TriZetto® Claims Administration Services

  • Outsource your claims administration and claims processing with TriZettoAdminister healthcare claims more efficiently. Decrease your operating costs, and improve your competitive position.

    Your claims volume is constantly in flux—and that can be a problem. Higher volume can strain your staff and resources, while lower volume can create costly employee downtime. Outsourcing your claims operation can help you manage these fluctuations for greater efficiency and lower cost—and keep you one strategic step ahead of the competition.

    Save money when you outsource claims administration to TriZetto.

    TriZetto Claims Administration Services provide comprehensive claims-process outsourcing for payers. Services include:

    • Adjudication with pend resolution
    • Adjustment processing/COB
    • Claims finalization
    • 1099 processing
    • Provider and member correspondence

    TriZetto’s services provide:

    • Flexible delivery models. You can outsource services on an ongoing basis or as needed to complete “on-demand” projects. And you can choose to outsource pieces of the business or entire business processes.
    • Flexible sourcing models. With more than 700 professionals working in onshore and offshore facilities, TriZetto can meet the scale, scope and cost demands of any payer organization.
    • Platform agnostic solutions. TriZetto’s knowledgeable resources have extensive claims, billing and enrollment experience on most core administrative systems, including the Facets™, QNXT™ and QicLink™ platforms as well as PowerSTEPP® (XTEN), AMISYS, PowerMHS®, PowerMHC®, Diamond, Xcelys®, EZ-CAP®, Claims Manager, Health LX (LuminX), MetaVance®, GBASS and FACTS™.


    The benefits of TriZetto Claims Administration Services.

    TriZetto handles claims administration for more than 65 clients annually, helping these organizations:

    • Reduce the cost of claims processing by as much as 40%.
    • Increase procedural accuracy to 99.4%.
    • Reach financial accuracy of 99.6%.
    • Decrease overall core administration expense an average of 20%.


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    Point of View: Seven Measures of a Successful Services Organization

    Partnering with the right BPO/ITO can have many benefits, such as a 20% decrease in overall administrative expenses and up to 40% cost saving in claims processing. Access this paper to find out how.

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  • Events

  • Latest News

    • August 11, 2014

      TriZetto Is Helping Payer Clients Prepare For CMS State Pilots For Dual-Eligible Beneficiaries Press Release August 11, 2014
    • July 15, 2014

      TriZetto Provider Solutions Awarded Ehnac Accreditation, Affirming Company As ‘Trusted Journey Partner’ To Healthcare Providers Press Release July 15, 2014
    • July 7, 2014

      TriZetto Announces General Availability Of Edge Server Solution That Helps Health Plans Meet Reform Requirements