Drive Efficiencies. Improve Performance. Maximize Your Investment.

With everything riding on your core claims and administration systems, you need a partner with a deep understanding of your business and the evolving industry, as well as the technology expertise to help you drive efficiencies, improve performance, and maximize the return on your TriZetto QNXT investment. 

A leader in healthcare consulting, Tegria has the proven experience you need to implement or extend your core systems. Our consultants are certified on the QCSI QMACS product and have worked on implementation, upgrade, and other related projects throughout QNXT product history – from QMACS 4.10 through QNXT 5.0. 

Our QNXT Services

Configuration and Implementation 

• Project Management
• Business Process
• Assessment and Workflow
• Model Office Planning and Setup
• Configuration Design and Maintenance
• Custom Code Design and Development
• Data Conversion and Auditing
• Reporting
• Change Management
• Release Management
• Quality Assurance
• Security Management
• Training and Documentation
• Post-Implementation
• Review

Database Management

• Unix Script Development
• Reporting Views
• Development of Stored Procedures for Processing and Reporting
• DBA Services

Data Integration

• Informatica
• Mercator
• Microsoft BizTalk
• SeeBeyond
• Sybase PaperFree

Reporting Tools

• Business Objects
• Cognos Impromptu, PowerPlay, BI Suite, Quiz
• Crystal Reports
• MS Access
• MS Reports
• SUPRTOOL
• SQL Server Reporting
• Services (SSRS)

Experience and Expertise

Our significant industry experience and product expertise cover all key areas of administrative and management systems, including:

• Customer Service
• Finance/Payment
• Utilization and Medical Management
• Benefits Management
• Claims and Encounters
• Capitation
• ANSII Transactions
• Coordination of Benefits (COB)
• Medicare/Medicaid
• Membership
• Premium Billing/Accounts
• Receivable
• Provider Setup
• Provider Contracts
• Specialty Lines of Business (e.g., Dental, Disability, and Life)

QNXT Connect Services

If your health plan has unique business requirements that QNXT Connect does not support “out of the box,” Tegria can help you implement and operate QNXT Connect successfully.

We have broad experience in healthcare electronic data interchange (EDI), having worked with most X12 transactions mandated by HIPAA in both the 4010A and 5010 transaction sets. We understand the specific challenges confronting health plans engaged in 5010 compliance efforts and have experience with many legacy EDI formats superseded by HIPAA (but still in use) and with healthcare transactions in areas that are not addressed or only partially addressed by HIPAA.

QNXT Connect Extension

We have demonstrated experience developing QNXT Connect “add-ins” to address anomalies and provide enhanced functionality for healthcare payer operations beyond what is contained in the core TriZetto product.

Claims Life Cycle Management

We have experience developing workflows and applications that address gaps in the standard TriZetto offering, which are necessary for smooth operation of QNXT Connect throughout the claims life cycle.

Biz Talk Trading Partner Configuration

The process for setting up and troubleshooting trading partners in BizTalk is complex and can be difficult to understand. We can help you set up the trading party, configure receive ports and locations, and implement 997 and 999 acknowledgments.