WASHINGTON – October 1, 2013. Gorman Health Group (GHG), the leading consulting firm and solutions provider in government-sponsored health care programs, announced its partnership with TriZetto Corporation to offer an end-to-end reconciliation solution that will enable health care payers to successfully participate in federal and state-based Health Insurance Marketplaces.
Gorman Health Group’s web-based workflow management software, Valencia™, will integrate with the TriZetto core administrative platforms, Facets™ and QNXT™, to drive and resolve membership and payment discrepancies through a health plan’s existing process. Through this combination, clients will have access to a solution that provides a workflow platform to manage this critical plan function.
Valencia™ is a timely solution that helps health plans reconcile membership between the Health Insurance Marketplaces and the health plan. “Participants in the Health Insurance Marketplaces need this capability today, as it is mandated by law,” said John Gorman, Executive Chairman of Gorman Health Group. “Valencia™ is a proven solution that already manages the payments of more than six million Medicare beneficiaries. The tool increases productivity of health plans’ staff while decreasing the compliance exposure of our clients.”
With the impending launch of the Health Insurance Marketplaces, health plans face critical administrative complexities in identifying and tracking membership and payments. Together, Valencia™ and TriZetto will provide health plans the necessary reconciliation capabilities needed to analyze data quickly and efficiently. The tool will provide transparency into the status of each individual and will help minimize payment shortfalls by identifying membership and revenue gaps between the Marketplace and the health plan.
“With more than 50 TriZetto clients in 30 states planning to participate in the Marketplaces in October, and millions of individuals projected to purchase insurance through the newly formed Marketplaces, health plans face the daunting task of reconciling individual and federal government payments based on their individual subsidy level,” said Dan Skari, Solution General Manager for Healthcare Reform at TriZetto.