Payer platform & interoperability, tested against the EHR.
A Cognizant TriZetto partner bench for Facets, QNXT, NetworX, CareAdvance — paired with an Epic-credentialed provider-side practice. We build the API on the payer side, then validate it against the EHR on our own bench. That round-trip is rare among payer-services partners.
Partner
TriZetto
R4
FHIR
2027
CMS-0057
180+
Epic-Cred.
Both sides of the wire
live wireRun-state, modernize, or both.
Whether your TriZetto stack is humming or due for a meaningful refresh — we'll meet it where it is.
TriZetto Facets
Configuration, custom development, upgrades; member, provider, benefit, contract, and claims module operations.
TriZetto QNXT
Run-state operations, integration build, batch tuning, member-services modules, and provider-network configuration.
NetworX & CareAdvance
Pricer logic for contracted networks, utilization management and care management configuration on CareAdvance.
Integration & Reporting
ETL into the data lake, EDI 270/271/276/277/278/834/835/837, BI cube, and analyst-grade reporting.
The CMS-0057 and Da Vinci workstreams.
We build the API on the payer side, then verify it against an EHR on our own bench. That round-trip validation is rare among payer-services partners.
CMS-0057-F Prior Authorization API
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires impacted payers — Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs — to implement and maintain a FHIR Prior Authorization API beginning January 1, 2027. We build the API on the payer side and validate it against EHR consumers (including Epic) on our own bench.
HL7 Da Vinci (CRD / DTR / PAS)
Coverage Requirements Discovery, Documentation Templates & Rules, and Prior-Authorization Support implementation guides. We implement the IGs on the payer side using TriZetto Facets/QNXT as the system of record, and verify the EHR side with our Epic-credentialed analysts.
USCDI Member Data Exchange
Patient Access API, Provider Directory API, and Payer-to-Payer data exchange aligned to USCDI v3+. Member consent, scope handling, and SMART-on-FHIR app launches treated as first-class flows, not afterthoughts.
Provider Data Management
Provider directory accuracy work driven by the No Surprises Act, credentialing intake automation, roster reconciliation across Facets/QNXT and downstream marketing surfaces, network-adequacy reporting.
Why this is rare
Our payer bench is supported by 180+ Epic-credentialed provider-side analysts.
Most TriZetto partners only know one side of the wire. When a CMS-0057 prior-auth call hits an EHR, the message gets parsed by Epic Hyperdrive, MyChart, or an App Orchard endpoint — and the failure modes there look nothing like Facets failures. We've seen both, and we test both.
180+
Epic-Credentialed
Cert.
Facets
Cert.
QNXT
24×7
Operations
Risk, Stars, and quality support.
The downstream work that turns the platform investment into Stars points and CMS revenue.
HEDIS Abstraction Support
Chart-chase coordination, supplemental data ingest, hybrid measure support.
Stars Analytics
Member-level Stars scoring, gap-closure prioritization, campaign-ready cohort lists.
Risk-Adjustment Validation
RAF accuracy review, HCC re-coding QA, RADV-ready documentation chains.
CAHPS / HOS Readiness
Survey-period prep, member-experience analytics, action-plan owners and due dates.
Three engagement models.
Pick the entry point that matches your governance — we'll bring the rest of the bench when you need it.
Managed TriZetto Operations
We take over day-to-day Facets / QNXT operations under your governance, runbook, and SLAs. Includes config changes, batch monitoring, upgrade prep, and ticket queues.
Run-state SOWInterop Build
CMS-0057 prior-auth API, Da Vinci CRD/DTR/PAS, Patient Access, Provider Directory, or Payer-to-Payer. Fixed-scope build with EHR-side validation included.
Interop SOWEmbedded Pod
Embed a 4-8 person pod into your platform team — configuration analysts, integration engineer, BA, and a platform-certified TriZetto lead — under your sprint cadence.
Pod SOWThe Stack
Both sides of the wire, certified
Cognizant TriZetto partner on the payer side, Epic-credentialed on the provider side. Gartner-recognized and KLAS Customer Rated for the product layer.
Third-Party Validated
The certifications under the BAA
What we sign with before we touch your member, provider, or claims data.
“The interop work was where we needed both sides of the wire. They built our CMS-0057 API, then put it in front of an Epic-credentialed analyst on their own bench to confirm the EHR end behaved the way the IG expected. That double-sided validation is what sold our CIO.”
Director of Interoperability
Regional Blues Plan · Anonymized; named reference available under mutual NDA
Bring us your hardest interop ask.
We'll walk through how we'd build it in TriZetto, validate it against Epic, and operationalize it through the run-state bench — in a single working session.