Proven value by delivering complementary software, services or technology that expand Facets®
Facets partners
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 Knowledge base 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.
OPTUM® Prospective Payment Systems
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.
Avalon Healthcare Solutions
Avalon Healthcare Solutions is the world’s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, covering more than 15 million lives, Avalon is pioneering a new era of value-driven care with its Lab Insights System. The company delivers 7–12% outpatient lab benefit savings and captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensure appropriate treatment protocols, and drive down overall cost.
Through Avalon's partnership with Cognizant, TriZetto® Facets® clients can rapidly realize these savings by leveraging the real-time Facets Interface to Avalon.
Zelis™ Healthcare
Zelis™ Healthcare delivers measurable value through our unparalleled claim integrity solutions, operational excellence and healthcare intelligence. Our integrated multiple products and solutions ensure that our clients are obtaining the highest level of savings on each claim through our robust technology and precise processes, enhanced with human expertise. Through our partnership with Cognizant for a near real-time interface to TriZetto’s® Facets™ core administration platform, we ensure that your daily claim process is kept intact, operation rule consistency automation is achieved, and most importantly, near real-time capabilities reduce turnaround time from days/hours to seconds. With the Facets™ interface to Zelis Payment Integrity services, you will also see reduction of loss ratio and increased operational transparency, all of which can lead to substantial savings.
ECHO®
ECHO® is an insurance technology company focused on removing the complexity and costs of healthcare payment processing. We manage every aspect of the payment process through a single HITRUST-certified platform fully integrated with TriZetto Facets: claim disbursement, provider EFT and ERA enrollment, compliance, reconciliation, reporting, and 1099 processing. With this simplified approach, we save our customers over $1 billion annually while issuing over 500 million transactions totaling over $100 billion in payments. ECHO maintains the largest network of healthcare provider payment and remittance delivery preferences and prides itself on providing the most electronic options to providers in a secure environment. The variety of our payment modalities promotes the most significant level of electronic adoption; and our fraud prevention tools comfort the over 330 payer customers and over 1 million providers in our network.
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.
ECHO®
ECHO® is an insurance technology company focused on removing the complexity and costs of healthcare payment processing. We manage every aspect of the payment process through a single HITRUST-certified platform fully integrated with TriZetto Facets: claim disbursement, provider EFT and ERA enrollment, compliance, reconciliation, reporting, and 1099 processing. With this simplified approach, we save our customers over $1 billion annually while issuing over 500 million transactions totaling over $100 billion in payments. ECHO maintains the largest network of healthcare provider payment and remittance delivery preferences and prides itself on providing the most electronic options to providers in a secure environment. The variety of our payment modalities promotes the most significant level of electronic adoption; and our fraud prevention tools comfort the over 330 payer customers and over 1 million providers in our network.
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 on 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.
Cúratus
Cúratus delivers end-to-end provider data management (PDM) technology to government-sponsored and commercial health plans and provider groups through our ProviderLenz ‘Platform as a Service’ (PaaS) system.
ProviderLenz is a full-service and AI-enabled PDM solution empowering automated dissemination of curated provider data to all operational systems within a payer’s IT infrastructure ensuring the most up-to-date provider information is available enterprise-wide. Payers leveraging ProviderLenz will reduce costs associated with managing provider data while improving operational efficiency, compliance, and customer service.
The many Cognizant payer clients using the industry-leading TriZetto® Facets® core administration platform can now leverage bi-directional and automated data exchange by utilizing the TriZetto® Configuration Orchestrator for Facets® to Provider Service with the ProviderLenz PDM technology. This integrated solution will further streamline claims-processing workflows, consolidate IT tools managing interactions with network partners, and reduce the administrative burden on those same network partners.
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 Strategic Alliances Team will work with you to determine if a potential partnership is appropriate.