TriZetto Provider Solutions™ Launches paperResolve™ in Partnership with Orbograph, to Address the Healthcare Industry’s Paper Explanation of Benefits Problems

TriZetto Corporation today announced that its TriZetto Provider Solutions (TPS) business unit has launched its paperResolve™ solution, which automates the posting of paper explanation of benefits (EOB) forms. The system applies a variety of automation technologies to the originating paper; generating EDI 835 ERA (electronic remittance advice) files for electronic posting into patient account systems, saving providers as much as 60 percent in processing costs per claim based on typical client results.

Posting paper payments and EOBs manually can be a slow and tedious process, costing $1.77 more per-transaction than electronic 835 remittance files1. This time-consuming process also can result in costly mistakes from incorrectly entered information. With the paperResolve solution, practices can simply scan paper EOBs and the data is automatically and accurately converted into an electronic format, reducing staff time and greatly reducing the possibility of error from manually rekeying data, thereby helping practices secure reimbursements more quickly.

TriZetto Provider Solutions developed its paperResolve solution in partnership with Orbograph, a premier supplier of healthcare payment automation solutions. The highly efficient and cost-effective paper conversion platform integrates with TPS’ eobResolve® contract compliance solution.

“The Orbograph technology goes beyond traditional EOB conversion tools to reduce the likelihood of errors, and more easily adapt to different formats and frequent changes in payer EOB forms,” said Lori Logan, Senior Vice President with TriZetto Provider Solutions. “By streamlining the process of converting paper forms into electronic data, providers can decrease administrative burden and reduce costs.”

Using a unique blend of automated EOB layout adaptation, optical character recognition, and specialized quality control processes, paperResolve reads all EOB remittance information necessary to create an EDI 835 output file from the scanned image of paper EOBs. The system can then customize output for specific reporting requirements using EDI 837 claim information. Clients with eobResolve can also input payment information to audit and reduce contract payment shortages.

TriZetto Provider Solutions’ paperResolve also enables physician groups to:

• Archive payment information securely and electronically for easy search and retrieval.
• Catalog and store relevant data from paper-based patient payments and payer correspondences in a secure electronic database.
• Audit additional electronic remittance advice files, which enable the practice to uncover denials and provide payers reimbursed claims according to the practice’s contract.

“In addition to creating more efficiency with revenue management, paperResolve enables the physician groups to analyze all remittances and payments for a more robust auditing process,” added Logan. “The practice is automatically alerted if they experience recurring shortages in payer reimbursements, such as a payer failing to pay claims in accordance with their provider contract. Adding EOB information into this process completes the payment cycle in addition to the ERAs already processed.”

To learn more about paperResolve, request a demo by calling 800-753-3638 or emailing analyticssales@trizetto.com.

About TriZetto Corporation

TriZetto Corporation provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. Working with more than 350 health plans, TriZetto solutions touch over half the U.S. insured population and reach more than 245,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.

About Orbograph

Orbograph (www.orbograph.com), a subsidiary of Orbotech, is a premier supplier of electronic/paper automation solutions in healthcare revenue cycle management (RCM) and recognition software for the U.S. check and lockbox processing markets. Orbograph technologies are in use in over 1,600 financial institutions, service bureaus, clearinghouses and billers processing billions of checks and claims annually. The cloud-based Healthcare Payments Automation Center (HPAC) is “Enabling Transformation of Healthcare Payments” by converting paper-based EOBs, correspondence and patient payments, normalizing ANSI X12 EDI 835 remittance advices and reconciling EFT/ACH payments to ERAs via reassociation. HPAC automates posting of receivables into patient accounting systems and hospital information systems, achieving straight-through processing levels of efficiency. Orbograph recognition technologies are “Enabling Transformation of the Check Experience” in 20 of the top 30 U.S. financial institutions with in-house check processing.

Footnotes:

1. 2013 CAQH Index™, May 5, 2014 revision, www.CAQH.org

Copyright © 2014 TriZetto Corporation. All rights reserved. TriZetto. the TriZetto Triangle logo, and eobResolve are registered trademarks and TriZetto Provider Solutions and paperResolve are trademarks of TriZetto Corporation or its subsidiaries. Other company and product names may be trademarks of the respective companies with which they are associated. The mention of such companies and product names is with due recognition and without intent to misappropriate such names or marks.