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The TriZetto (News - Alert) Group, Inc. today announced that their business management service has helped Johns Hopkins HealthCare (JHHC) reduce a large “backlog of medical claims (and) claims-operational expenses and resolve other administrative issues,” according to a company press release.

Johns Hopkins HealthCare serves more than 300,000 members, including approximately 212,000 managed Medicaid beneficiaries, according to the press release.

American physicians spend a shocking “almost four times as much in money and staff time on administrative costs” as physicians to our North, under the single-payer system in Ontario, Canada, a recent study has found, according to a story by Mark Crane.

Physician practices in the United States spent $82,975 per physician per year while Canadian practices spent $22,205, all because Canada’s single payer system allows physicians’ offices to only have to deal with one entity, reports Stephanie Bouchard at healthcarefinancenews.

“We were swimming in a sea of paper,” said Steve Lees, director of operations at JHHC, in the press release. “Someone had to do something.”

JHHC chose Trizetto front-end services, including “mailroom functions such as opening and sorting paper-based claims, converting paper claims to electronic format and transferring these to the core administrative system; image storage and retrieval, and workflow management,” among others.

“The backlog was quickly eliminated, provider complaints declined and processing times improved,” Lees was also quoted as saying, pointing out that TriZetto “consistently met our requirements for accuracy and turnaround time.”

When JHHC’s Medicaid enrollments surged, the organization decided to “send a portion of the claims not processed automatically by the core administrative platform to TriZetto’s claims administration services team, to process manually,” according to the press release.

Lees said that Trizetto’s services have helped to decrease claims-operational expenses by approximately 20 percent, saving the organization $300,000 annually. JHHC’s administrative staff now has time “to proactively contact providers, helping them make the transition from paper-based claims to electronic data interchange. This has led to further cost-savings, and paper-based claims have declined from 75 percent to 7 percent of total claims.”

The press release said that many healthcare organizations, looking for ways to reduce administrative costs and improve quality, are turning to business management services, according to Thomas Rekart, TriZetto’s senior vice president of business management services. “Demand is increasing as health plans seek effective ways to meet the challenges of healthcare reform legislation,” he said. “Plans that serve the managed Medicaid market are particularly focused on reducing administrative spend, as state budgets are constrained while Medicaid enrollments are likely to surge in the coming two to five years.”

Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM (News - Alert) in her 20-year career. To read more of her articles, please visit her columnist page.