Technology Optimization

HealthRules Web

Large Health Plan Streamlines HealthRules® Implementation

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TECHNOLOGY OPTIMIZATION Client Snapshot: 700,000+ members | 34,000+ network providers | 40 hospitals | 110 urgent care centers Challenge: Transitioning from Legacy System to HealthEdge’s HealthRules® Tasked with safeguarding both performance and financial stability, the healthcare plan’s CIO confronted critical hurdles: RESULTS SUMMARY IMPROVEMENT in process clarity, system reliability, and operational efficiency IMPROVED FIRST-PASS ADJUDICATION […]

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TriZetto Facets Workflow Web

First-Pass Claims Rate Soars as Major Healthcare Plan Implements TriZetto Facets Workflow

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TECHNOLOGY OPTIMIZATION Provided by SourcEdge, now part of Alivia Client Snapshot: 375,000+ members | 21,000+ network physicians | 2,800+ sites of care Challenge: Maximizing Efficiency in Claims Workflow Management The client needed to optimize their claims processing by implementing TriZetto Facets Workflow while transitioning from their legacy system. They faced several critical challenges: The organization

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trizetto facets web

Major Healthcare Plan Achieves Rapid Claims Backlog Reduction Using TriZetto Facets

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TECHNOLOGY OPTIMIZATION Provided by SourcEdge, now part of Alivia Client Snapshot: 375,000+ members | 21,000+ network physicians | 2,800+ sites of care Challenge: Managing Complex Claims Backlog While Maintaining Quality Standards The client encountered a significant claims adjudication backlog in their TriZetto Facets environment that threatened to impact their operations and provider relationships. Their internal

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U.S. Health Plan Rapidly Expands in Affordable Care Act and Medicaid Using Facets

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Summary: A U.S. health plan aimed to rapidly expand its product lines into the Affordable Care Act and Medicaid sectors across multiple states. Facing the challenge of converting their legacy system to TriZetto’s Facets platform without the necessary expertise or processes, they enlisted SourcEdge (now part of Alivia) to navigate the expansion. Results:

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Regional Health Plan Going Beyond the No Surprises Act for Price Transparency

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Summary: In response to the No Surprises Act, a regional health plan aimed to offer its members more than the required basic cost-sharing information. They sought to develop a comprehensive price transparency tool that would include all possible charges associated with medical procedures, providing members with accurate and meaningful cost estimates. Results:

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CDPHP: Masks PHI Using De‑Identification Throughout the Software Development Lifecycle

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Summary: Dan Kinser, VP of Core Systems at Capital District Physicians’ Health Plan (CDPHP) joined SourcEdge to emphasize the importance of protecting Protected Health Information (PHI) throughout the Software Development Lifecycle (SDLC) in a presentation at the 2023 Cognizant Health Sciences Conference. The focus was on implementing de-identification techniques to ensure patient privacy and maintain

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Health Plan Taps AMISYS Advance Expertise to Meet Deadlines and Unique Challenges

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Summary: Faced with the challenge of transitioning their claims processing system in-house by a non-negotiable deadline, a prominent Florida health plan with over 80,000 members turned to SourcEdge for their expertise in AMISYS Advance. The project demanded rapid adaptation and expert execution to overcome significant operational and staffing hurdles. Results:

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