CASE STUDY

CSEA EMPLOYEE
BENEFIT FUND:
Increasing business efficiency and
effectiveness with the TriZetto Facets
core administrative system
Client:
The Civil Service Employees Association Employee Benefit Fund (CSEA EBF), established in 1979,
is a non-profit labor trust based in upstate New York. With a staff of 62, the EBF provides dental
and vision benefits to a population of nearly 250,000 covered lives. The union represents public
employees in New York State.
The EBF was nominated in 2013 for the TriZetto Healthcare Excellence Award, in recognition of
the organizations achievements in improving the efficiency and effectiveness of the business of
healthcare.

Challenge:
The Civil Service Employees Association EBF traditionally had processed claims on the TriZetto
ClaimFactsTM platform and, in 2009, faced the choice of continuing to maintain the legacy system,
shopping for a new vendor, or converting to the TriZetto Facets platform.
The legacy system was not flexible enough to handle organizational needs, says William F. Howard, director of the EBF, noting that it had been designed at a time when electronic claims were
almost non-existent. As a result, EDI rejection rates were high. Reporting also had become a
concern, and department managers were spending much of their time working with paper reports
that were difficult to customize.
It was essential that the conversion to a new system come in on time and under budget, Howard
says. Many years ago, he points out, a costly new system that had been developed for the EBF was
rejected by users, and the organization did not want to repeat that experience.

Solution:
The CSEA EBF elected to convert to the TriZetto Facets core administrative system, with project
support from TriZetto Consulting Services.
We chose to move forward with Facets because of our confidence in the TriZetto team and our
solid partnership that has extended over the course of many years, Howard says.
Facets is a highly flexible and scalable core administrative system that helps payer organizations
maximize efficiencies through greater automation, respond quickly to new market opportunities,
and conduct smooth transactions with providers and members.
TriZetto Consulting Services professionals help clients optimize TriZetto solutions and improve
efficiency. TriZetto consultants have deep experience in TriZetto products and in the healthcare
industry and can help clients leverage system capabilities to achieve quantifiable gains in productivity, profitability and client satisfaction.

THE CLIENT
A non-profit labor trust that
provides dental and vision benefits
to union members and their
families.

THE CHALLENGE
Replace an aging legacy system,
increase administrative efficiencies
and achieve an on-time and onbudget implementation.

THE SOLUTION
The TriZetto Facets core
administrative system, with project
support from TriZetto Consulting
Services professionals.

THE RESULT
Conversion to the Facets system
was completed on time and
$280,000 under budget. Since the
implementation:
User feedback has been
overwhelmingly positive
Department managers no longer
spend hours each day fixing dataconversion errors from the eligibility
system, as Facets handles this
with an error rate below 1 percent
The rejection rate for EDI
transactions has declined from 10
percent to less than 5 percent

Result:
The conversion was accomplished on time and under budget and reflected a true partnership with TriZetto,
Howard says. Since our staff is so small, we needed the support offered by TriZetto to carry out the conversion. We worked very closely with the TriZetto team to implement the 4.61 Facets solution in 2010 and then
the 5.01 Facets update most recently. The EBF was the first TriZetto customer to complete this important
upgrade.
As initial project planning took place, the EBF discussed with TriZetto the problems it had had with the
development of a new system many years earlier. TriZetto helped us tailor our approach to better meet EBF
needs, and the consultant team helped us integrate staff/user feedback into screen-view and programmatic
changes that made adoption of the new Facets system that much easier, Howard says.
We are very pleased with how responsive TriZetto was to our needs and proud that we were able to develop a
system that absorbed many of the observations made by our users during the testing phase.
The on time and under budget standard was critically important, and we drove this project toward that objective. We found the TriZetto team very willing to assist us in meeting that goal, Howard says. The project
not only was completed on time, but it also came in $280,000 under budget.
Since implementing the solution, we have experienced much more efficient claims processing and tracking at
the EBF, and it has also empowered our claims staff to help us modify our Facets approach, he says.
Today, department managers no longer spend hours each day fixing data-conversion errors from the eligibility
system, as Facets handles this automatically, with an error rate below 1 percent.
The rejection rate for EDI transactions has declined from 10 percent to less than 5 percent. The EBF created
a Web-based reporting solution that saves time and reduces reliance on paper. And the EBF stopped using
Social Security numbers for member IDs, assigned random ID numbers, and generated new ID cards for members and dependents.
The system adopted by the EBF was not representative of some cookie-cutter approach; the EBF worked with
TriZetto to implement a specialized solution that represented customized user inputs so that the program
that was ultimately adopted was one that fully met the EBF needs, Howard says, adding that user feedback
has been overwhelmingly positive.

The conversion to Facets has greatly enhanced our claims processing and has offered tools
and reports that have helped to make the EBF a much more efficient operation.
William F. Howard, director, Civil Service Employees Association Employee Benefit Fund

About TriZetto
TriZetto, a Cognizant company and business unit within Cognizants healthcare practice, provides worldclass information technology solutions to make better healthcare happen. TriZettos world-class technology
products, in combination with Cognizants consulting, IT and business process services at scale dramatically
simplifies the deployment and adoption of technology and improves operationshelping to reengineer the
business of healthcare today, while reimagining it for tomorrow.

For more information on how TriZetto can help you enhance revenue growth, drive
administrative efficiency, and improve the cost and quality of care, call 1-800-569-1222
or visit www.trizetto.com.

TriZetto Corporation
9655 Maroon Circle
Englewood, Colorado 80112
1-800-569-1222
www.trizetto.com

Copyright 2015 TriZetto Corporation. All rights reserved. TriZetto and the TriZetto Triangle logo are registered trademarks, and ClaimFacts and Facets are trademarks of TriZetto Corporation or its subsidiaries.
Other company and product names may be trademarks of the respective companies with which they are associated. The mention of such companies and product names is with due recognition and without intent to
misappropriate such names or marks.

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