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FHIR®-Based Payer-Provider Solutions
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Richer data, faster

Based on our TriZetto® Unify strategy, our FHIR® based payer-provider solutions are designed to bridge the gaps between payers and providers. By enabling near-real-time, bidirectional data exchange between payers and providers, our solutions break down silos and empower clinicians and administrative staff to make better decisions during the moments that matter—those critical decision points in the care continuum. 

Built on open standards such as Fast Healthcare Interoperability Resources (FHIR®) and United States Core Data for Interoperability (USCDI), our payer-provider solutions help support compliance with both current and future regulations. By seamlessly integrating with payer systems and existing workflows and remaining open to connecting with a variety of provider EHR systems, our payer-provider collaboration solutions are scalable, future-proof options for any healthcare organization.

Our solutions

The TriZetto Payer Prior Authorization Solution standardizes, automates and streamlines the prior authorization process to help reduce the administrative burden and associated costs for both payers and providers. This SaaS-based solution expands our interoperability portfolio and helps payers meet the requirements for the Coverage Requirements Discovery (CRD), Documentation Template and Rules (DTR) and Prior Authorization Support (PAS) processes as outlined by the Da Vinci implementation guides.

The TriZetto Payer Care Gaps Solution is designed to transform the healthcare ecosystem by enabling the seamless, bidirectional exchange of quality measure data between payers and providers, as well as between a payer’s quality and care platforms. This modular portfolio solution helps address critical gaps in care reporting and facilitates updates to data of interest related to specific quality measures. 

By providing real-time, actionable information, this solution empowers healthcare stakeholders to deliver high-quality care during critical moments in a patient’s healthcare journey, ultimately leading to better health outcomes and higher patient satisfaction.

Take the first step

Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital healthcare solutions is vast and growing. Our expertise in healthcare IT services enables us to integrate cutting-edge technology seamlessly into your operations.

Let’s talk about how healthcare solutions can work for your business.