TriZetto Support Services

Facets Optimization

As the market’s leading payer claims system, Facets is typically already in-place at most health insurers. A major concern for COOs and CIOs is whether their organization is accessing the full functionality of Facets. CTG’s Facets optimization approach starts with identifying all the functional requirements of the organization. From there a gap analysis is completed as the basis for a comprehensive migration strategy with recommendations and action plans to optimize usage of Facets while increasing NCQA ratings. CTG Health Insurance Solutions functions as a true partner working closely with the client’s staff to ensure a cost-effective and seamless implementation of the Facets optimization plan. For our clients, CTG’s significant Facets experience and innovative optimization approach delivers:

• Shortened project schedules
• Streamlined benefit set-ups
• Consolidated table data
• Increased auto-adjudication rates
• Improved operational metrics

Facets Staffing

CTG provides Facets-specific resources to augment existing staff to support Facets integrations, projects, and the implementation of add-on products. CTG’s significant Facets experience enables it to accurately evaluate current and future project requirements, and to make informed, cost-effective recommendations for technical, business, and executive resource needs. Our partnership approach ensures that CTG technical and business resources integrate seamlessly with client project and management teams while preparing the internal organization to operate without external support.

Facets Testing

CTG applies its proprietary STBox™ testing methodology to Facets testing projects through its STBox/SAFE (Structured Approach to Facets Enhancements) solution. STBox/SAFE is a highly structured web-based testing solution with an emphasis on software configuration management and change control for all aspects of testing. We employ detailed workflows for major testing activities covering all aspects of software testing including process, people, and infrastructure. In addition to offering test scripts customized for health care payers, CTG uses standard and best practice test scenarios for the health insurance industry. The major benefits of using our STBox/SAFE solution for Facets enhancements are reduced costs, improved software patch management, and shortened timelines for upgrades.

Facets Implementation and Version Upgrades

Engaging CTG Health Insurance Solutions as your partner in a Facets implementation ensures your new system will operate at or near full functionality as soon as it is operational. CTG’s implementation and integration experience is a significant value-add we bring to systems installations. We can seamlessly migrate your existing claims systems to Facets while also integrating Facets with other systems in place within your IT environment. In addition, CTG provides version upgrade services. Our expert business and technical upgrade consultants will work with you to leverage your financial, business, and IT requirements along with the application vendor’s new release expertise. Our resources bring the subject matter expertise and direct labor savings necessary to leverage the most cost-effective project team scenario. CTG resources minimize upgrade project timeframes and costs, and assist Facets application clients in obtaining a higher level of automation from the Facets enterprise solution.

NetworX™

CTG Health Insurance Solutions supports the entire TriZetto NetworX suite including NetworX Modeler™, NetworX Pricer ™, and NetworX Provider Modeler™. By increasing the automation of your network management processes, claims pricing, and contract administration, the NetworX suite can reduce costs and improve efficiency. Our in-depth knowledge of health insurance claims and provider systems and processes and how they interface, combined with CTG’s significant network management experience, helps you leverage your NetworX™ investment to its full potential.

CareAdvance™

CTG ensures the organization-wide success of TriZetto’s CareAdvance Enterprise application by facilitating its strategic alignment across business planning, IT, and medical management functions. Our consultants bring healthcare provider and payer industry knowledge, along with CareAdvance 4.4 and Facets Feed expertise, to determine the best implementation strategy for CareAdvance. Our approach integrates multiple clinical data sources to create new and strategic clinical repositories that support the automation of patient stratification and implementation of a personal health records system. We also optimize work processes through automation and data capture to effectively enable member contact and meet reporting requirements. Additionally, we support selection and usage of health risk assessment tools. CTG’s approach results in the best and highest use of CareAdvance as a medical and disease management infrastructure that meets or exceeds all your organizational goals.