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For Third Party Administrations (TPAs) to effectively compete with larger plans, system functionality and performance must be maximized. These integrated application modules further extend the functionality and efficiency of the QicLink core by addressing areas of strategic business function as well as labor intensive processes that provide opportunity for increased automation.

QicLink Premium Billing™ allows TPAs to tailor billing, receivables, aging, lapse and cash posting control processes to meet their needs and supports automatic premium invoicing and payment via EFT. The application provides multi-level agent commission calculation options and automatically calculates and adjusts invoices due to late notification of enrollment; updates carrier and agent files when invoices are paid; and provides complete 1099 tracking for vendor and agent commission processing.

QicLink ClaimWorkflow™ helps improve business processes via functionality that includes multi-source data acceptance (via clearinghouses and direct provider submission), automated rules-based routing of claims and encounters, and claims adjudication-based on pre-assigned routing conditions.

QicLink ClaimRules™ enables rules-based, procedure-driven claims/encounter adjudication by incorporating efficient plan building and maintenance procedures using a pre-built claim logic matrix. The result is greater claims payment accuracy, increased auto-adjudication and significant cost savings.

QicLink Customer Service™ provides ready access to multiple levels of information using point and click functionality, drop-down boxes, scroll lists and multiple sort and display options. Service call detail is captured and unresolved queries can be referred to another individual or department while management monitors and tracks call volumes and performance levels.

QicLink dataPiction™ allows today’s powerful relational database reporting and query tools to access QicLink application data. The system supports report distribution and offers an Open Database Connectivity (ODBC)—compliant report writing tool for web-based publishing and ad hoc reporting.

QicLink Claims Overflow Services offer an efficient, cost-effective alternative to accommodate those instances where a TPA’s in-house team is temporarily overburdened with outstanding claims and is facing an overflow situation. Cognizant adjusters receive random audits for accuracy and consistency, while the organization’s ready access to extensive on-site QicLink expertise further ensures high performance standards and reliability.

QicLink Application Management Services deliver high-quality hosting services that enable TPAs to focus on client-facing core competencies, while IT infrastructure and application management functions are expertly maintained.  Key Business Indicators provide information to assess the quality of services delivered, and specific Service Level Agreements (SLAs) guarantee system availability and performance levels

QicLink modular add-ons

QicLink Business Extension

Optimize operations and extend application functionality

QicLink Specialty Modules

Comprehensive functionality to support specialty lines of business

QicLink Network & Care

Effective tools that support today’s complex provider network and care management initiatives

QicLink Partners

Manage the cost and quality of care with access to affordable, QicLink-integrated solutions


Connect to a vast network of PPOs for electronic claims routing and re-pricing

Related services

Business process services

Services that offer meaningful business outcomes.

Business consulting

Benefit from our unparalleled healthcare business consulting expertise.

Next-gen technologies

Put next-generation technologies in place that build a stronger, more agile business and lay the groundwork for future AI and automation initiatives.

Infrastructure services

Get services that ease the strain of managing your infrastructure so you can focus on managing your business.

IT professional services

Take advantage of our unrivaled resources and healthcare expertise to meet your IT business needs.

Services/Benefits administration

Apply our proven software, technology, expertise and tested methodologies to manage your business more effectively.

Business process-as-a-service

Our integrated software and services healthcare BPaaS solution includes process optimization, digitization and large-scale efficiencies.

Contact us

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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