Trizetto
Trizetto by Cognizant is the enterprise healthcare revenue cycle and claims management platform trusted by major health plans, hospitals, and large healthcare organizations. Integrated with AdvancedCare, it delivers comprehensive claims processing, adjudication, and payment solutions with the scale and reliability needed for high-volume operations.
Enterprise Scale
Process millions of claims with proven reliability for large healthcare organizations
Connected Network
Direct connections to 2,000+ payers and healthcare organizations nationwide
Automated Workflows
Intelligent automation reduces manual intervention and accelerates processing
Key Features
Comprehensive Claims Management
Trizetto provides end-to-end claims management from submission through adjudication and payment. The platform handles all claim types including professional, institutional, pharmacy, and dental claims. Advanced claim editing ensures compliance with payer rules and industry standards before submission. Direct electronic data interchange (EDI) connections to major payers enable fast, reliable claim transmission. The system supports both HIPAA 5010 and prior transaction standards for maximum compatibility. Automated status tracking provides real-time visibility into every claim's lifecycle.
Intelligent Claims Processing
Trizetto's Claims Processing platform uses sophisticated rules engines and artificial intelligence to automate claim adjudication. The system performs medical necessity reviews, bundling analysis, and duplicate detection automatically. Pre-payment and post-payment audits identify potential fraud, waste, and abuse. Contract management ensures accurate reimbursement based on negotiated rates. The platform supports value-based payment models including quality bonuses and risk-based contracts. Real-time analytics identify trends in claims patterns, utilization, and costs.
Network & Connectivity Solutions
As one of the largest healthcare technology networks in the U.S., Trizetto connects providers, payers, and patients seamlessly. The clearinghouse network processes over 11 billion transactions annually with 99.95% uptime. Electronic eligibility verification provides instant benefit information. Electronic remittance advice (ERA) and electronic funds transfer (EFT) streamline payment processes. The platform supports electronic prior authorizations, reducing administrative burden. API-based integrations enable modern connectivity patterns for real-time data exchange.
Platform Capabilities
Clearinghouse Services
Process claims to 2,000+ payers with direct EDI connections and 99.95% uptime
Claims Adjudication
Automated claim processing with medical necessity reviews and payment accuracy
Payment Integrity
Pre-payment and post-payment audits identify overpayments and potential fraud
Contract Management
Manage payer contracts and fee schedules with automated rate updates
Revenue Analytics
Comprehensive reporting on claims, payments, denials, and revenue cycle metrics
API Integration
Modern REST APIs enable real-time integration with practice management systems