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Adoption Leaders Program User Experience..  Overview of Company:  53,000 covered lives in HMO/POS, Dental, Consumer Directed, Individual and ASO product.

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Presentation on theme: "Adoption Leaders Program User Experience..  Overview of Company:  53,000 covered lives in HMO/POS, Dental, Consumer Directed, Individual and ASO product."— Presentation transcript:

1 Adoption Leaders Program User Experience.

2  Overview of Company:  53,000 covered lives in HMO/POS, Dental, Consumer Directed, Individual and ASO product lines.  2014 – offering Individual on the Federal Facilitated Marketplace  PHP Products:  QNXT Core 5.10.003.000, A/R, Dental, Case Management, Claim Test Pro, Connect, McKesson ClaimCheck, MicroDyn, and 3M Physicians Health Plan

3  July 2013, QNXT 5.01.012.000 (R12) Sprint 1 Testing– July 15, 2013 Sprint 2 Testing – July 29, 2013 Sprint 3 Testing - August 12, 2013 Hot Fix Testing – September 18, 2013 Go Live - September 28, 2013 QNXT 5.01.012 HOT Fix Participation in ALP – R12

4  PHP made the decision to participate in ALP for 5.10.002 even though we had no plans to upgrade to this release  Business felt strongly there was value in testing Understanding new functionality Ability to provide feedback to TriZetto Opportunity to collaborate with other Qnxt Users  November 8, 2013, QNXT 5.10.002 Sprint 1 Testing– November 8, 2013 Sprint 2 Testing – November 22, 2013 TriZetto 5.10.002 GA Release Participation in ALP – 5.10.002

5  McKesson ClaimCheck 10.1.1.513  CCI/OCE 20.0/20.0  Integration Wizard 7.04-5.0  MicroDyn DRGActive 2 YR 2.0.134.0  Claim Test Pro 4.2.3.2244  SPRINT 1 - tested 7k claims  SPRINTS 2 & 3 - tested 4k claims Test Environment Third Party Readiness

6  Benefits of Early Adoption:  Able to preview Exchange functionality  Test various configuration options  Allows us to see what functionality works and where there are issues  Collaboration between other ‘BETA’ health plans Early Adoption

7 R12 Issues / Defects STATUSCOUNT ASSIGNED8 CLOSED5 PENDING RELEASE7 INTERNAL ASSISTANCE3 ON HOLD – WT. DEVELOPMENT1 RESEARCHING / WORKING1 TOTAL25

8  Incident #1588003 - APTC Billing Issue TT#BRD00483123  Code modification completed; released in GA 5.01.0012 on 8/21/13  Incident #1588889 - Missing TobaccoSubstanceUse field in Premium rate table File Layout (PolicyAdmin.accdb) TT#DWU493439  Code modification completed; released in GA 5.01.0012 on 8/21/13  Incident #1592617 - Unable to add a unique zip code/county combination record to a premium region already containing the same zip code Current Issues of Note Priority - High

9  Incident #1577202 - 834 QNXT Help Screen for Tobacco Indicator  Resolved with existing solution released in GA 5.01.0012 on 8/21/13  Incident #1578506 – Mammogram benefit allowing more than two visits per year  Research/Working Current Issues of Note Priority - Medium

10 * Activity #1313 (Rule 1014 enabled)  A/R – Release payment batch  Activity #1315 (Rule 1014 enabled)  A/R – Apply payment to invoice  Note: Configure Rule 1014 (Hold Enrollments for Initial Payment) for one or both of the above activities to automatically apply payment to the subscriber’s A/R account New User Security Activities

11 Questions

12 Confidential | Copyright © 2014 TriZetto Corporation 12 Workshop Survey We would like to extend you an opportunity to provide candid feedback. During the workshop you should have 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.


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