Proven value by delivering complementary software, services or technology that expand Facets®
Facets partners
Avalon Healthcare Solutions
Avalon Healthcare Solutions is the world’s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs and improve clinical outcomes. Working with health plans across the country, covering more than 15 million lives, Avalon is pioneering a new era of value-driven care with its Lab Insights System. The company delivers 7–12% outpatient lab benefit savings and captures, digitizes and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensure appropriate treatment protocols and drive down overall cost.
Through Avalon's partnership with Cognizant, TriZetto® Facets® clients can rapidly realize these savings by leveraging the real-time Facets Interface to Avalon.
Lyric pre-pay editing solutions
Lyric, formerly ClaimsXten Portfolio, is an integrated partner with more than 35 years of expertise as a leader in pre-pay editing. Using a technology-first approach, Lyric’s vision is to simplify the business of care by offering a comprehensive platform of payment accuracy and integrity offerings to provide savings and quicker speed to value for health plan customers, enabling more efficient use of resources to reduce cost of care, to benefit payers, providers and patients. Lyric is proud to be 2025 Best in KLAS for Pre-payment Accuracy and Integrity and is HI-TRUST and SOC2 certified.
Lyric’s editing solutions help to deliver up to $20 billion of annual value, including 9 of the top 10 payers across the country. They are clinically based and backed by experienced medical directors, health information specialists and certified coders. Using robust claims history, Lyric’s customizable editing solutions automate edits, rules and policies sourced by nationally recognized organizations—including Centers for Medicare and Medicaid Services, the American Medical Association and specialty societies, as well as a health plan’s unique payment and medical policies—to help customers correctly process and pay both professional and facility claims.
Lyric’s pre-pay claim editing is divided into primary and secondary claim edit offerings, each with distinct sources and purposes:
Primary editing
Primary editing combines both industry-sourced and customized content to ensure accurate claims processing. The industry-sourced content draws from reimbursement guidelines, medical policy, KnowledgePacks and Lyric's extensive Knowledge Concept Library.
Complementing this, customized content is specifically tailored to meet individual health plan needs through Lyric's Policy Management Module, which addresses unique scenarios and policies. Through these primary edits, claims are verified to meet basic coding and billing standards, preventing obvious errors and maintaining compliance with established guidelines.
Lyric’s primary editing is integrated to TriZetto Facets customers via the near real-time TriZetto® Facets® Adapter for ClaimsXten, increasing administrative efficiency and speed to value.
Secondary editing
Secondary editing goes beyond primary edits to deliver incremental savings opportunities and drive consistency. This advanced editing leverages robust claims history and expands the review to additional medical claims, including inpatient claims. Secondary editing uses advanced concepts, plan-specific policies, industry subject-matter experts and market trends to identify new opportunities to increase savings and unlock greater value.
Claims have an increased level of complexity that goes beyond traditional primary editing. A secondary editing solution ensures you maximize the opportunity to pay claims accurately. This layering, or “stacking” of both types of editing, is successfully used by many payers today to drive maximum value in prepay editing.
Lyric’s secondary editing is integrated to TriZetto Facets customers via the near real-time TriZetto® Facets® Interface for Lyric Secondary Editing, increasing administrative efficiency and speed to value.
OPTUM® Claims Editing System
The OPTUM Claims Editing System, an integrated partner product, is a powerful adjunct to the Facets enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant Knowledge base of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.
Zelis™
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients.
Zelis and Cognizant formed a strategic partnership a decade ago that has since helped more than 50 companies and more than 20M members across Commercial, Medicare and Medicare Advantage lines of business. Our seamless integration to TriZetto Facets is facilitated by the TriZetto® Facets® Interface for Zelis® Payment Integrity amplifies Zelis’ ability to drive efficiency and savings by delivering innovative cost management and payments solutions. Zelis solutions are tailored to meet unique payer requirements, driving efficiency on very claim, every day.
Zelis Out-of-Network Services use ClaimPass®, our multilayered approach that utilizes all applicable channels and opportunities to find the best savings on non-par claims. First, the net cost of the claim is determined by applying historical data, payment integrity technology, clinical and coding expertise, supportable benchmarks and scalable technology. ClaimPass then determines the optimal discount by dynamically evaluating multiple savings options:
- Supplemental Networks
- Expert Negotiations
- Zelis Choice Provider Agreement
- Reference Based Pricing
Zelis Payment Integrity offers end-to-end payment integrity solutions for both pre- and post-payment. Our human-led, tech-enabled approach combines advanced technology with clinical expertise to detect coding errors, inappropriate charges and high-risk claims. By detecting improper claims early, we achieve direct savings and avoid, waste, reducing downstream administrative costs. Our multi-channel integrated approach to payment integrity helps ensure a positive financial experience for providers, payers and members.
OPTUM® Prospective Payment Systems
The OPTUM® Prospective Payment Systems (PPS) software application, an integrated partner product, maps, groups and prices facility claims to ensure appropriate reimbursement. OPTUM®’s ECMPro™ application integrates with TriZetto®’s NetworX Suite® solution to manage grouping, pricing, editing and mapping for Federal (DRG, APC, ASC, IRF, SNF, CAH, LTCH, IPF, Physician) Prospective Payment Systems (PPS) and more than 20 state and payer specific PPS. Facility (inpatient and outpatient) and professional Medicare PPS, and a number of Medicaid PPS are integrated with NetworX Pricer® to support auto-adjudicated claims processing. Users can also apply the supported Medicare and/or Medicaid PPS to their commercial business processing. The integrated solutions streamline claims-processing workflows to reduce reimbursement errors and improve payment integrity.
ECHO®
ECHO® is an insurance technology company focused on removing the complexity and costs of healthcare payment processing. We manage every aspect of the payment process through a single HITRUST-certified platform fully integrated with TriZetto Facets: claim disbursement, provider EFT and ERA enrollment, compliance, reconciliation, reporting, and 1099 processing. With this simplified approach, we save our customers over $1 billion annually while issuing over 500 million transactions totaling over $100 billion in payments. ECHO maintains the largest network of healthcare provider payment and remittance delivery preferences and prides itself on providing the most electronic options to providers in a secure environment. The variety of our payment modalities promotes the most significant level of electronic adoption; and our fraud prevention tools comfort the over 330 payer customers and over 1 million providers in our network.
Zelis® Payments
Zelis is on a mission to modernize the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers and healthcare consumers. Our platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients. We use technology to create win-win-win solutions, so payers and providers can focus on delivering care to people when and where they need it.
Zelis Payments is powered by innovative products, partnerships, intelligent treasury management, a robust rules-based engine and unmatched payer and provider relationships. At the heart of our innovative approach, products, expertise and capabilities lies our flagship solution, Zelis Advanced Payments Platform (ZAPP). ZAPP helps payers process high volumes of claims payments and communications, along with corresponding technical requirements and rules, in one integrated platform. In a single platform, medical, dental, WC and P&C insurers can manage their provider payments and data files, according to provider preference, vendor and member disbursements, and member communications, EOBs and ID cards, in print or digital formats. ZAPP helps payers simplify and streamline operations, reduce complexity and stay compliant, while providing a personalized, efficient and intuitive payments and communications experience.
Zelis Payments is transforming the healthcare payments landscape by providing a seamless experience that prioritizes choice, convenience and efficiency, benefiting payers, providers and members alike—creating a modernized healthcare experience for everyone.
Cúratus
Cúratus delivers end-to-end provider data management (PDM) technology to government-sponsored and commercial health plans and provider groups through our ProviderLenz ‘Platform as a Service’ (PaaS) system.
ProviderLenz is a full-service and AI-enabled PDM solution empowering automated dissemination of curated provider data to all operational systems within a payer’s IT infrastructure ensuring the most up-to-date provider information is available enterprise-wide. Payers leveraging ProviderLenz will reduce costs associated with managing provider data while improving operational efficiency, compliance, and customer service.
The many Cognizant payer clients using the industry-leading TriZetto® Facets® core administration platform can now leverage bi-directional and automated data exchange by utilizing the TriZetto® Configuration Orchestrator for Facets® to Provider Service with the ProviderLenz PDM technology. This integrated solution will further streamline claims-processing workflows, consolidate IT tools managing interactions with network partners, and reduce the administrative burden on those same network partners.
Simplify Provider1™
Simplify Healthcare enables Provider lifecycle management solutions for payers through a scalable, enterprise-grade, secure, compliant and configurable cloud-based software platform—Simplify Health Cloud™. Simplify Healthcare solutions drive significant cost take out and growth through a combination of highly configurable automation, AI and intelligent data flows.
Provider1™—Single source of truth for provider data with capabilities to manage the provider lifecycle across provider onboarding, contracting, credentialing, roster file management and provider data management. Provider1™ is the only integrated end to end solution that connects PDM, Credentialing, Contracting, Self-serve and eSign.
When used with Provider1™, Claims1™, enables transmission of provider data to TriZetto Facets, through the TriZetto® Configuration Orchestrator. The integrated solution significantly reduces the manual configuration of provider data into Facets® and hence results in reduced time from sale to “ready to serve” enabling sales teams to sell much deeper into the season, increased claim and configuration accuracy, and an opportunity to optimize configuration processes.
Simplify Benefits1™
Simplify Healthcare enables Benefits and Product lifecycle management solutions for payers through a scalable, enterprise-grade, secure, compliant and configurable cloud-based software platform—Simplify Health Cloud™. Simplify Healthcare solutions drive significant cost take out and growth through a combination of highly configurable automation, AI and intelligent data flows.
Benefits1™—Single source of truth across all LOBs (Medicare Advantage, Medicaid, Medicare Supplemental, ACA, Large Group Self Insured and Fully Insured) for the products and benefits plan including product catalog, mandated and marketing materials (DocGen), filing with regulatory bodies automatically, reporting, intelligent AI enabled Sales Front end.
When used with Benefits1™, Claims1™ enables transmission of benefits data to TriZetto Facets through the TriZetto® Configuration Orchestrator. The integrated solution significantly reduces the manual configuration of benefits into Facets and hence results in reduced time from sale to “ready to serve” enabling sales teams to sell much deeper into the season, increased claim and configuration accuracy, and an opportunity to optimize configuration processes.
Simplify Service1™
Service1™—Benefit Inquiry solution which aggregates product benefits data and make it available to customer service and any other digital channel in human understandable language. It enables payers to deliver an omnichannel improved benefits inquiry experience to members, providers, employer groups, brokers/agents, care managers and other stakeholders. The platform is proven to reduce benefit inquiry call handle times from 10+ minutes to less than 5 minutes.
Become a partner
If your organization offers solutions that could potentially enhance those offered within Cognizant’s line of TriZetto Healthcare Products and provide added value or an enhanced experience for our payer clients, click here. Our Strategic Alliances Team will work with you to determine if a potential partnership is appropriate.