QNXT 1
A comprehensive healthcare management system developed by TriZetto.
What is QNXT?
This serves as a centralized platform for stakeholders across the healthcare ecosystem to access and manage information related to the QNXT healthcare management system.
What is myQNXT?
Assisting reviewers in evaluating the medical necessity and appropriateness of healthcare services.
What is clinical guidelines and criteria?
The module supports the expansion of the provider network by identifying potential new providers, evaluating their qualifications, and facilitating the contracting and credentialing process.
What is Provder Network Expansion?
This can be used to communicate with their healthcare providers, schedule appointments, and manage their healthcare needs.
What is the portal?
This module is a component of the QNXT healthcare management system designed to facilitate the management of healthcare services utilization
What is the Utilization Management (UM) Module?
This tile offers a summary of the member's demographics, health plan enrollment informationrollment information, and other information
What is the Member Tile?
This tile will provide an overview of information regarding pre-authorization requests.
What is claims processing?
Upon receipt, the QNXT system performs checks to ensure that the submitted claims contain accurate and complete information.
What is data validation?
What is real-time?
Healthcare providers can submit these electronically or manually to insurance carriers or third-party administrators through the QNXT system.
What are claims?
This allows users to review the specifics of each claim and verify its accuracy.
What is the expand details buttion (paper clip)?
The process of managing prior approval for services.
Waht is pre-authorization?
QNXT is designed to integrate with other healthcare systems and applications, enabling seamless data exchange and interoperability across different systems.
What is integration and interoperability?
The Benefit Tile allows users to access this kind of information about their coverage.
What is detailed information?
A review of a healthcare services that has already been provided.
What is a retrospective review?
Users can view a summary of their healthcare benefits and coverage details through this tile.
What is the Benefit Tile?
Task assignment, tracking, and monitoring. Helping to ensure that reviews are conducted in a timely manner and that appropriate follow-up actions are taken.
What is workflow management?
The QNXT Claim Module facilitates denial management processes. It generates denial notices, communicates reasons for denials to providers and members, and initiates the appeals process if necessary.
What is the denial management?
The UM Tile facilitates the submission process and provides updates on the status of these types of requests.
What is pre-authorization?
It checks membership status, coverage effective dates, plan details, and other eligibility criteria to ensure that members are entitled to receive the services they seek.
What is Eligibility Verification?
This tile will serve as the primary documentation platform to allow constant open communication, facilitating peer support, information sharing, and updates related to the member’s care.
What is the interact tile?
It determines the eligibility of services, calculates payment amounts, and identifies any discrepancies or exceptions that require review.
What is adjudication?
The module provides real-time visibility into the status of claims throughout the processing lifecycle.
What is claim status tracking?
This page includes details such as provider names, specialties, contact information, office locations, NPI, and taxonomy information.
What is the summary page?