ComplaintsforTriZetto Provider Solutions

• Initial Complaint

  05/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I have been over charged by at least $10,000. I have requested a supervisors call to no avail. I have asked for a description of criteria in the 2 different packages on my account and no one can answer. I was charged for providers I dont even have. I was charged for providers submitted under 30 claims which should not be.

  Business response

  06/06/2024

  First, Trizetto Provider Solutions (TPS) would like to apologize for the frustrations experienced by our valued client.  Service and quality are at the top of our core values when meeting a clients revenue cycle needs.  We truly understand the challenges and expenses one has when operating a practice and want to make the process a positive experience where we are involved.
  
  Since the initiation of this complaint, we are actively reviewing the concerns outlined in this matter. Our leadership has prioritized this account and will coordinate with the client in order to provide a prompt and accurate resolution.
  
  Our solutions involve review of the dispute, communicate outcome of review and a clear escalation process should any concerns arise in the future.  TPS prides itself in our work and client interactions, we look forward to a successful partnership as we finalize the remaining work needed to resolve this matter.  

  Customer response

  06/11/2024

  My June invoice was overcharged as well.  After I emailed they did fix it.  They stated that they are still reviewing my account.  So I am still waiting on resolution.

  Customer response

  06/24/2024

  Senior Management reached out to me.  She did a full audit on my account and they have issued me a refund! Going forward she will keep an eye on my account to make sure invoicing is accurate.  I am very satisfied with the resolution.

• Initial Complaint

  02/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In June 2023, I contracted with Trizetto and their subsidiary Cognizant, for them to provide services to credential me with various insurance companies. This is required as a medical provider to be able to bill insurance. I paid $250 on June 6, and submitted all required documentation over the following months. I was told I would receive itemized bills but instead received bills labeled "credentialing." I have been told on several occasions that my applications were in process, yet when I contacted ********* Cigna, and BlueCrossBlueShield, I was told no applications had been submitted. Trizetto billed me another $900. Multiple emails and phone calls to every contact person have gone unanswered. on January 16, A friend employed at ****************** learned that my final contract had been mailed to Trizetto on January 11. They emailed it directly to me and it was signed and finalized. Trizetto did not respond to my emails regarding this contract. I am unable to operate my business without credentialing, and I have given Trizetto all my personal and financial information, as this is required for the process. I need the process to be completed and I need for them to not have access to my information any more.

  Business response

  02/14/2024

  First, Trizetto Provider Solutions (TPS) would like to apologize for the frustrations experienced by our valued client.  Service and quality are at the top of our core values when meeting a clients credentialing needs.  We truly understand the challenges and expenses one has when starting a new practice and want to make the process a positive experience where we are involved.
  
  Since the initiation of this complaint, we have engaged with the client to address the various concerns outlined in the initial response.  Our team has worked closely with the client to address their immediate concerns and has offered various solutions to move forward successfully. Our manager will prioritize this account as our team continues to actively work with the client in order to provide prompt and accurate servicing.
  
  Our solutions involve scheduled bi-weekly calls; solutions to the reporting requests and a clear escalation process should any concerns arise in the future.  TPS prides itself in our work and client interactions, we look forward to a successful partnership as we finalize the remaining work needed to credential this account.  

  Customer response

  02/16/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  11/16/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I signed a contract with Trizetto in April 2023 to provide insurance enrollment/credentialing or update with >10 payors and **** update/maintenance services. After more than 6 months of working together and providing requested documents and signing applications promptly when asked, I was ultimately not enrolled appropriately with ANY payers. What I was finally able to determine after filing a Dispute Notice was that they had been credentialing me under the wrong specialty. They had not updated my **** profile information or documents nor had they informed me that my NPI taxonomy needed to be updated. I was subsequently rejected by some payers or incorrectly enrolled with others. I paid so much money in overhead waiting for these contracts to be established that my business nearly went out of business before it opened (and still may). There are several issues with this group including lack of communication between the departments, lack of knowledge about the local/regional insurance networks, inability to reach supervisors or customer service agents to resolve issues in a timely manner. I spoke with one supervisor to review disputes and she was very defensive of the account manager's work, they spoke to each other in another language and laughed at me and ultimately refunded $300 which was interestingly, exactly how much they were attempting to charge me for more work which I had not authorized. I've had to hire another company to re-credential me with payers under the correct specialty and I've had to go back in to the **** and NPI websites and update the information and documents (which is a service they charged me for!)I'm seeking a full refund since I will have to pay a new credentialing company to re-do the work.

  Business response

  11/22/2023

  Thank you for allowing us to respond to this matter.
  
  The client signed a contract on April 3, 2023 and had all required documents provided to TriZetto Provider Solutions (TPS) by May 8,2023.  We then assigned an Account Manager on May 9, 2023. The credentialing has been in process for approximately 5 months and can take up to 180 days or more, based on the various plans being pursued.   Currently, there is only one plan still open for credentialing, while the other plans are now outside of our control for various reasons (effective dates, closed panels, address for provider is out of service area), thus the plans are at completion for our services.  Each plans has specific requirements or unique documentation for each provider to qualify for enrollment. Enrollments were completed based on the information the client submitted to us and the work outlined in the contract.
  
  TriZetto Provider Solutions is also not responsible for maintaining the providers NPPES site and taxonomy code assigned to their specialty.  With regard to CAQH maintenance TriZetto cannot validate who did or did not make changes within CAQH; TriZetto is willing to credit the charge of this service in the amount of $150.  To our knowledge, no plan was impacted due to the credentialing for CAQH not being updated/attested. The insurance plans use multiple tools to credential and enroll each provider, including, but not limited to CAQH, NPPES,and the applications submitted.  All tools must be in alignment, if not,the plans requirements will determine how each provider will or will not be enrolled. 

  Customer response

  11/27/2023

  Complaint: 20879387
  
  I am rejecting this response because:
  If the reasons for the lack of insurance credentialing were as stated (out of area, panel closed, etc) then that information could be easily ascertained with payer discovery services and would not require 5-6 months or full application packet so I should be refunded full $150 for each of those companies. 
  In addition, I relied on you for credentialing expertise so if documents were incomplete or conflicting, I would expect you would inform me of the discrepancy so it could be corrected. You were provided logins to both CAQH and NPPES and actually were responsible for initiating type 2 NPI. 
  The company has since billed me for an additional $150 for unclear, unauthorized services and now offers to reimburse me the same amount it says I owe them. 
  I continue to ask the company to provide documentation of any insurance enrollment that has been completed correctly (Addiction Medicine) which I would be happy to pay for. 
  Otherwise, this company has charged me for services it has not provided and continues to charge me for services I have not requested or authorized. 
  This has caused significant damage and appears to be a recurring pattern and practice. 
  I request a full refund in order to pay another company to initiate and complete this work. 
  
  Sincerely,
  
  *******************

  Business response

  12/04/2023

  We truly understand the challenges and expense one has when starting a new practice.  *************** plan has their own rules and regulations to follow when determining if they will allow a provider to join their network.  TriZetto stands by its original assessment of how the credentialing was handled on your behalf.TriZetto will provide a final status report to you, as well as, comply with the desired settlement requested.  TriZetto strives to make all clients satisfied in the quality of our services provided.

  Customer response

  12/05/2023

  In the business response it said that they would comply with the desired settlement requested and I had asked in a previous correspondence that they refund me all my money except the $250 non-refundable fee stated in the contract. Im afraid that if I accept the response before the $$ is actually returned then they wont refund me. Is it OK to reject the response until terms are clear and theyve begun the refund? 

  Customer response

  12/06/2023

  Please note on the Invoice Breakdown it indicates they will NOT be issuing a refund and the line items that say yes towards refund were bills they stopped sending me. So NO refund has been agreed to or actually refunded on their end. They may have said that in their email but on the next day they sent me this Status Update. I responded with explanations why they should refund me in the email attached. 

  Customer response

  12/15/2023

  Still awaiting response from BBB regarding new information submitted in attachment.  Surely the business simply saying in their response to BBB that they will offer a refund does not sufficiently meet the criteria for closing the case.  ************ has already proven to me that they are not trustworthy to do what they say (hence the complaint to BBB) and indeed a day after telling BBB they would refund me they sent me an invoice breakdown (attached) clarifying why they would NOT be giving me a refund.  Please continue to monitor this case otherwise this company will have no incentive to return my money.  Thank you

• Initial Complaint

  03/22/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  It has been almost one year since Trizetto/********* agreed via contract to start the credentialing process for my clinic. I signed up for them to credential four insurance companies. It has been nothing short of a nightmare since I spent (lost) 100s of dollars to get NOTHING in return! Communication is non existent, emails and phone calls are never returned and If you do hear back it's with a generic email response that was pre-written and has nothing to do with the question or issue at hand. Several email addresses that I did have from prior "sales/marketing" staff which i obtained during initial communication while signing up with them now says that I am "blocked" from correspondence. The representative that I am supposedly assigned to rarely answers my emails and NEVER has once answered my phone calls. Actually, the extension is invalid. Once, following a complaint to his supervisor I received an "update" call from him and his supervisor that from what I understand was supposed to be occurring on a scheduled basis. I have repeatedly had to resubmit the SAME sensitive data over and over. This is information related to my clinic and my medical license that I have redundantly submitting MULTIPLE times. None of this should be happening. It is unconscionable to me that they remain in business with these incompetencies. I have paid my account in full despite having none of what i paid for. I will have to pick up from here, take a huge loss from an inability to accept insurance and finish this process myself. I see no other option! Disgraceful.

  Business response

  03/29/2023

  TriZetto has completed 3 of the 4 enrollments with the last plan that has some dependencies on the client.  Leaders with the credentialing department have been trying to return ******* call and have been told she is unavailable and calls having been going to automated voice mail.  We would like to setup bi-weekly calls with ***** and to ensure she receives her status updates bi-weekly as well.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩