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

The ClaimsExchange service is integrated with the QicLink™, Facets™ and QNXT™ enterprise core administration systems to seamlessly connect healthcare payer organizations to a vast network of PPOs for electronic claims routing and re-pricing via a single point of connectivity. This automated service has highly configurable routing rules to support complex workflows, real-time re-pricing in conjunction with Cognizant’s line of TriZetto network management solutions and the exchange of fraud and abuse data with trading partners.

Pre-Adjudication – ClaimsExchange is 5010 and ICD-10 compatible and reduces payer/PPO barriers. By integrating the multitude of PPOs directly into the process flow, claims can be accurately re-priced based on the provider databases and contract parameters in effect.

Post-Adjudication – ClaimsExchange automatically captures discounts on out-of-network claims via a post-adjudication interface with fee negotiators. Claim selection takes place after a claim has been adjudicated in the QicLink or Facets application. This allows the claim to be negotiated for a discount after benefit determination but prior to payment—reducing adjustments due to ineligible claims.

Benefits of this unique post-adjudication functionality:

  • Negotiations are based on allowable charges
  • No transaction fees are assigned to payer
  • Only eligible claims are sent for negotiations
  • Potential added savings may be captured on non-contracted claims
  • Reporting capabilities capture re-pricing and out-of-network discount activity


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


Business Process Services

Services that offer meaningful, business outcomes.

Business Consulting

Unparalleled healthcare business consulting expertise.

Next-Gen Technologies

Leverage the power of next-generation technologies to build a stronger, agile business.

Infrastructure Services

Services to manage your infrastructure so you can manage your business.

IT Professional Services

Unrivaled resources and healthcare expertise to meet your IT business needs.

Services/Benefits Administration

Software, technology, expertise and proven methodologies to help you manage your business more effectively.



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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