, but you’ll also be able to see trends and identify ways to maximize reimbursement.
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I have been a customer of TriZetto Provider Solutions since July 2010 and am happy with the service from each one of the employees that I have been associated with during that time period.
Nancy Jones — Jemison Internal Medicine, PC, Jemison, Alabama

Latest News

  • 06.01.2016

    What’s New in Diagnosis Coding?

    Change is coming in payment models for physician practices. The repeal of the sustainable growth rate formula and replacing it with the merit based incentive payment system (MIPS) and the alternative payment models (APM) provide a fundamental shift for physician practices.

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  • 06.01.2016

    MIPS: What You Need to Know Now

    Just seven months remain before the new Medicare physician payment systems go into effect. On April 27, the federal government released the proposed final version of MIPS, one of the new systems. Here’s what you need to know now. 

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  • 05.03.2016

    Underprofile Payments: Detection and Resolution

    Let the old saying, “we all make mistakes,” be your guiding principal for monitoring the money coming in from third-party payers. As remittances are received from payers, your duty is to verify that the information is correct. Sounds like a simple task, but there are several crucial steps to achieving consistent success in recognizing and remediating less-than-expected – underprofile – payments. 

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See how TriZetto Provider Solutions can help you positively impact your organization’s bottom line with our ROI Calculators.

Many practices are part of, or soon will be part of, Accountable Care Organizations (ACO) or other Alternative Payment Models (APM). These payment models will provide bonuses or penalties, based partially on the severity of the practice’s patient population. The payer uses diagnosis codes submitted on claims to determine this severity. Payments for individual physician services are based on CPT code, but now, accurately reporting co-morbidities and underlying medical conditions will affect reimbursement for physician practices.

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Times are changing. A greater number of patients are covered by health insurance than ever before and many don’t understand their health plans. Patient financial responsibility has increased and practice revenue is now more dependent on patient payments. Learn how your practice can navigate skyrocketing patient financial responsibility in this recorded webinar hosted by TriZetto Provider Solutions and Betsy Nicoletti.

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In February, the Centers for Medicare and Medicaid Services (CMS) released new rules regarding overpayments. Historically, overpayments – often referred to as “credits” in the business office – have been identified and addressed at the practice’s own volition. CMS’ Final Rule removes any latitude you may have relied upon in the past, requiring Medicare overpayments to be returned no later than 60 days after being identified.

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