January 05, 2012

TriZetto (Denver) has acquired Medical Data Express (MDE, Chandler, Ariz.), expanding the vendor's offerings for Medicare Advantage and Medicaid payers. Health plans use MDE's technology and services to meet federal and state mandates for claim submissions that require medical encounter data formats. Plans also use MDE for automated end-user claims-testing technology to complete system upgrades, migrations and configuration changes, helping to ensure accuracy and reduce costs, according to TriZetto.

Aligned with the overall vision of health reform, the use of encounter data supports the development of better quality measures for managing Medicare beneficiaries and building more accurate risk adjustment models, according to TriZetto. Encounter data includes diagnosis and treatment information for all medical or behavioral services obtained by a patient.

"By acquiring MDE, TriZetto is cementing its ability to offer customers a proven, comprehensive and reliable solution that helps payer organizations meet federal and state requirements for medical encounter data processing," comments Trace Devanny, chairman and CEO, TriZetto. "We are committed to continuing to enhance our suite of solutions helping Medicare and Medicaid plans leverage the efficiencies they gain for strategic advantage while maintaining compliance."

MDE supports Medicaid and Medicare plan customers that submit encounter data to more than 35 Medicaid state organizations and is positioned to meet the timelines established by CMS for Medicare Advantage plans. TriZetto will continue to make its Claims Data Manager application available to Medicare Advantage plans to process RAPs, or risk-adjustment processing, data submissions until the RAPs data requirement sunsets. CMS requires plans to submit both RAPs and encounter data beginning in 2012. TriZetto's managed Medicare and managed Medicaid solutions that currently serve more than 14 million Medicare Advantage and Part D members and over 12 million Medicaid members.

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek ...