Correctional Healthcare
Identifying Efficiencies in a TriZetto QNXT System Assessment
SUMMARY
A large prison healthcare provider in the United States turned to Mediant Health Resources to analyze their system and provide recommendations on how to gain efficiencies. The complexity and non-standard nature of their segment, along with the size of their organization, resulted in numerous customizations to their TriZetto® QNXTTM implementation that increased processes and workload.
BACKGROUND
As a leader and pioneer in healthcare for correctional facilities for more than 35 years the client had built a reputation for providing high-quality healthcare and reentry services that improved the health and safety of patients, reduced recidivism, and bettered the communities where their employees worked and lived. Their services span
15 states and serve approximately 115,000 inmates.
CHALLENGE
Correctional healthcare is comparatively non-standard and complex. The client’s large size and broad scope further added to the challenges of healthcare IT in this environment. When they implemented Cognizant’s TriZetto® QNXTTM Enterprise Core Administration System custom interfaces were required in order to adapt to the needs of the organization. As part of this customization, they developed the CARES system to administer claims authorization matching while simplifying the end-user experience. These customizations created additional processes and workloads in the areas of claims payment, provider administration, and end-user training. The client sought to simplify these processes and improve operating efficiency. They required an experienced and trusted partner to assess their claims system and provide recommendations for change.
SOLUTION
The client was impressed by the level of expertise and experience available through Mediant Health Resources, and turned to the healthcare IT support and staffing company to meet their needs. Mediant was engaged to provide a thorough assessment of their custom claims system implementation and to recommend options that would best allow them to simplify the system environment. Mediant provided two expert consultants with more than 20 years of experience in TriZetto® QNXTTM and healthcare IT architectures in order to best meet the client’s needs.
RESULTS
Mediant Health Resources consultants brought incredible insight to the project as well as a deep understanding of the TriZetto® QNXTTM Enterprise Core Administration platform. They were able to quickly understand the client’s architecture in only a few days, and delivered the assessment within the first week of the project. Mediant consultants were able to call out redundancies as well as provide recommendations for a more efficient, streamlined architecture that works seamlessly with the client’s custom CARES system as a front end, while utilizing updated web services calls to TriZetto® QNXTTM for data administration.
Mediant’s assessment and recommendations for the scope of the client’s contract were completed ahead of schedule allowing Mediant to go above and beyond. Mediant’s consultants also provided plans for how best to resolve their recommendations within the project timeframe and budget.
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