TriZetto Reviews

Pros

Switching to electronic records has brought real long-term savings for me by cutting down on paperwork, improving staff efficiency and lowering office supply and day-to-day operating costs. It also does a lot for patient involvement since the portal lets people view their health information, book appointments and message their providers directly. On top of that, safety features such as medication warnings and allergy alerts help reduce mistakes and support safer patient care.

Cons

Getting everyone comfortable with the system takes time and staff usually need training before they can fully adjust to the new technology. During that transition, productivity can dip a bit. There are also valid concerns around data security since EHR systems can be exposed to cyber threats and data breaches which means strong protections and constant monitoring are necessary.

Pros

This is continually upgraded to keep up with new trends and adopts new things easily. It is secure and everything from enrolling a member and adding a provider to completing the final claim settlement step can be handled within one application.

Cons

Users often run into latency while navigating the application during peak times. Audit or history records also do not provide much detail. Only the latest changes are visible. When a record is updated, it should show which fields changed each time, rather than showing only the most recent changes.

Pros

It can handle several different functions within the same program.

Cons

Text formatting could be refined especially the capitalization.

Pros

The database structure is useful for EDI reporting and tracking, supporting effective research and resolutions for client issues through custom reports. Reports can be produced directly in the application. Backend data can also be paired with error logs, supplying downstream information for the Executive Dashboard through development of a new MS Access Benefit Load and Tracking Database. It's a strong platform for troubleshooting incidents and errors in 837 and 835 making the process quite simple. QNXT data also works nicely with SQL queries run on Oracle or SQL Server, including joins across database tables.

Cons

This does a good job pricing claims, administering members and managing billing but adapting it to new processing requirements can be difficult. One example is doing a member lookup and replacement before processing. It takes in 837 claims and EDI 834 enrollment files through Microsoft BizTalk Server, where BizTalk's native EDI parsing pipeline translates them into XML within the Connect application. It then receives and passes the XML through its modules. In many cases, custom logic is needed to get the message through successfully. That may mean adding file enrichments or lookups, such as the member lookup and replacement, routing conditionally based on whether a file succeeds or fails or validating data in advance so one failed record does not bring down the whole transaction set. Custom logic is generally added either through applications deployed in BizTalk or through agents developed for this. BizTalk applications are powerful and flexible but using them effectively takes advanced skills. Developers need to know BizTalk and have a strong grasp of XML to work with the EDI correctly. BizTalk also lacks built in APIs that make healthcare EDI development easier. For a member lookup, for example, a BizTalk application would need to be built to find and replace the member and updating those fields requires familiarity with XPath navigation through BizTalk's XML schemas. Agents can be written in C# .NET and deployed with the provided wizard. A Pre Agent can run before processing and a Post Agent afterward. Agents can access an XML version of the EDI data QNXT receives, including claims, enrollments and other data sets. This avoids the need for specialized BizTalk knowledge but it comes with limitations. EDI appears as XML inside another XML wrapper, with file specific metadata and multiple levels of nesting so XPath can be difficult to work with when developing an agent. Testing custom pre and post agents means attaching a debugger or interpreting log entries in the process log browser. Tracking is also limited as this shows only when an agent starts and finishes, with basic record counts and a success or failure status. Although a deployment wizard is available, custom agents may need regular updates to stay compatible with new versions. Pre and Post agent steps do not have access to the full X12 EDI message or powerful EDI parser, validator and splitter tools among their APIs. Those tools would help with editing and resubmitting problem claims or enrollments. As a result, preprocessing EDI files in an existing TriZetto QNXT implementation can still be challenging.

Pros

Interface is really easy to use which makes navigating across functions smooth.

Cons

Backdoor functions aren't available for certain tools in the system.

Pros

This provides the flexibility and functionality needed to improve performance and increase efficiency.

Cons

I dont have anything negative to point out.

Pros

Connects easily with a variety of different solutions.

Cons

Theres nothing to dislike about it.

Pros

It brings together healthcare insurance functions in one large, responsive database.

Cons

It could use better reporting services and integration with other reporting tools.

Pros

TriZetto's interface and overall user experience work really well for me. It connects closely with my other software and fits our workflows nicely.

Cons

Limited features and mobility are drawbacks for me and I'd like to see both expanded a bit.

Pros

Error reports come back quickly and everything else is easy to keep track of.

Cons

I wish denials came with email notifications.

Pros

Using it is simple and connecting it with other operating systems takes little effort.

Cons

Its limited functionality is a limitation.