Puerto Rico’s Leading Medicare HMO Chooses TriZetto’s Hosted QNXT System to Improve Efficiency of Core Administration

NEWPORT BEACH, Calif.--(BUSINESS WIRE)-- The TriZetto Group, Inc., today announced that Aveta Inc., one of the nation’s largest providers of managed healthcare services, has purchased the QNXT^TM enterprise administration system for its MMM Healthcare operations in Puerto Rico and has selected TriZetto to implement, manage and host the application.

Utilizing TriZetto’s QNXT application is another step in Aveta’s ongoing commitment to develop innovative, cost-effective models of care management. The application will automate claims adjudication, premium billing, enrollment, customer service and other functions central to the administration of MMM’s Medicare HMO for more than 180,000 members across 78 counties. The system, which will reside in and be managed from one of TriZetto’s data centers, is expected to be implemented by the summer of 2010 and will replace two production versions of MMM’s legacy platform.

“TriZetto’s QNXT platform will help us dramatically improve the efficiency of our claims adjudication and other core administrative functions,” said Richard Shinto, M.D., president, chief executive officer and a director of Aveta. “More than this, this application helps us fulfill our growth goals, enhance the beneficiaries’ experience and offer an overall more sustainable offering for our Medicare plans in Puerto Rico.”

TriZetto provides software and IT services that help payers and other healthcare organizations move toward Integrated Healthcare Management (IHM). IHM is the systematic application of processes, shared information and aligned incentives to optimize the coordination of benefits and care for the healthcare consumer.

Integration of core benefits and care management systems with constituent engagement is an emerging trend in healthcare. TriZetto, in fact, believes that IHM is the key to dramatic improvement not just for payer organizations but for all constituents of U.S. healthcare.

“MMM is one of a number of Medicare plans that recently have chosen TriZetto’s QNXT core administration system to realize its vision of integrating people, processes and technology across the organization to further improve the cost and quality of care,” said John Jordan, president of the regional healthcare market at TriZetto. “MMM also is on the leading edge of a trend among healthcare payers to focus on the core competency of serving customers and network providers, while tasking TriZetto to support operations through our core competency of implementing and managing enterprise software.”

TriZetto’s QNXT application has 48 health plan customers, covering more than 15 million licensed members. TriZetto Services manages applications for more than 35 healthcare payers representing more than 35 million lives in the United States and internationally.

About Aveta and MMM Healthcare

One of the largest providers of managed healthcare services in the United States, Aveta Inc. is redefining healthcare management to meet the challenges of today’s complex healthcare environment. Developing innovative models that coordinate care for approximately 227,000 Medicare beneficiaries and more than 342,000 commercial members, Aveta builds provider networks and Medicare Advantage programs that are sustainable, cost-effective and utilize advanced technologies. The company is headquartered in Fort Lee, N.J., and currently has operating subsidiaries in California, Illinois, Arizona and Puerto Rico. For more information, visit www.aveta.com.

Part of the Aveta Inc. companies, MMM Healthcare, Inc. is a health maintenance organization that provides Medicare Advantage health plans for the elderly and disabled population in Puerto Rico. It also offers special needs plans, which cover chronic obstructive pulmonary diseases, pre-end stage renal diseases, congestive heart failure and diabetes. For more information, visit www.mmm-pr.com.

About TriZetto

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management^®, the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The company’s offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.

The TriZetto Group
Loren Finkelstein, 303-542-2460
[email protected]
or
Schwartz Communications
Melissa Bruno, 781-684-0770
[email protected]

Source: The TriZetto Group, Inc.