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December 19, 2006

BlueCross BlueShield to use TriZetto claims software

BlueCross BlueShield of Tennessee has become the first health plan to purchase TriZetto Group's real-time patient liability and point-of-service claims adjudication offering, Provider POS Direct.

By CBR Staff Writer

Provider POS Direct enables healthcare providers to determine and share with patients the exact cost of a procedure prior to the delivery of care. It also provides the option of real-time financial settlement among the patient, provider and health plan before the patient leaves the provider’s office, which can increase satisfaction and reduce administrative expense.

BlueCross BlueShield of Tennessee, which serves 2.3 million members and is the largest insurer in the state, expects to implement the product by the end of 2006 to a limited pilot group of providers.

Provider POS Direct is fully integrated with the Facets administrative system that BlueCross BlueShield of Tennessee has used since 1996. It can help provide price transparency for patients and providers via real-time access to medical benefit and procedure information in order to determine covered benefits and the exact provider reimbursement due from both the member and health plan.

Providers can use the software either in advance of treatment, at the time of scheduling, or after the patient has received care, when the actual claim is available for processing.

BlueCross BlueShield will be able to use Provider POS Direct via a portal on the health plan’s website to access its administrative system, determine exactly how much the patient will owe, and then make arrangements to collect the payment.

BlueCross BlueShield of Tennessee understands that healthcare is shifting to put consumers at the center of care, and we’re committed to a technology strategy that enables us to better address the needs of our members, providers and employer groups given this emerging model, said Chris Levan, CIO for BlueCross BlueShield of Tennessee.

Provider POS Direct is one more innovative way we can help our providers connect patients to information to help them make smart choices, while at the same time connect these clinicians to information that can make the system more efficient and effective, he continued.

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