QNXT™ - TriZetto Integrations Scott Johnson, AVP T3 Architecture Derrick Drewry, Dir. QNXT GM Anne Neal, Dir. QNXT Product Owners

Key Integrations for QNXT™ in 2014 TriZetto Workflow Initial focus is QNXT Workflow – Claims Beta release August 2014 GA release November 2014 NetworX Pricer™ & PBA Supplemental to QNXT Pricing Methodologies Beta release August 2914 GA release November 2014 TriZetto Communication System (TCS) Manages constituent communication Initial features release in R6 Continued development in R7

TriZetto Workflow Integration

What is TriZetto Workflow? Streamlines delivery of work (e.g. claims) to users Prioritizes and routes tasks based on business rules defined by health plan

Workflow Success Story Boston Medical Center (BMC) HealthNet Plan is a not-for-profit managed care organization serving more than 275,000 members. CHALLENGE No simple way to capture and measure claim adjudicators’ productivity. Labor intensive, time consuming & inaccurate. SOLUTION Preferred method to calculate adjudicator productivity was to use generate reports using TriZetto Workflow data. RESULT Improved accuracy in measuring claim processing time. Trackability of employee productivity by user, role, “gap” time etc. Less time gathering data, more time analyzing data. Overall increase in quality, efficiency and performance management. Should we want to call out Facets specifically, or talk generically about workflow?? Direct them to Facets Workflow case study??

TriZetto Workflow Architecture High-Level Constraints Re-Use Successful Domain Model Modernize services offering Provide responsive, web-based user interface Standards / WebProfile compliant

Workflow Engine – Component View Sourced From Facets Workflow Re-Engineered Component

Workflow Engine – Consuming Modules Crisp Boundaries between User Interfaces and Engine APIs Pluggable security model SPA-style user interfaces drove API definition HTTP(S) / REST

QNXT Business Domain QNXT™ Workflow for Claims Architectural Overview Integrations QNXT UI Custom Code RESTful Web Services QNXT Business Domain Unit Tests Data Storage

QNXT™ Workflow for Claims Architecture Domain Driven Design All business related logic and decisions centralized into Domain Business rules, processes and procedures Business and technology experts collaborate throughout the Domain building process Technological decisions can reside outside of core Domain logic Changing a UI to a different platform Changing the data storage to another vendor RESTful Web Services Extensibility layer that exposes Domain logic Follows HTTP web standards to ease integrations New QNXT UI, other software integrations and custom code Lightweight transport options for better performance and scalability

QNXT™ Claims UI Overview Browser Z X Browser X X Patient: Provider: From Date: To Date: X Browser Y Patient: Provider: Patient: Provider: Save Save Save Content Server Web API Server Domain Logic Server Database Server

QNXT™ Claims UI Angular JS Bootstrap Future proof JavaScript Library provided by Google Set to support current and future web technologies Enforces strict decoupling of business logic from UI logic Minimizes future maintenance complexities Supports Unit Testing Build robust, flexible code base that can withstand change Bootstrap Create flexible, cross browser user experience Support for Responsive Design Built-in support for mobile platforms including tablets and phones Reacts to changes to browser window size on desktop platforms

QNXT™ Workflow for Claims Development Strategy TZG Workflow Features Select Queued Item Set Aside Take Break Claim Features Search Entry Mass Adjudication Authorization, Authentication & Licensing Installer Documentation

TriZetto Communication Systems (TCS) Integration

TriZetto Communication Systems (TCS) What is TCS? Delivered as part of Foundation Run Time (IHMF) Common & integrated solution for all constituent communication Provides customizable document generation utilizing MS Word for template authoring Tracks all outbound communication Supports delivery of communication across all industry standard formats (print, email, IVR etc.) Key System Component – Template Builder Utilizes Microsoft Word & Visual Studio Template Builder plug-in Generates templates containing static text, images, tables, content controls and custom data (XML) etc., Capable of including or excluding content based on conditional operators from the core system, such as member demographics. If QNXT customer has TMS, VBB, ICD-10 TM….they have the Foundation Run Time Technology/platform questions – Technology booth can address specific questions FREE – install & operate cost, but no separate purchase or license fees Not a full blown communication device Delivery format Print – snail mail, email, document stored on secure site etc. Email – different template, exchange server tie in to send an email IVR – take request to TCS, process as output in a different XML shape to be used as request to IVR solution, as an example Utilizes Microsoft Word & Visual Studio Template Builder plug-in – stored in TCS DB in DOCX format

TCS Architecture QNXT™ will interact with TCS via WCF Foundation Component database is the primary data storage Templates, XML, Merge Instructions etc. Update IHMF to Foundation (IHMF) TCS doesn’t initiate call to core product, products call TCS through a service interface – sending placeholder XML with data with instructions to use a template. Batch process takes those requests to fulfill those requests as defined by the call to TCS.

TCS Overview TCS Template Builder Overview QNXT to TCS Integration Overview Top image – TCS template builder Bottom image – how QNXT will use the template to create a communication, in this example welcome letter

TriZetto Communication System (TCS) Starting development in R6 Generate XML structure to populate TCS template (placeholder XML) Future Development Access TCS directly from QNXT™ Full/complete integration to TCS build services to; Return available templates Create communication based on available templates Create single fulfillment of communication Create batch fulfillment of “queued” communication Return communication already sent to constituents Technology center to see Joe & team for Foundation information

NetworX® Integration

NetworX® Integration Complete in R5 Future development Select to price through NetworX Pricer & map to NetworX Rate Sheet Future development 2015 1st quarter - Pricer 2015 2nd quarter - PBA NetworX Integration Break-out Session will cover more details! “This session will provide an engaging discussion on the integration of the NetworX suite (Pricer, Modeler & Payment Bundling Administration) with QNXT.” More information on NX Integration in sessions scheduled at 11.45 & 2.45 - this session will provide an engaging discussion on the integration of the NetworX suite (Pricer, Modeler & Payment Bundling Administration) with QNXT.

We would like to extend you an opportunity to provide candid feedback. Session Survey We would like to extend you an opportunity to provide candid feedback. During the workshop you should’ve 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.

Thank You!