Helps expand its provider reach

TriZetto Group's Gateway EDI subsidiary increased its customer base of healthcare providers by 50 percent with the acquisition of 10-year-old revenue cycle management and electronic transaction processing systems company ClaimLogic.

The deal marks TriZetto’s continued expansion into the provider market and in one fell swoop increased by 60,000 to more than 180,000 the number of providers who now use its products and services. The acquisition of ClaimLogic helps TriZetto reach a different segment of the provider market: large hospital systems and larger physician groups, where TriZetto’s base has been smaller physician practices.

With the scale we are building  -  when you look at the 180,000 providers, who are directly connected to us and then this huge payer footprint with over 350 health plans and benefit administrator organizations  -  we are now able to strategically approach both payers and providers from a collaboration standpoint and bring some real scale to the game," said Chris Hunter, TriZetto senior vice president and president of its physician market group.

The acquisition comes at a time that is seeing marked increases in the number and nature of payer-provider collaborations in the industry. "We are continuing to see increased market demand for collaboration and improved connectivity between payers and providers and seeing them work more closely together," Hunter added.

"The acquisition enables TriZetto to support greater provider-payer collaboration in the hospital-system market, including academic medical centers," said Trace Devanny, chairman and CEO of TriZetto. "Improving access to information between the providers and hospitals who deliver care and the health plans that pay for the care will enhance workflow processes and help reduce costs."

For Oklahoma City-based ClaimLogic the deal was about joining a company with a similar view of the market.

 "Like Gateway EDI, ClaimLogic has always taken pride in putting customers first," said J.P. Davis, COO and co-founder of ClaimLogic. "The combination of our solutions will allow our clients more customization and flexibility to improve their workflow management objectives while improving their top and bottom lines."

One example of this, is the upcoming launch later this year of a pilot program from TriZetto that will provide a real-time payment assurance and claims editing solution connecting providers with the claims systems of multiple health plans.

The idea is for TriZetto to provide better and more accurate plan coverage information to providers that can help them manage the patient payment responsibilities early on. By getting the patient information at the point of care providers can reduce the amount of bad debt incurred when they need to chase patient payments later.

According to Hunter, this is exactly the kind of program that can benefit from the added breadth of service and customer base provided by the ClaimLogic acquisition.

“One of the first questions a provider will ask when (you) broach the subject is how many payers are involved. Likewise the payers want to know how many providers you have. Scale in this business is very important,” Hunter said.