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TriZetto Unify
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Why Cognizant?

Proven innovation and scale
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Seamless ecosystem connectivity
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Future-ready architecture
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Flexible deployment
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Workflow harmony    
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AI-driven transformation
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Regulatory confidence
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Unified solutions
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Unify strategy

At the heart of our TriZetto Unify strategy is a comprehensive framework combining provider, intermediary and payer experiences into one interoperability foundation. Built for scale, TriZetto delivers many-to-many interoperability—enabling multiple providers to seamlessly connect with various payers through a single platform.

  • Provider experience

    Enabling provider participation and engagement through multiple connectivity options. 

    • Direct API connectivity with EMR and PMS

    • SMART embedding on FHIR applications to keep providers in their workflows

    • FHIR connectivity extension to providers by supporting their existing clearinghouse relationships 
  • Integrated intermediary

    Enabling trusted, accurate and resilient transactions across the healthcare ecosystem.

    • Provider and trading partner onboarding and authentication

    • Governance, validation, enrichment, orchestration and routing across FHIR and X12—bilingual data processing and exchange
       
    • API hosting, translation and gateway management
  • Payer experience

    Enabling payers to manage oversight, compliance and innovation from one interface. 

    • Integrated with TriZetto core administration (Facets®, QNXT™) and care management systems (CareAdvance®, QNXT UM, Facets UM)

    • Modular, open architecture supports compliance, analytics and care-quality workflows

Interoperable solutions

TriZetto delivers a suite of interoperable solutions that can be adopted individually or deployed as a fully connected digital fabric. Each component is designed to address critical areas of payer-provider collaboration, regulatory compliance and clinical data exchange.

  • Electronic prior authorization (CRD, DTR, PAS)
  • Clinical data exchange (CDEX)
  • Provider access (clinical data APIs)
  • Care gaps and quality measures (DEQM and GIC)

Our TriZetto prior authorization solutions deliver unified, dual-sided workflows that simplify and accelerate the prior authorization process across the TriZetto Enablement Platform. Designed to meet CMS-0057 requirements and built on FHIR and X12 standards, our solutions bridge payer and provider systems to reduce administrative burden and improve care access.

  • Automate CRD, DTR and PAS across both payer and provider user experiences

  • Support X12 278 conversion, ensuring full interoperability between traditional transactions and FHIR workflows

  • Enable real-time administrative and clinical decision-making

  • Pre-build, optimize integrations for payer systems:

    • Core administration systems (Facets, QNXT)
    • Care management systems (CareAdvance, QNXT UM, Facets UM)

Together, these capabilities create a streamlined prior authorization ecosystem that supports regulatory compliance, enhances operational efficiency and improves collaboration between payers and providers.

The TriZetto Payer Electronic Prior Authorization empowers payers with a comprehensive, intelligent platform to manage prior authorization workflows with precision, speed and compliance. Built to align with CMS-0057 and Da Vinci implementation guides, the solution orchestrates data exchange between provider-initiated requests and payer utilization management systems—reducing friction, improving outcomes and enhancing oversight. 

  • Real-time dashboards provide visibility into utilization trends, process efficiency and authorization outcomes, enabling data-driven decisions

  • The solution connects with core UM applications, clinical guidelines and delegated vendors to ensure consistent response orchestration across the payer ecosystem

  • Intelligent decision automation combining administrative and clinical insight to reduce denials and improve outcomes

The TriZetto Provider Electronic Prior Authorization is designed to meet providers where they are—whether in large health systems or independent practices—by offering flexible, standards-based connectivity that integrates seamlessly into existing workflows. The solution empowers providers to automate prior authorization processes without disrupting their current systems or relationships.

  • SMART on FHIR app submission from EMRs

  • Direct API submissions from EMRs

  • Extended FHIR connectivity to providers by supporting their existing clearinghouse relationships
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The TriZetto Payer Care Gaps Solution creates a single, streamlined ecosystem for clinical documentation exchange, reducing administrative burden and improving interoperability by enabling seamless, bidirectional exchange of quality measure data between payers and providers to address gaps in care. The solution provides near real-time, actionable information to empower healthcare stakeholders to deliver high-quality care, leading to better health outcomes and higher patient satisfaction.

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The TriZetto Payer Clinical Data Exchange Solution delivers a unified, dual-sided workflow for solicited attachments supporting both prior authorization and claims processes. This solution aligns with HL7® Da Vinci CDEX implementation guide standards.

  • Automates task-based requests and submissions using API for prior authorization and claims documentation

  • Supports LOINC-coded requests, enabling precise data targeting and reducing unnecessary data exposure

  • Integrates with payer core systems, including Facets and QNXT, and care management platforms such as CareAdvance

  • Accepts structured and unstructured formats, ensuring flexibility across provider systems

  • Enables efficient clinical and administrative decision-making through seamless FHIR-based exchanges

Delivering strategic value

The TriZetto Unify strategy is not just a compliance infrastructure—it is a transformational interoperability foundation:

  • Enables faster, more accurate decisions by blending administrative and clinical workflows

  • Reduces administrative costs by consolidating payer interfaces

  • Reduces denials and delays through enriched, validated transactions

  • Enhances health outcomes through bidirectional care gap and quality measure flows

  • Provides seamless, multiple experiences for payers, providers and partners across healthcare
TriZetto Unify enables faster, bidirectional payer-provider communications with richer sets of clinical and administrative data. It is open and built on industry standards such as HL7® FHIR® and helps organizations comply with emerging interoperability regulations.
Disclaimer: HL7®, and HL7® FHIR® are registered trademarks of Health Level Seven International, and their use of these trademarks does not constitute an endorsement by HL7.

Take the first step

Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital healthcare solutions is vast and growing. Our expertise in healthcare IT services enables us to integrate cutting-edge technology seamlessly into your operations.

Let’s talk about how digital healthcare IT solutions can work for your business.