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

3. 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

4. TriZetto Workflow Integration

5. 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

6. 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??

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

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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. TriZetto Communication Systems (TCS)
Integration

16. 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, , 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, , document stored on secure site etc.
– different template, exchange server tie in to send an
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

17. 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.

18. 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

19. 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

20. NetworX® Integration

21. 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 & this session will provide an engaging discussion on the integration of the NetworX suite (Pricer, Modeler & Payment Bundling Administration) with QNXT.

22. 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 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.

23. Thank You!