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Blue Cross and Blue Shield of Kansas City Improves Productivity, Profitability with TriZetto's Facets e2 Workflow Application.

NEWPORT BEACH, Calif. -- The TriZetto Group Inc. (NASDAQ: TZIX) today announced that Blue Cross and Blue Shield of Kansas City (BCBSKC) is processing an average of 15 percent more claims per day since implementing TriZetto's Facets e2 Workflow software. Facets e2 Workflow automates manual processes and streamlines workflows, helping health plans to reduce claims turnaround times and administrative costs, while helping to increase satisfaction among providers and members.

For health plans, one key to efficient claims processing is routing claims to the right person at the right time, as workloads fluctuate. With Facets e2Workflow, claims are prioritized and routed automatically according to rules established by the plan's business staff. The application uses a natural language feature, which allows health plan employees - even those without extensive IT training - to add or change rules quickly and easily.

A user of TriZetto's Facets[R] administrative software since 1999, BCBSKC processes more than 9.6 million healthcare claims annually. While most claims are processed automatically through the Facets system, some require manual handling. According to BCBSKC Chief Information Officer Kevin Sparks, these manual claims created workflow "bottlenecks," resulting in inefficiencies for claims staff.

"A team of BCBSKC supervisors would start the day by reviewing paper reports that listed the claims requiring manual processing. The supervisors would then send paper lists to claims examiners outlining which claims to process," said Sparks. "Of course, if the reports were late, then people up and down the line couldn't do their jobs."

What's more, the paper reports didn't contain enough information to "flag" high-priority claims for prompt processing, such as claims from provider organizations whose contracts specify rapid turnaround. Without the information they needed to prioritize the claims, processors could "cherry pick" which claims to process, often starting with the easiest claims first - not necessarily the ones requiring urgent attention.

The paper-based system was in need of an overhaul. The customer selected Facets e2 Workflow in part because of its ability to integrate smoothly with its Facets core administrative system. Additionally, BCBSKC had successfully deployed and benefited from other specialized software components from TriZetto, including the HealthWeb[R] Internet platform for online business transactions; NetworX Pricer[TM] and NetworX Modeler[TM] applications for provider contract management; Facets e2 Defined Contribution module for consumer-directed benefit plans; and CareAdvance[TM] Enterprise software for comprehensive care management programs.

Facets e2 Workflow was fully implemented at BCBSKC in late 2005. The application allows the customer to automatically identify, prioritize and route claims according to specific criteria, such as provider contract provisions and date of submission. In addition, BCBSKC can establish rules to route claims based on factors such as a particular processor's skill level, staff training requirements, the organization's specific lines of business and more.

"The Workflow solution quickly delivered ROI benefits that are obvious and measurable," said Sparks. "Our administrative costs are down, and satisfaction is up among providers and members, who see claims being processed more quickly. We have a strong technology partner in TriZetto, whose solutions are designed to help health plans solve real-world business problems."

To further help BCBSKC's claims supervisors manage workflow and reduce manual labor, the application automatically redirects claims if one staff member is overloaded with claims and another's queue is not at full capacity. Supervisors can view all claims activity in real time through the Facets e2 Workflow "dashboard" and make other workflow adjustments as needed. The dashboard also provides supervisors with an up-to-the-minute count of claims processed by each examiner, which can serve as a performance motivator for employees.

Since implementing Facets e2 Workflow, BCBSKC's claims supervisors and examiners no longer wait for paper reports each morning; they simply log on to the workflow system and begin working. Before Facets e2 Workflow, the time that claims supervisors spent on sorting, distributing, and prioritizing claims was equivalent to two full-time employees. Today, these tasks are fully automated, freeing supervisors to focus on key priorities.

About Blue Cross and Blue Shield of Kansas City

Blue Cross and Blue Shield of Kansas City, the largest not-for-profit health insurer in Missouri and the only not-for-profit health insurer in Kansas City, has been part of the Kansas City community since 1938. BCBSKC provides health coverage to nearly 900,000 residents in the greater Kansas City area and Northwest Missouri. The company offers a number of benefit programs that can be included in many group health plans for area employers. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. For more information on the company, visit their Web site at

About TriZetto

Touching more than 35% of the U.S. insured population, TriZetto is distinctly focused on accelerating the ability of healthcare payers to lead the industry's transformation. The company provides premier information technology solutions that enhance its customers' revenue growth, drive their administrative efficiency, and improve the cost and quality of care for their members. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company's broad array of payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at
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Publication:Business Wire
Date:Nov 16, 2006
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