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Martin's Point Licenses TriZetto QNXT

The nonprofit health insurer aims to improve administrative efficiency and support growth while sustaining its high levels of member and provider satisfaction, the company says.

Martin's Point Health Care (Portland, Maine) has licensed TriZetto's QNXT enterprise administration system. It is also implementing TriZetto's Medicare modules and Web-based provider and member service applications.

"We're targeting a 10 percent to 15 percent higher first-pass auto-adjudication rate, and TriZetto's QNXT system will help get us there," Greg McCarthy, vice president of information systems and health plan operations at Martin's Point, says in a statement. "We know, too, that a TriZetto platform can scale to our plans to significantly grow membership in our health plan offerings."

Martin's Point Medicare plan, Generations Advantage, currently provides coverage for about 6,000 people across Maine. The Martin's Point US Family Health Plan, a TRICARE plan, serves some 31,000 military retirees, dependents and families of active-duty personnel in Maine, New Hampshire, Vermont, New York and Pennsylvania. Additionally, Martin's Point administers a commercial employer group product called Point Partners.

TriZetto's Medicare modules will help ensure compliance with CMS regulations, proper reconciliation of data and correct reimbursement for Martin's Point's Medicare Advantage program, the company says. Licensed modules include the Financial Reconciliation Manager, the Risk Score Manager, the Enrollment Administration Manager, the Claims Data Manager and the HCC Risk Adjustment Manager.

Saint Mary's Health Plans licensed TriZetto's claims program earlier this month. The vendor also has recently launched personal health record and benefits platforms.

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

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