Business Intelligence

How to Make Money in Network Management

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Executive Summary

A large national MCO wanted to lease parts of its provider network in order to increase revenue; but the payer's multiple legacy systems were already at capacity and couldn't take on the added work of pricing claims for leased portions of the network. Pricing these external claims manually or outsourcing the task to a third party would render the network-leasing program unprofitable. The payer implemented TriZetto NetworX Pricer. NetworX Pricer is a software application that automates pricing of claims, regardless of the number or complexity of applicable contracts. The application readily integrates with any system or systems and reduces errors, delays and manual labor.

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