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QNXTTM is a claims processing system supported by The TriZetto Group. Prominence Health Plan has licensed QNXT from TriZetto to serve as its Claims Engine and Customer Support base. QNXT is an integrated system that allows us to combine many functions that are currently spread across multiple systems into one system where the data needed to do our day-to-day jobs is essentially in one database. Having data in one database not only means less toggling between systems but also results in consistent data.
The QNXT system provides benefits in many areas:
Benefits: QNXT allows for the creations of coinsurance and copayment groups that are assigned to employer policies. This reduces the need to create multiple benefits plans and improves benefit configuration accuracy.
Claims: Increased auto-adjudication rates and authorization-to-claim match results in faster payments to providers and more consistent application of benefits.
Contracts: QNXT allows for the creations of Model contracts, which are then copies for new contracts. Only the variations between the Model and new contracts need to be updated, reducing by 50-75% the number of fee schedules to maintain.
Enrollment: QNXT has the ability to add multiple enrollment segments on the member record so all of a member’s coverage history can be viewed from one member record. QNXT has a mass member change functionality that allows a group of members to be moved from one policy, benefits, or PCP to another all at once instead of moving them one at a time.
Care Advocate Resource Guide 2021 Q1-Q2
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