TriZetto QNXT Workflow Marty Newton V.P. Product Portfolio Management David Symonds Lead Solutions Specialist

Session Agenda TriZetto Workflow QNXT Claim Workflow QNXT Appeals and Grievances Workflow Future QNXT Workflow Plans

TriZetto Commitment to Workflow High priority during development No additional 3rd party licenses required Total Cost of Ownership Designed to work across TriZetto portfolio of solutions Reusability Enrollment Claims UM A&G Bringing solutions together through workflow integration

QNXT TMS EDM Future TriZetto Workflow Claim Workflow EAM Workflow A&G Workflow Claim Workflow UM Workflow Enrollment Workflow Future Workflow TMS EAM Workflow Future Workflow EDM EDM Workflow Future Workflow Future Future Workflow

QNXT Claim Workflow

QNXT Claim Workflow Introduced in 2014 with QNXT 5.2 Agile development roll-out Introduced in 2014 with QNXT 5.2 Client TCO top priority Developed by TriZetto specifically for healthcare No 3rd party investment required TriZetto Workflow Engine New technology Improved user experience Model for future QNXT module redesigns Improved development environment Improved integrations QNXT Claims UI

QNXT Claim Workflow Data Qualifiers Claim id Log date Adjudicate date Clean date Birthdate Gender Last name VIP status Insured id Carriermemid (member id) Dx code Occurrence span code (UB) Occurrence start date (UB) Occurrence thru date (UB) ICD procedure code Condition codes (UB) Final DRG code (UB) Line of business Claim status Claim edit Claim source Claim Form type Total charges Type of bill (UB) Admission date Admission source Admission type Claim start date Claim end date Claim line Edit severity REV code LTC Benefit plan ID Contract ID Employer Policy number Discharge date Discharge status

QNXT Claim Workflow Upcoming Features Graphical view of productivity by user Ability to set productivity targets See productivity by user. See and modify what queues and roles that user belongs to. Choice of time periods for which to set productivity targets Daily Weekly Monthly Quarterly Annually

Future Claim Workflow Manager’s Dashboard

QNXT Claim Workflow Demo David Symonds

QNXT Appeals & Grievances Workflow Screen shots included are for demonstration/example purposes only, final product screens may vary

High Level Overview New A&G module with Workflow Engine will: Track who and how grievance or appeal is requested Track due dates based on assigned itineraries from Workflow Attach related claims and/or Authorizations User View of all cases assigned to Coordinator Manager’s Dashboard View New A&G module with Workflow Engine will: Initiate “Case” from Call Tracking Set different level steps to route and set due dates based on SLA Itineraries configured in Workflow Engine A&G Coordinators Review group or users involved in process Groups and Users configured in Workflow Engine

QNXT A&G Solution QNXT Call Tracking QNXT A&G Module QNXT Core Optional 3rd Party Partner New License QNXT Call Tracking TriZetto Workflow Engine QNXT A&G Module Document Management QNXT Core “Call” Source Call Type Initial Notes Route Case Case Level Case Itinerary Priority Queues Dashboard Case details Notes Dates Documents Claim UM Member Provider Case Review Disposition Search Reports Inbound Outbound Document Workflow TCS

Call Tracking Entry

A&G Entry

A&G User Console

A&G User Console with items “at risk”

A&G User Console w/ user tasks

A&G User Console – Grievances w/ “at risk”

QNXT A&G Workflow Timeline Currently in development Scheduled initial release on November 4, 2015

Future QNXT Workflow

QNXT UM & Enrollment Workflow New UIs Single page data entry – removal of wizards Save work “in process” Similar “themes” across QNXT modules when introducing workflow Claim to UM A&G to Claim, UM, Member Workflow engine will coordinate across QNXT modules, for example Auth creation Nurse/Medical Director review Documentation required UM Workflow

Thank You