Individual & Small Group

  • TriZetto healthcare reform and population health management

  • Edge Server [3 R’s] Solution - TriZetto Encounter Data Manager™ for Exchanges

    HHS has recently confirmed that the Edge Server requirement is not only for health plans that participate in Exchanges, but also for health plans that serve the individual and small group markets. Health plans need to be able to share consolidated, scrubbed and masked information that includes enrollment, medical claims, and pharmacy claims data on a recommended monthly basis.

    Pre-integrated with TriZetto’s Facets™ and QNXT™ core administration applications, TriZetto Encounter Data Manager (EDM) for Exchanges provides an interface from the enrollment and claims data sources to generate and edit files submitted through the Edge Server to HHS. The EDM for Exchanges application helps you scrub, mask, submit and track complete files according to the varying HHS submission and format requirements for delivery to the Edge Server. The solution allows for greater efficiency and supports your compliance efforts with accurate submission files and error fixes to better maximize risk scores and deliver higher reinsurance revenue. EDM for Exchanges can run on premise at your facilities or you can opt to utilize TriZetto’s AMS services to host and support the solution. EDM for Exchanges can be used with other non-TriZetto core administrative platforms.