TriZetto Introduces Encounter Data Manager for Exchanges

Proquest LLC

TriZetto Corp. announced the launch of its Encounter Data Manager (EDM) for Exchanges solution for health plans participating in state or federal Exchanges or non-Exchange individual and small group markets.

According to the company, the new solution will enable health plans to meet new Health and Human Services (HHS) data submission and distributed data collection requirements created under the Affordable Care Act (ACA).

Under ACA, HHS will require plans to provide specific enrollment, medical and pharmacy files in a secure environment through what is has been dubbed an "EDGE Server." Originally focused on health plans participating in Exchanges, the requirements apply to all health plans serving the individual and small-group insurance markets.

"The clarification of the requirements has caught a lot of plans off-guard," says Dan Skari, solution general manager at TriZetto. "TriZetto has more than 50 clients currently participating on the Exchanges and more than 100 additional clients participating in the individual and small-group plan market, who are turning to TriZetto to support their efforts to meet this new compliance mandate."

The Exchange solution leverages more than a decade of experience helping clients manage Medicare and Medicaid data in a similar way. While the solution is pre-integrated to TriZetto's Facets and QNXT core administrative systems, it is also architected to support other non-TriZetto legacy systems that will need to comply with the new requirements. TriZetto's EDM for Exchanges provides an interface from enrollment, claims and pharmacy data sources, as it generates and edits the files before populating data on an EDGE Server according to the submission and format requirements of HHS.

"Our clients are well-positioned to address the submission requirements for the EDGE Server with our Encounter Data Manager for Exchanges solution. TriZetto has a long history of supporting clients as they work to meet these types of encounter reporting requirements. EDM has been deployed successfully by our government program clients for more than 12 years," adds Skari.