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Proven value by delivering complementary software, services or technology that expand Facets™.

Facets partners operate in cooperation with the solutions offered in the TriZetto Facets Enterprise line of core administration products and services. These partner organizations have proven their value by delivering complementary software, services or technology that enhances or expands the functionality and effectiveness of the Facets line. The businesses and solutions identified here meet the quality and integrity standards we have established for our partner organizations—allowing integration and/or facilitated interaction with our industry-leading Facets technology.

FACETS PARTNERS

  • Claims Editing and Auditing

    ClaimsXten™

    Help Improve Claims Payment Efficiency, and Reduce Costs

    Health plan operations are complex. Regulatory and CMS policy changes, evolving clinical guidelines, and new reimbursement models challenge payers to ensure payments are medically and contractually accurate. Are you looking for ways to improve claims payment accuracy, while reducing costs? Achieve it with ClaimsXten™ and strengthen provider, member, employer, and regulatory relationships. With payment policy development experience that spans over 30 years and a client base that includes 80% of the top 20 largest health plans and 45 Blue Cross Blue Shield plans, Change Healthcare has served an essential role in reducing the cost of healthcare. By correcting inappropriately billed claims, ClaimsXten has saved billions of dollars for the industry.

    ClaimXten™ is an integrated partner product that provides an advanced claims auditing solution for applying complex payment and medical policies, and complex provider contract terms to the adjudication process. The ClaimsXten™ - Facets™ Connector helps to increase administrative efficiency and enables customers the flexibility to process each claim under the specific terms and conditions of each benefit plan. ClaimsXten™ combines the Change Healthcare clinical claims management software and rules engine, a comprehensive library of clinical rule content, and a services team of medical claims experts to provide your organization with more medical and administrative savings opportunities.

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    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 KnowledgeBase 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.

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  • Claims Grouping and Pricing

    OPTUM®

    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.

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  • Healthcare Account and Funds Management

    ALEGEUS 

    With the industry’s #1 multi-purse benefit debit card platform tightly integrated with the TriZetto Healthcare Products Facets platform, Alegeus enables integrated consumer benefit account management of HSA, FSA, HRA and dependent care accounts. By giving them access to their flexible benefit account balances using a convenient debit card, Alegeus empowers members to better manage their healthcare expenses and to take a more active role in their health and wealth situation.

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  • Healthcare Payments Technology

    ZELIS™ PAYMENTS

    Zelis™ Payments is a leading healthcare payments technology company dedicated to delivering value via exceptional client experiences. Our solutions facilitate regulatory compliance and streamline the transfer of healthcare payments and data. Through our proprietary integration with Cognizant’s TriZetto® Facets, Zelis Payment’s technology becomes a part of your daily workflow to create a seamless payment process, which improves accuracy and reduces process complexity for significantly improved cost control. To ensure provider satisfaction and reduce noise, we employ a unique, provider-centric enrollment and support model, which encourages electronic adoption and network retention.

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  • Outbound Printing and Fulfillment

    REDCARD

    RedCard delivers reliable, client branded, enhanced design and production of critical customer communications including healthcare checks, Explanation of Payments (EOPs), Explanation of Benefits (EOBs), Healthcare (ID) cards, enrollment-related correspondence, and letters delivered in the mail or via the Web. RedCard enables clients, through an integrated set of web-based self-service management tools, the ability to redesign its member and provider communication utilizing the latest four-color technology. Based upon client-specific needs, it will also enhance communication time frames using its industry first, healthcare episode-based claim bundling option. This integrated system creates new cost savings while changing the frequency, look, and feel of the communications, allowing for fewer customer service calls and an overall better experience.

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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 Stragetic Alliances Team will work with you to determine if a potential partnership is appropriate.

May 20–23, 2018 Cognizant Healthcare Conference

The Healthcare Conference brings our clients and partners together to discuss strategies and solutions that will help address the challenges you are facing today.

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At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.

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