EFFICIENCY AND SECURITY
Automate and simplify operational tasks
Accelerate and improve the process of testing and deploying new core system configurations.
With Claim Test Pro, you can test claims data efficiently and cost effectively and verify with confidence that correct claim totals are being paid. The solution greatly reduces the need to create test cases manually, automates the management and reconciliation of results, tracks and documents test projects and cases, and electronically converts system data to applicable testing data sets to create a robust and applicable testing environment.
In addition, Claim Test Pro provides a comprehensive set of testing suites that support more diverse testing schemas and enables testing of a multitude of provider reimbursement scenarios. The solution automates many processes that were previously done manually, helping plans increase administrative efficiencies by reducing the resources needed to manage these initiatives. An added benefit of Claim Test Pro is that it provides management tools that track and report progress.
Plans that do not have a strategy for testing and validating claims data may be at risk. Claim Test Pro can help you:
- Reduce overpayments to providers. Data that has been thoroughly vetted helps ensure that your plan is paying contracted providers the correct amounts
- Lower administrative costs. Reduce errors in provider payments and manual rework, helping drive down costs
- Trim test cycle time. Automation can help plans save hundreds of hours building and documenting test cases
- Reduce critical defects introduced to production. The application is virtually self-documenting, automatically summarizing what you have tested and reconciled
We offer interfaces with third-party solutions from ECHO, Zelis and Lyric Secondary Editing that enable quick and seamless data and batch exchanges between these solutions and our Facets® and QNXT™ core administrative systems.
CareAdvance Connect allows care managers to download patient data from their case list in Clinical CareAdvance and conduct offline patient assessments in patient homes. When they regain Internet connectivity, care managers can upload the completed assessments to Clinical CareAdvance with the touch of a button.
This seamless data exchange between CareAdvance Connect and Clinical CareAdvance delivers your organization benefits such as:
- Reduced administrative inefficiencies through accurate and comprehensive data collection
- Improved care manager productivity and enhanced data integrity
- Decreased data risk with protected PHI
- Affordable initial and long-term cost of ownership
Testing teams need a way to quickly analyze if data can be leveraged for test cases and understand coverage gaps. Configuration Data Analyzer analyzes a specific subset of configuration data. This optimization product provides use cases and relevant data models that can be converted into members, providers and claims that are useful for targeted testing. It also delivers relevant statistical models to evaluate risk against volume of testing.
EDI Transaction Generator is a web application that provides a faster, smarter and more effective solution to automate EDI test data creation for healthcare transactions. This solution reduces time-consuming EDI data generation efforts by up to 70−80% and produces compliant 834, 837 and other file formats.
Synthetic Executable Enterprise Data is a healthcare test data management tool that provides PHI-free synthetic member and claim data for testing purposes. This synthetic data covers a wider range of real-world scenarios, business processes and conditions to enable more accurate testing and wider coverage.
Advanced Batch Framework allows clients to quickly build and standardize batch processes and gain more control over batch operations. This flexible solution supports Facets batches in either a traditional data center or in cloud-based infrastructures. With Advanced Batch Framework, you can:
- Execute batch tasks, including custom tasks, with a single runbook to streamline batch monitoring into one job, instead of several
- Optimize workflows and enhance regulatory compliance by ensuring batches execute properly during scheduled windows
- Equip business users with easy access to real-time information about batch status
- Analyze batch processing performance for continuous improvement
Before adding new functions, changing system configurations or design, it is important to test them in a way that keeps health information fully protected. Test Data Generator creates non-production data sets of both transactional and configuration data, allowing healthcare organizations to test possible changes before implementing them. The tool ensures that protected health information (PHI) remains fully secure by stripping the data of personal identifying information and creating key word files with all new identity information. The result is size-controlled data sets of randomized non-production data.
Using Test Data Generator, healthcare organizations can:
- Reduce the risk of exposing PHI that occurs when production data is simply copied into non-production data bases for testing
- Create multiple specialized test databases and control their size and composition
- Reduce non-targeted environment copies
- Decrease demands on specialty IT resources
- Improve security
TriZetto® Testing Automation Suite is a licensed software solution that automates the validation and testing of health plan software product implementations. It can be used to automate data-driven testing such as benefit configuration data, batch processes, API integrations, upgrade and regression testing scenarios and EDI-type transaction processing. Testing Automation Suite can reduce cost and alleviate staffing pressure by automating much of the test execution process.