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TriZetto’s NetworX Pricer Claims Processing Technology Granted Patent for Unique Functionality in Pricing Healthcare Claims

Tuesday, November 09, 2010

Greenwood Village, CO -- The TriZetto Group, Inc. today announced that its NetworX Pricer® software application will be awarded a patent by the United States Patent and Trademark Office (USPTO) this winter. After a nearly decade-long application process, the USPTO issued a Notice of Allowance for the NetworX Pricer system in early fall 2010, with the official patent soon to follow. With this patent, the NetworX Pricer software is recognized as a distinctive application to help payers simplify the complex process of pricing healthcare claims.

“This patent highlights the unique value that TriZetto’s NetworX claims pricing engine provides our customers,” said Dave Pinkert, president of national accounts at TriZetto. “This patent reinforces what our customers already know – that the NetworX Pricer software is an innovative and valuable application. We are pleased the patent recognizes the uniqueness of our software, which simplifies the incredibly complex task payer’s face when pricing incoming healthcare claims by taking the many rules and contracts governing them and arriving at an accurate, automatically priced claim that is ready for payment. But our claims pricing innovations are just the beginning; we expect to be awarded many more TriZetto patents in the future.”

TriZetto’s patent covers the computerized method of repricing electronic claims for reimbursement according to a specific health plan’s contract, including conversion, checking, review, and allowance of a claim. In essence, the patent protects technology that allows payers the ability to manage broader and more complicated contracts with speed and accuracy. Specifically, the NetworX Pricer software can fully automate claims pricing associated with contracts that have many variables and terms; price claims associated with contracts that have varying calculation and qualification codes; and price claims associated with contracts that use multiple claim elements, rate sheets and associated priorities. It increases administrative efficiency and payment accuracy, and improves cycle times.

TriZetto’s NetworX Pricer is a Java-based application that integrates with a health plan’s claims systems to automate claims pricing, whether the health plan uses one core system or multiple applications. It has 55 customers covering 75 million insured lives. This patent is one of the first to be issued from numerous pending patents applications that will advance TriZetto’s NetworX® suite of products.

About TriZetto

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry, with its technology touching half of the U.S. insured population. TriZetto’s vision for the industry, Integrated Healthcare Management, is the optimized coordination of benefits and care for healthcare consumers to improve the value of every healthcare dollar spent. The company’s offerings include enterprise and component software, I.T. outsourcing services, business process outsourcing services and consulting that help payers transform and optimize their operations to enhance revenue growth, to drive administrative efficiency and to improve the cost and quality of care.

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