Capital BlueCross has implemented TriZetto’s integrated software and services solution to enhance existing high-performing claims-processing unit and network and care management.

The integrated software solution has already enabled Capital BlueCross to increase claims auto-adjudication rate and reduce pended-claims inventory (claims in line for processing) and its claim days on hand (time for processing).

TriZetto’s Blue Cross and Blue Shield market segment president Sal Gentile said that the company’s network management system has assisted to rebuild and restructure Capital BlueCross provider contracts.

"Our care management platform has streamlined the administration of helpful disease management programs that support plan members in its central Pennsylvania and Lehigh Valley service area."

TriZetto solution has been designed to automate member enrollment, premium billing, claims administration and customer service; streamline the delivery of work to users, improving business processes while reducing manual labor and errors; and automate critical aspects of disease management.