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Contract Management

TriZetto Provider Solutions Revenue Analytics

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  • Analyzes payer agreement and identifies underpayment
  • Generates appeal forms and paperwork, and tracks the dispute
  • Delivers reimbursement intelligence, including contract modeling
  • Integrates with athenaCollector®

Close the gaps between expected and actual claim reimbursement

On average, 9% of commercial claims and 1% of Medicare claims are paid incorrectly1. Revenue Analytics from TriZetto Provider Solutions helps you avoid leaving money on the table. We monitor transactions, identify errors and underpayments, and automate the appeals process – saving your staff hours of time.

What It Does

TriZetto Provider Solutions Revenue Analytics reduce administrative hassles and provide greater transparency into payer performance. Our solutions give providers the ability to identify underpaid claims, automate the dispute, and track the recovery. With clear data and fewer manual checks, you can make decisions and take action that can boost earnings and help your organization grow.

Our solutions seamlessly integrate into athenaCollector, handling file transfers and processing on a daily basis automatically, without the need for manual effort.

Product Details

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Contract Management

Monitor every transaction, identify errors and underpayments, and automate the appeal process to save your staff hours of time. No more manual checking – eobResolve helps track and reclaim missing revenue, and reduces the number of future errors by identifying common errors and payer trends.

Features and Benefits

  • Variance reporting: Identifies costly underpayments and overpayments
  • Appeal documentation: Automates the completion of payer dispute forms
  • Recovery tracking: Provides a built-in return on investment (ROI)
  • Enhanced payer explanation: Creates an enhanced explanation of each payment, allowing underpayments to be worked efficiently
  • Maintenance of contract terms: Removes the burden of understanding and maintaining payer-specific pricing and clinical edit rules

Contract Modeling

Using cutting-edge business intelligence, contractResolve reduces unaddressed payer contract risks using your payer’s own claim rules. With our highly accurate contract analysis engine, you can analyze real and hypothetical contract performance, and build and compare current versus proposed fee schedules.

About NHXS

Over 250,000 providers trust TriZetto Provider Solutions™ to simplify the revenue management process and reduce costs associated with claims processing. We pinpoint areas of lost revenue, decrease claims rejections and improve payment turnaround times. For more information about reducing administrative hassles and maximizing your revenue, visit

1 2013 AMA National Health Insurer Report Card

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