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Santa Clara Family Health Plan selects Trizetto for Integrated Solutions and Services that Enable Rapid Launch of Duals Demonstration Project

Corporate news | Thursday, October 9, 2014

Denver, Colo. – October 9, 2014 – TriZetto announced today that it was selected by Santa Clara Family Health Plan (SCFHP) to provide integrated administrative solutions and services that will support SCFHP's participation in a duals demonstration project involving the state of California, the Centers for Medicare & Medicaid Services (CMS) and several state counties and health plans.

The three-year project, Cal MediConnect, aims to improve care and control costs for beneficiaries eligible for both Medicare and California's Medi-Cal program. Dual-eligible beneficiaries account for an inordinate share of healthcare costs because they often live with complex and costly medical conditions.

TriZetto is providing SCFHP with integrated solutions that include core administration, enrollment administration, encounter data management, and application management services. TriZetto's experience figured prominently in its selection from a competitive field.

"TriZetto provides tremendous depth of experience in the Medicare and Medicaid markets," said Elizabeth Darrow, CEO of SCFHP. "Nationally, it serves more than 60 percent of managed Medicaid lives and more than 30 percent of Medicare Advantage lives, as well as 47 health plans with dual-eligible lines of business. TriZetto's the right partner to help SCFHP serve this population in Santa Clara County with high-quality, well-coordinated benefits and care."

SCFHP said speed-to-market was another consideration in its selection of TriZetto. "We need to be ready to enroll dual-eligible members in November 2014. We determined that TriZetto's integrated solutions for this market segment will enable us to meet the aggressive timeline," said Gary Kaplan, SCFHP's vice president of information technology.

"For nearly 20 years, SCFHP has been a healthcare steward for Santa Clara County," said Rob Scavo, president, payer market, at TriZetto. "It has partnered with local providers to enable care for adults and children who cannot access or afford it, and SCFHP has worked diligently to build a community of concern for the underserved. We're greatly impressed by this, and TriZetto is committed to the smooth, successful launch of SCFHP's dual-eligible program in November."

TriZetto's application management services for SCFHP include data-center hosting, disaster recovery operations, security provisions and help-desk services, as well as system management that will update the platform and help it run smoothly. Additionally, these services improve system performance and availability for a flat, predictable monthly fee.

TriZetto's core administration system will simplify benefits administration for SCFHP's duals demonstration project. For every office visit or other medical service, the system will automatically process both Medicare and Medicaid benefits for the dual-eligible member with a single claim submission, claim payment and remittance advice. TriZetto's Enrollment Administration Manger and Encounter Data Manager solutions will support separate reporting for Medicare and Medicaid and provide specialized functionality such as reconciliation and member true-up with CMS.

About TriZetto Corporation

TriZetto Corporation provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. Working with more than 350 health plans, TriZetto solutions touch over half the U.S. insured population and reach more than 250,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit

Media Contact:
Wesley Bryant-King
TriZetto Corporation