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TriZetto Healthcare Products / Medicare

Solutions that grow medicare markets

Our experience and capabilities will help you effectively address your Medicare administration needs, revenue management and data submission so you can respond quickly to evolving mandates and regulatory requirements.
The number of people receiving Medicare benefits is projected to rise nearly 60% by 2030. For health plans serving this market, long-term success demands increased system efficiencies to support this rapid growth. Medicare market success also requires tools that enable continued compliance with changes in Medicare reporting rules, complex Centers for Medicare and Medicaid Services (CMS) regulations and the Medical Loss Ratio (MLR) requirement.
With more than 30% of all Medicare Advantage and Part D lives processed on our core systems, the Cognizant line of TriZetto Healthcare Products provides an extensive portfolio of capabilities to meet the specific needs of your business. This comprehensive and highly effective combination of advanced technology and services offerings can help you lower administrative costs, increase speed to market and decrease total cost of ownership. Other capabilities work to:
  • Automatically enroll new members
  • Generate, edit and reconcile required Risk Adjustment Payment System (RAPS) and encounter data submissions
  • Accurately reconcile Medicare members
  • Enhance risk score accuracy to receive proper reimbursement
  • Identify where members have Hierarchical Condition Categories (HCCs)
  • Utilize analytics to improve your Five-Star Quality Rating
  • Coordinate and improve care for Medicare members
  • Manage new reimbursement and care models


Core Administration

Increases payer efficiency, improves productivity, reduces costs and positions your business for growth.

Cognizant Interoperability Solutions

Offers end-to-end solution that pairs modular SaaS products with industry-leading strategic consulting to connect disparate systems, standardize data and enable secure, authenticated access in real-time.

Provider Reimbursement Solutions

Automates pricing scenarios to provide the best value to payers, providers and patients.

Quality Management

Enables payer/provider collaboration to reduce costs and drive overall quality improvement.

TriZetto® EngageMember®

Members may interact anytime, anywhere and receive a detailed view of their coverage information with compelling metrics, timely notifications and relevant healthcare content.

Business Process-as-a-Service

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

TriZetto® EngageProvider®

Enables physicians and other care providers to access detailed information on their patients, efficiently log claims and make templates for common claims, as well as easily create referrals and authorizations.

Trading Partner Management

Manages EDI trading partners with one cost-effective, cloud-enabled technology service.

Care Management

Connects care managers to members and providers while reducing costs, personalizing interventions and improving care quality.

Optimization Software Products

Automate and simplify operational tasks associated with our core healthcare technology solutions, Facets and QNXT.

TriZetto Elements®

Extend the functionality of your core system by providing critical capabilities from enrollment through risk adjustment, to efficiently administer government solutions.

Portal Technology

Automates transaction processing and information exchange between payer organizations and their external constituents.

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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