Advanced Claim Editing

Submitting cleaner claims with the TriZetto clearinghouse is possible thanks to the TriZetto® Advanced Claim Editing feature. This feature goes beyond traditional claim scrubbing solutions by incorporating machine learning-based denial prediction algorithms, automated eligibility checks, and over 30,000 coding-specific edits to catch denials before they reach the payer. Its AI models, trained on historical data from millions of claims, accurately predict and can help reduce avoidable denials by 50%, allowing providers to optimize their revenue cycle. Operating within the TriZetto clearinghouse portal, it identifies claims with potential errors, providing explanations and solutions for easy corrections and resubmissions.

Advanced Claim Editing enables providers to proactively manage their revenue cycle, reducing the financial burden of denials and improving claim acceptance rates. By implementing these robust safeguards, practices can focus more on patient care and less on administrative challenges, enhancing their financial health and operational efficiency.

With Advanced Claim Editing providers can:

• Identify potential denials by leveraging AI and machine learning to secure proper reimbursement
• Reduce administrative costs and back-end work through proactive intervention
• Increase speed-to-payment by submitting cleaner claims