Saint Mary’s Licenses TriZetto’s QNXT Essentials Solution to Improve Administrative Efficiency, Support Growth and Ease ICD-10 Migration

Nevada-Based Community Health Plan Opts for Software, Hosting and Implementation With Predictable Monthly Fee

NEWPORT BEACH, Calif.--(BUSINESS WIRE)-- The TriZetto Group, Inc. today announced that Saint Mary’s Health Plans (SMHP) in Reno, Nev., has licensed TriZetto’s QNXT Essentials^TM software and services to improve the reliability and functionality of its information systems, automate more of its administrative processes and support business growth and HIPAA 5010 and ICD-10 migrations.

Providing health coverage to 40,000 people in Nevada, SMHP expects to go live on TriZetto’s QNXT^TM 4.7 system on Jan. 1, 2011.

“We considered multiple core administration systems, and the usability and functionality of TriZetto’s QNXT platform across several departments appealed most to our employees,” said Don Kowitz, chief executive officer of SMHP. “We also heard many positive reviews about the QNXT application from our peers in the Health Plan Alliance, a national membership organization of provider-sponsored and independent payer organizations.

“TriZetto’s hosting service will help us go live expeditiously and provide a lower TCO than if we were to staff and manage the system ourselves,” he added. “The QNXT system will ease our migration to HIPAA 5010 and ICD-10 code sets, and the platform will scale to our planned growth in Las Vegas and elsewhere across the region.”

The QNXT Essentials web package licensed by SMHP also includes TriZetto's new Member and Provider Service real-time portal applications. The license further includes TriZetto’s ClaimCheck Connector product, a specialized module that interfaces between the QNXT platform and McKesson’s ClaimCheck application.*

“Saint Mary’s Health Plans’ decision attests to TriZetto’s aggressive commitment to serve community health plans,” said Rob Scavo, president of the TriZetto unit that serves local and community health plans. “Our commitment is reflected in packaging and delivery that makes our time-tested QNXT application accessible to community plans, helping them meet the challenges of efficiency, growth, regulatory compliance and federal healthcare reform. And our commitment is reflected in the more than $60 million we spend every year in R&D to help ensure our products continue to be responsive to this market’s unique requirements.”

Specially designed for community health plans, the QNXT Essentials solution includes TriZetto’s entire QNXT enterprise administration system, accelerated implementation process and toolkit, and full-service application hosting and management services for a low, predictable monthly fee with no upfront investment. TriZetto's QNXT Essentials package includes the following components:

• The complete QNXT enterprise administration system, a rules-driven, user-configurable application, with .NET architecture, that automates and supports all core plan administrative processes, including membership enrollment, premium billing, claims adjudication and customer support.
• Application management and hosting, including hardware, infrastructure, 24/7 support, updates, upgrades and disaster recovery.
• A proven implementation methodology with a rapid go-live; pre-configured quick-start templates for plans, contracts, benefits and policies; data-conversion support and other technical assistance; modeled reports; project oversight; and user training.

About Saint Mary’s Health Plans

Saint Mary’s Health Plans (SMHP) was established in Reno, Nev., in 1993, initially as a Health Maintenance Organization (HMO) affiliated with Saint Mary’s Regional Medical Center. Through substantial growth it now consists of HealthFirst, the HMO; Point-of-Service health plans; Saint Mary’s Preferred Health Insurance Company, which provides PPO health plans; and CDS Group Health, a third-party administrator. Additionally, SMHP owns the Preferred Health Care Network (PHCN) provider network. SMHP’s HealthFirst HMO has earned the prestigious NCQA accreditation for quality. Saint Mary’s Health Plans’ access to network providers includes 34 hospitals and over 3,500 providers statewide, with additional access to providers outside of Nevada through network lease arrangements. For more information, please visit www.saintmaryshealthplans.com or call 1-888-840-9080.

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’s vision for the industry, Integrated Healthcare Management, is the optimized coordination of benefits and care for healthcare consumers to improve the value of every healthcare dollar spent. 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.

Disclaimer:

* McKesson^® and ClaimCheck^® are registered trademarks of McKesson Health Solutions LLC.

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

Source: The TriZetto Group, Inc.