Saint Mary’s Health Plans Licenses TriZetto’s Claims Program

The Nevada-based health insurer selected the service partially because it dovetails with its growth strategy.

Reno, Nev.-based Saint Mary’s Health Plans has licensed the QNXT Essentials system from Newport Beach, Calif.’s TriZetto.

The health insurer, which claims 40,000 customers in Nevada, will go live with the system next January 1. It will use QXNT Essentials to improve the reliability and functionality of its information systems, automate more of its administrative processes and support business growth and HIPAA 5010 and ICD-10 migrations, according to a press release.

“TriZetto’s hosting service will help us go live expeditiously and provide a lower TCO than if we were to staff and manage the system ourselves,” Saint Mary’s CEO Don Kowitz says in a statement. “The QNXT system will ease our migration to HIPAA 5010 and ICD-10 code sets, and the platform will scale to our planned growth in Las Vegas and elsewhere across the region.”

Specially designed for community health plans, the QNXT Essentials platform includes TriZetto’s entire QNXT enterprise administration system, accelerated implementation process and toolkit and full-service application hosting and management services. The package licensed by Saint Mary’s also includes TriZetto's new Member and Provider Service real-time portal applications and its ClaimCheck Connector product, a specialized module that interfaces between the QNXT platform and McKesson’s ClaimCheck application.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, distribution, core systems, customer interaction, and risk ... View Full Bio