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TriZetto 2008 Corporate Template

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TriZetto 2008 Corporate Template
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Confidential
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Copyright © 2014 TriZetto Corporation
Getting The Most Out Of
Your 5.x Enhancements
Keith Herbert, Director Facets Product Design
Dave Resnick, Manager Facets Product Design
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Copyright © 2014 TriZetto Corporation
Agenda
 Release Schedule & Communication
 Product Feature Highlights 5.01 through 5.10
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Government Programs
Compliance
Client Satisfaction
Usability
Architecture Advancement
 Preview of Future Releases
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Copyright © 2014 TriZetto Corporation
Release Schedule &
Communication
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Copyright © 2014 TriZetto Corporation
Release Schedule
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Facets™
5.2
• R1 – November 5, 2014
• R2 – February 4, 2015
Facets™
5.10
• R5 – May 7, 2014
• R6 – August 6, 2014
• R7 – November 12, 2014
Facets™
5.01
• R17 – May 7, 2014
• R18 – August 13, 2014
• R19 – November 12, 2014
Copyright © 2014 TriZetto Corporation
Release Communication
 Release Preview
 High level view of
Release content
 Published post planning
 Provides early visibility into content
 See the R5 Demos that are posted – Copy/Paste, EHB, HIX
820….more to come!
 Release Review Meetings
Client Reviews – pre-release
Review of select fixes
Enhancement review
Session Recording
Data Models and presentations
published
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Copyright © 2014 TriZetto Corporation
Release Communication
 Upcoming Release reminders
 Letter Server support deprecated as of October 2014
 5.10 R7 and 5.20 R1 will not have an install for Letter Server
 Support for generating letter request data (ATLT) continues through
5.20 release
 EDI 4010 and 5010 pre-addenda transactions support ends as of
5.10 R7/5.20 R1
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Copyright © 2014 TriZetto Corporation
Product Features,
Government
Programs
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Copyright © 2014 TriZetto Corporation
Medicare-Medicaid (Dual) Eligibles
 Process a single claim
for members with both
Medicare and Medicaid
coverage
 Enhanced Claims
Adjudication Routine
 Stores Claim and
Line Item data for
reporting
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Copyright © 2014 TriZetto Corporation
Medicare-Medicaid (Dual) Eligibles
 Class/Plan Definition
 Supplementation
applies
 Secondary Product
 Secondary Network Set
 New Secondary Product
application
 Limited set of
Components
 Establish Variable
Components
 New Secondary Plan
Processing Rules
application
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Copyright © 2014 TriZetto Corporation
Medicare-Medicaid (Dual) Eligibles
Additional information on Medicare-Medicaid (Dual)
Eligibles can be obtained at “Lessons Learned Around
Participating in Serving the Dual-Eligible Population”
workshop, Tuesday 10:45-11:45.
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Copyright © 2014 TriZetto Corporation
Product Features,
Compliance
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Copyright © 2014 TriZetto Corporation
FSA Partial Rollover
 IRS requirement is to
allow for optional partial
rollover of FSA funds
into the next year, with a
maximum amount of
$500
 Mutually exclusive to
existing Grace Period
availability
 Changes made to FSA
Administrative
Information application
in 5.10R3
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Copyright © 2014 TriZetto Corporation
Reform related enhancements
 Cost Sharing Batch
 Essential Health Services
 Membership changes:
 Support Rating of the 3 oldest children
 New Applications
 Enrollment Channel Description
 Exchange ID Description
 Exchange Rules Product Component
 Subscriber/Family Changes to collect Enrollment
Source, APTC status and Subsidy amounts
 Subsidy Billing Changes
 APTC Status
 Exchange delinquency
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Copyright © 2014 TriZetto Corporation
Reform related enhancements
Further details on Reform related enhancements are
available:
 Healthcare Reform Exchange Experience
Workshop
 Solutions Center
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Copyright © 2014 TriZetto Corporation
Additional Compliance Enhancements
 Core 835 ERT/ERA
 2014 Clinical Editing Criteria includes ICD-10
 Consumer Friendly Descriptor fields for Procedure
Codes
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Copyright © 2014 TriZetto Corporation
Product Features,
Client Satisfaction
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Copyright © 2014 TriZetto Corporation
Rendering Provider Enhancements
 Medical Claims and
Encounters
 Claim Level
 Hospital Claims and
Encounters
 Claim & Line Item
Levels
 Propagation
 Claim to Line Item
when line level ID is
blank or invalid
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Copyright © 2014 TriZetto Corporation
 New Qualifiers for:
 DOFR
 Supplemental
Conversion Rules
 NetworX Pricer
 Workflow
 ClaimsXTen
 Added to:
 Customer Service
 Web Services
Automatic Copayment Reduction
 Provides the option to
limit the line item
copayment amount to a
percentage of the line
item allowable
(medical/hospital only)
 Service Rule Definition
modified to provide the
option to Warn or Reduce
when copayment exceeds
the stated percentage
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Copyright © 2014 TriZetto Corporation
Additional Enhancements
 MMS Void
 HIPAA Gateway Purge and Archive of Transactions
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Copyright © 2014 TriZetto Corporation
Product Features
Usability
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Copyright © 2014 TriZetto Corporation
5x User Interface
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Improved navigation experience
Docking preferences
Resizing & Pinning
Auto-hiding & Fluid re-display
Modernized Look to Tree Control
Scrolling
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•
•
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Copyright © 2014 TriZetto Corporation
Application Tab Windows
Browser Application
Favorites – frequent use
applications
New Font Style
Securing Sensitive Information
Masking of IDs
 Facets Security Config
 Partial or Full Masking
 TIN, EIN, Medicare ID,
Medicaid ID, Original
Subscriber ID
 Applications & Searches
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Copyright © 2014 TriZetto Corporation
Copy to Clipboard
 Passive Enablement
 Security
 Application level
 Search results display
 Availability
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List Grids
Search Results Display
Interaction with masked information
Facets application’s Open Record area,
Formatted Text area, and Dialogs
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Copyright © 2014 TriZetto Corporation
Placeholder for embedded video
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Copyright © 2014 TriZetto Corporation
Architecture
Advancement
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Copyright © 2014 TriZetto Corporation
TriZetto Upgrade Framework
5.10 R5
 Enhance the ability to facilitate and coordinate the execution of
independent upgrade actions when moving from one Facets release
to another
 Upgrade Framework
 Upgrade multiple Facets
Databases (Core, AR, AU,XC)
 Oracle, SQL Server, Sybase
 Checks Actions
 Verification Scripts
 Winter Tech Overview – on CX
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Copyright © 2014 TriZetto Corporation
Major Release Binary Installation – 5.2 R1
 Multi-release project to
modify how the Facets
binaries are installed
 Sets up the ability to
upgrade to a new major
release without having to
do a full uninstall and install.
 5.2 will be the last time that will need to be done.
 The changes will provide the ability to upgrade from
5.2 to 5.3 similar to an upgrade from 5.2 R1 to 5.2 R2.
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Copyright © 2014 TriZetto Corporation
Workflow – Optional Java Server – 5.2 R1**
 New option for java server
implementation - TomEE
 No changes required for Facets
Workflow applications
 Facets end user experience is not
changed
 Impact – Total Cost of Ownership
** introducing in 5.2 R1 for evaluation purposes
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Confidential
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Copyright © 2014 TriZetto Corporation
Facets UI – Applying New Technology
 5.01 R10 – Introduced the Qualified Health Plan
Definition application
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Built on WPF/C# platform
XAML Presentation Layer
New paradigms
Features developed based on R&D for Claim Search
Copyright © 2014 TriZetto Corporation
Facets™ UI – Applying New Technology
 5.10 - 5.20 timeframe – Research & Development
 Technology direction
 From WPF/C#/XAML to pure web application – HTML
 Web Application Proof of Concept – Workflow Routing Rules
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Confidential
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Copyright © 2014 TriZetto Corporation
Facets™ R6 – Preview Highlights
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Copyright © 2014 TriZetto Corporation
Facets™ 5.10 R6 Preview (August)
 Compliance & Reform
 FSA Partial Rollover
 Compliance Maps for CMS Edit Parameter
 Premium Age Calculation for Exchange Support
 Performance
 835 Multi-engine performance improvements
 Audit Archive – R7 planned delivery (Client Survey item)
 Client Satisfaction
 Workflow – Group Related Entity qualifiers
 iCES Transfer/Added Lines functionality
 Facets/TCS Integration – Spell Check
 ITS
 14.5
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Copyright © 2014 TriZetto Corporation
Facets™ 5.10 R6 Preview
 Real Time Accumulator Service (5.1R6)
 New Offering
 Paradigm is shifting due to requirements around a single
deductible or limit
 Health Plans need the ability to keep in sync with 3rd party
vendors in a real time manor
 Built on ReST architecture
 Contact your SAE for more information or to step a meeting
to review the functionality
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Confidential
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Copyright © 2014 TriZetto Corporation
Beyond R6…..
 Client Satisfaction
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Selective application of deductibles to stoploss
Addition of Group ID and Plan ID as NetworXPricer® qualifiers
Display Plan Year for Accumulators
Error when a claim spans subgroup termination
Modification of HRA/FSA COB routine calculation of Maximum
Amount to Pay
 Performance
 Claim Archive Redesign for Performance
 Government Programs
 Dual Eligibles recalculation of OOP amounts
 Zero Dollar Premium (Exchange)
 Subsidy Tolerance (Exchange)
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Copyright © 2014 TriZetto Corporation
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Copyright © 2014 TriZetto Corporation
Questions?
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Copyright © 2014 TriZetto Corporation
Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Copyright © 2014 TriZetto Corporation
Thank You!
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Copyright © 2014 TriZetto Corporation
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