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Health Plan Simplifies Upgrades and Gains Efficiencies by Adopting a Common Eligibility Service Layer

The Challenge

One of the nation’s largest publicly operated health plans providing coverage to low-income residents wanted to eliminate cumbersome file transfers between applications. These transfers bypassed certain rules and functionality within the health plan’s TriZetto QNXT core administration system—impeding access to valuable data, impacting administrative performance and data consistency, and causing additional work for eligibility and claims processing teams.

The health plan also wanted to reduce operational and upgrade costs by adopting a common eligibility service layer to support its five lines of business. A Cognizant Consulting team partnered with the client’s team to map, prototype and implement an application solution that disseminates and removes reliance on custom file load processes.

Our Approach

The TriZetto QNXT eXtended Integration (QXI) service-oriented architecture allowed the health plan to quickly and easily access, search and update information stored within the QNXT system. By implementing a new enterprise service business within QNXT that included a transactional-based eligibility and enrollment process, transactions are now captured on a real-time basis. In addition, the solution eliminated five different code bases and their data redundancies.

Money and Time Saved by Extending Integration Functionality

Our support team continued to work with the health plan after the implementation to identify and resolve any remaining system bottlenecks, further increasing performance levels from 30,000 transactions per hour to 100,000 per hour.


60% saving

on the future upgrade costs


processing speed

50% reduction

in eligibility transactions