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A large managed care organization was planning to convert to for-profit status while it also was negotiating a renewal contract with a prominent multi-hospital system. Historically, negotiations with the system had been tense and time-consuming and sometimes wound up being covered by the local media. The payer wanted to set a new tone for negotiations and improve relations with the provider system. The payer implemented TriZetto NetworX Modeler. NetworX Modeler is a software application that enables payers to model provider contracts-no matter how complex- and precisely evaluate the financial implications of proposed rates and terms before agreements are signed. The application readily integrates with any claims data source, including legacy claim systems.
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