Proven value by delivering complementary software, services or technology that expand QNXT™.
QNXT partners
Lyric pre-pay editing solutions
Lyric, formerly ClaimsXten Portfolio, is an integrated partner with more than 35 years of expertise as a leader in pre-pay editing. Using a technology-first approach, Lyric’s vision is to simplify the business of care by offering a comprehensive platform of payment accuracy and integrity offerings to provide savings and quicker speed to value for health plan customers, enabling more efficient use of resources to reduce cost of care, to benefit payers, providers and patients. Lyric is proud to be 2025 Best in KLAS for Pre-payment Accuracy and Integrity and is HI-TRUST and SOC2 certified.
Lyric’s editing solutions help to deliver up to $20 billion of annual value, including 9 of the top 10 payers across the country. They are clinically based and backed by experienced medical directors, health information specialists and certified coders. Using robust claims history, Lyric’s customizable editing solutions automate edits, rules and policies sourced by nationally recognized organizations—including Centers for Medicare and Medicaid Services, the American Medical Association and specialty societies, as well as a health plan’s unique payment and medical policies—to help customers correctly process and pay both professional and facility claims.
Lyric’s pre-pay claim editing is divided into primary and secondary claim edit offerings, each with distinct sources and purposes:
Primary editing
Primary editing combines both industry-sourced and customized content to ensure accurate claims processing. The industry-sourced content draws from reimbursement guidelines, medical policy, KnowledgePacks and Lyric's extensive Knowledge Concept Library.
Complementing this, customized content is specifically tailored to meet individual health plan needs through Lyric's Policy Management Module, which addresses unique scenarios and policies. Through these primary edits, claims are verified to meet basic coding and billing standards, preventing obvious errors and maintaining compliance with established guidelines.
Lyric’s primary editing is integrated to TriZetto® QNXT™ customers via the near real-time TriZetto® QNXT™ Adapter for ClaimsXten, increasing administrative efficiency and speed to value.
Secondary editing
Secondary editing goes beyond primary edits to deliver incremental savings opportunities and drive consistency. This advanced editing leverages robust claims history and expands the review to additional medical claims, including inpatient claims. Secondary editing uses advanced concepts, plan-specific policies, industry subject-matter experts and market trends to identify new opportunities to increase savings and unlock greater value.
Claims have an increased level of complexity that goes beyond traditional primary editing. A secondary editing solution ensures you maximize the opportunity to pay claims accurately. This layering, or “stacking” of both types of editing, is successfully used by many payers today to drive maximum value in prepay editing.
Lyric’s secondary editing is integrated to TriZetto QNXT customers via the near real-time TriZetto® QNXT™ Interface for Lyric Secondary Editing, increasing administrative efficiency and speed to value.
OPTUM® Claims Editing System
The OPTUM Claims Editing System, an integrated partner product, is a powerful adjunct to the QNXT™ 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.
Zelis™
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients.
Zelis and Cognizant formed a strategic partnership a decade ago that has since helped more than 50 companies and more than 20M members across Commercial, Medicare and Medicare Advantage lines of business. Our seamless integration to TriZetto QNXT is facilitated by the TriZetto® QNXT™ Interface for Zelis® Payment Integrity amplifies Zelis’ ability to drive efficiency and savings by delivering innovative cost management and payments solutions. Zelis solutions are tailored to meet unique payer requirements, driving efficiency on very claim, every day.
Zelis Out-of-Network Services use ClaimPass®, our multilayered approach that utilizes all applicable channels and opportunities to find the best savings on non-par claims. First, the net cost of the claim is determined by applying historical data, payment integrity technology, clinical and coding expertise, supportable benchmarks and scalable technology. ClaimPass then determines the optimal discount by dynamically evaluating multiple savings options:
- Supplemental Networks
- Expert Negotiations
- Zelis Choice Provider Agreement
- Reference Based Pricing
Zelis Payment Integrity offers end-to-end payment integrity solutions for both pre- and post-payment. Our human-led, tech-enabled approach combines advanced technology with clinical expertise to detect coding errors, inappropriate charges and high-risk claims. By detecting improper claims early, we achieve direct savings and avoid, waste, reducing downstream administrative costs. Our multi-channel integrated approach to payment integrity helps ensure a positive financial experience for providers, payers and members.
Micro-Dyn Medical Systems, Inc.
Micro-Dyn Medical Systems, Inc. offerings are integrated partner products. Micro-Dyn specializes in software products for healthcare claim DRG calculation, APC assignment, Medicare reimbursement calculation, data editing, and validation to Medicare specifications. Micro-Dyn’s DRGActive™, APCActive™, and PRICERActive™ software and data editing components integrate seamlessly with QNXT to immediately add data validation, DRG/APC calculation and Medicare reimbursement capability.
OnBase® by Hyland
OnBase® by Hyland, an enterprise content management (ECM) solution, integrates with TriZetto® QNXT™ to provide payers with a single point of access for clinical and administrative content. OnBase for TriZetto QNXT gives users access to related content from within QNXT’s native view, meaning adjusters and plan administrators do not need to leave their QNXT window to search for information, speeding claims resolution and increasing member and provider satisfaction.
WEX Inc.
Cognizant and WEX Inc. have partnered to offer consumer-driven healthcare administration and benefits card solutions for payer organizations. Through the partnership, WEX Inc.'s industry-leading consumer-driven healthcare administration system, WEX Health Cloud, is available to Cognizant TriZetto® QNXT™ enterprise core administration system clients. The partnership agreement includes the WEX Health Payment Card which uses patented technology to achieve the highest auto-substantiation rates in the industry. WEX Inc. simplifies the business of healthcare through WEX Health Cloud, a cloud-based healthcare financial management platform that drives efficiency for benefit administration technology, consumer engagement, and advanced billing and payments. Our partner organizations enable us to deliver our industry-leading and award-winning solution to 225,000 employers and more than 24 million consumers. Together we take the complexity out of defined contribution, HSAs, HRAs, FSAs, VEBAs, PRAs, premium billing, public and private health insurance exchanges, COBRA, wellness plans, and transit plans. Learn more at www.wexinc.com, and follow WEX Inc. at @WEXIncNews.
Change Healthcare
Change Healthcare is an integrated partner with the QNXT™ enterprise core administration system, providing a single, automated communications and payments platform. The Change Healthcare QNXT interface provides a seamless connection for streamlined implementation; and enables better member engagement with printed and electronic communications across all lines of business, including Commercial, Individual, Medicare, Medicaid, PBM and Dental. Change Healthcare provides significant opportunities for QNXT customers to reduce overall costs, mitigate risk and drive digital adoption associated with regulated and non-regulated member communications and provider payments. Preference-based intelligent payment analytics drives the most cost-effective payment distribution platform. Change Healthcare is the industry’s largest communications vendor dedicated 100% to healthcare, which provides economical and technology-enabled solutions with efficiencies at scale, including savings with participation in the Change Healthcare Health Payers USA cooperative, the nation’s first and largest healthcare postage cooperative. QNXT customers also have better controls with access to a comprehensive web-based virtual mailroom, which provides configurable self-service document management, editing, composition, audit, tracking and reporting.
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 QNXT: 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 is on a mission to modernize the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers and healthcare consumers. Our platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients. We use technology to create win-win-win solutions, so payers and providers can focus on delivering care to people when and where they need it.
Zelis Payments is powered by innovative products, partnerships, intelligent treasury management, a robust rules-based engine and unmatched payer and provider relationships. At the heart of our innovative approach, products, expertise and capabilities lies our flagship solution, Zelis Advanced Payments Platform (ZAPP). ZAPP helps payers process high volumes of claims payments and communications, along with corresponding technical requirements and rules, in one integrated platform. In a single platform, medical, dental, WC, and P&C insurers can manage their provider payments and data files, according to provider preference, vendor and member disbursements, and member communications, EOBs and ID cards, in print or digital formats. ZAPP helps payers simplify and streamline operations, reduce complexity and stay compliant, while providing a personalized, efficient and intuitive payments and communications experience.
Zelis Payments is transforming the healthcare payments landscape by providing a seamless experience that prioritizes choice, convenience and efficiency, benefiting payers, providers, and members alike—creating a modernized healthcare experience for everyone.
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® QNXT™ core administration platform can now leverage bi-directional and automated data exchange by utilizing TriZetto® Configuration Orchestrator for QNXT™ 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.
Simplify Provider1™
Simplify Healthcare enables benefits and provider lifecycle management solutions for payers through a scalable, enterprise-grade, secure, compliant and configurable cloud-based software platform—Simplify Health Cloud™. Simplify Healthcare solutions drive significant cost take out and growth through a combination of highly configurable automation, AI and intelligent data flows.
Provider1™ – Single source of truth for provider data with capabilities to manage the provider lifecycle across provider onboarding, contracting, credentialing, roster file management and provider data management. Provider1 is the only integrated end to end solution that connects PDM, Credentialing, Contracting, Self-serve and eSign.
When used with Provider1, Claims1™ enables transmission of provider data to TriZetto QNXT, through the TriZetto® Configuration Orchestrator. The integrated solution significantly reduces the manual configuration of provider data into QNXT™ and hence results in reduced time from sale to “ready to serve” enabling sales teams to sell much deeper into the season, increased claim and configuration accuracy and an opportunity to optimize configuration processes..
Simplify Benefits 1™
Simplify Healthcare enables benefits and product lifecycle management solutions for payers through a scalable, enterprise-grade, secure, compliant and configurable cloud-based software platform—Simplify Health Cloud™. Simplify Healthcare solutions drive significant cost take out and growth through a combination of highly configurable automation, AI and intelligent data flows.
Benefits1™ – Single source of truth across all LOBs (Medicare Advantage, Medicaid, Medicare Supplemental, ACA, Large Group Self Insured and Fully Insured) for the products and benefits plan including product catalog, mandated & marketing materials (DocGen), filing with regulatory bodies automatically, reporting, intelligent AI enabled Sales Front end.
When used with Benefits1, Claims1™ enables transmission of benefits data to TriZetto QNXT through the TriZetto® Configuration Orchestrator. The integrated solution significantly reduces the manual configuration of benefits into QNXT and hence results in reduced time from sale to “ready to serve” enabling sales teams to sell much deeper into the season, increased claim and configuration accuracy, and an opportunity to optimize configuration processes.
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.