The TriZetto Group, Inc. announced that its wholly owned subsidiary, Gateway EDI, has acquired ClaimLogic, a medical claims and payment processing company, which broadens TriZetto’s combined healthcare provider and payer client base to include hospitals and additional large medical practices.
TriZetto, a supplier of payer-to-provider information technology and solutions, now offers revenue cycle management and EDI solutions to more than 180,000 care providers, the press release states.
ClaimLogic has served healthcare organizations such as Emory Healthcare and University of Virginia Physician’s Group for more than a decade.
“Uniting the expertise and tools of Gateway EDI and ClaimLogic will allow us to offer new solutions to our combined provider customers,” said Charlotte Martin, president and COO of Gateway EDI, in the press release. “We are eager to blend our resources to serve as an even stronger partner for our clients.”
TriZetto and Gateway EDI also recently acquired NHXS, a company that helps practices manage reimbursement and minimize the administrative cost of recovering lost revenue.
The California Medical Association points that most payer contracts, including Medicare, include language that states the physician will be reimbursed at the lesser of either the payer’s fee schedule or the physician’s billed charge - otherwise known as “lesser of,” and that many physicians may not be aware of this.
Samantha Gluck notes that the healthcare reform act includes “considerable changes to Medicare reimbursement policy for both physicians and hospitals.” HITECH has set down many requirements for clinicians to meet that can be both confusing and expensive.
Another challenge will be the value-based payment modifier initiative which is still being developed but is set to start in 2015, according to Ben Penn. At that time, select physicians will either receive bonuses or reduced reimbursement based on the quality and cost of care they provided to their patients in 2013. In 2017, the value-based modifier will apply to all physicians who treat Medicare patients, creating yet another obstacle to getting paid.
Trizetto and its subsidiaries help healthcare professionals deal with the challenges of getting paid under the new rules and regulations of reform.
ClaimLogic’s current leadership team will continue to run the organization’s day-to-day operations.
Edited by
Brooke Neuman
