The TriZetto Group devotes itself to the companies that pay the doctor's bills. Targeting health plans, benefits administrators, and other health care payers, the company provides software and IT services designed to simplify provider network, transaction, and business process management. It resells third-party medical billing applications from such vendors as Metavante, while its own applications include Web-based payment tools and enterprise software for insurers and benefits administrators. Clients have included BlueCross BlueShield of Tennessee. The company's Gateway EDI subsidiary specializes in revenue cycle management software. TriZetto was founded in 1997 and acquired in 2008 by Apax Partners.
TriZetto has tried to capitalize on its expertise in healthcare records management as the federal goverment reforms the nation's healthcare landscape. It also manages Web portals that enable patients, physicians, and insurance companies to manage health care data, appointments, and claims activity. In addition to offering hosted and licensed software, TriZetto provides business process outsourcing (BPO) and business process engineering (BPE) services. The company handles such tasks as claims administration, enrollment, and billing for health plans.
The company has nine US offices, with additional facilities in Pune, India. It added a third office in India in 2012 to support growing demand for business management services from the health care industry. TriZetto's business management services include enrollment and premium billing processing, claims administration, configuration services, and the conversion of paper documents to electronic transactions.
TriZetto has used acquisitions to expand its BPO/BPE capabilities. In 2012 it bought Michigan-based Kocsis Consulting, which provides health care payers with services such as end user training in a variety of systems, including TriZetto products such as Facets and QNXT. It also provides various other BPE services such as change management and process improvements.
TriZetto also bought Medicare and Medicaid management provider Medical Data Express that year. The acquisition expanded its claim submissions offerings and ability to provide federal and state data processing regulatory compliance. Additionally in 2012, through subsidiary Gateway EDI, TriZetto acquired NHXS, a developer of software used by medical practices to manage physician reimbursement while minimizing administrative costs, and ClaimLogic, a medical claims and payment processor, that expanded Trizetto's customer base to include hospitals and additional large medical practices.
The previous year, TriZetto acquired Baltimore-based BPO services provider Tela Sourcing. The deal gave TriZetto greater access to the health care market which it sees as a growth area, and added offshore outsourcing resources in India. TriZetto also gained operations centers in Maryland and Illinois. – less