Testing and Validation for TriZetto Facets Product Builds

Get a Front-Row Seat to Efficiency. Save Hundreds of Personnel Hours.

The Industry's First and Only Platform Specifically Engineered to Automate and Optimize the Testing of Facets Product Builds

What it is

With ClaimOptima™ by SourcEdge

, you can execute rapid testing for product builds using your benefit designs and test claims all seamlessly working together.

The time savings are nothing short of revolutionary—what used to take weeks can now be accomplished in mere minutes. But it’s not just about speed; it’s about precision. ClaimOptima is designed to eliminate human errors and even self-correct as it learns, ensuring unparalleled accuracy.

How it Works

ClaimOptima gives you the ability to upload your product benefits directly into the system. Forget about setting up individual test cases; all you need are claims that represent the range of services you both cover and non-cover. ClaimOptima will automatically match these against the uploaded benefits, flagging any discrepancies instantly. 

If a behavioral health out-of-network claim is paid at 90% coinsurance when it should not be covered at all, ClaimOptima will catch it. This level of automation allows you to sift through a large volume of claims rapidly, whether they are test claims or actual production claims experiencing issues. 

Whether you’re in the pre-production phase or troubleshooting existing plans, ClaimOptima offers the versatility to meet all your benefit testing needs.

WHAT YOU GET

Improved quality of testing results

Speed the time of testing

Reuse knowledge over and over

Fewer amounts of testers needed

Centralize the knowledge needed

Improved quality of testing results

Reuse knowledge over and over

Speed the time of testing

Fewer amounts of testers needed

Centralize the knowledge needed

INSPIRATION SERVING 25+ HEALTH PLANS

Using this proprietary technology for our consulting efforts led to high customer demand for ClaimOptima. After witnessing the speed and quality of the results, the platform was made available for commercial use. SourcEdge serves as a trusted technology solutions partner helping health plan CIOs and VPs modernize and maintain their claims and business systems. We bring modern tools and talented people to every initiative helping health plans serve their members / patients and providers.

PROUD SPONSOR & PRESENTER

2024 Cognizant Health Sciences Conference

SourcEdge, An Alivia Company, was Cognizant’s First Healthcare Certified Consulting Partner. During this four-day event, SourcEdge and Alivia Analytics will discuss its combined products and services for commercial and government health plans.