Medicaid Solutions

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  • Increase your share of the Medicaid market—with TriZetto.

    The formula for success in the Medicaid managed care market is clear. You have to increase the efficiency of administrative operations, navigate the demands of healthcare reform, and transform your operations to meet the changing business requirements of this dynamic market segment.
    Whether your plan is large or small, national or local, an established payer or a new organization, TriZetto delivers the comprehensive solutions that will help you succeed in the Medicaid market.

    TriZetto, the experienced healthcare IT provider, can help you achieve Medicaid success.

    With solutions that support more than 60 percent of managed Medicaid members today, TriZetto is an industry leader for health plans seeking to improve their market share. TriZetto medicaid solutions cover all aspects of Medicaid management—from claims processing to medical management and core administration to network management.

    With TriZetto's comprehensive Medicaid solutions, you can:

    • Improve compliance with CMS requirements
    • Increase administrative efficiency
    • Reduce costs
    • Optimize revenue
    • Leverage healthcare IT reform to compete more effectively


    TriZetto's healthcare IT solutions include:

    Core Administration

    TriZetto’s Facets and QNXT platforms are the leading core administrative systems for healthcare payers in the healthcare IT managed Medicaid market. Both systems automate business processes, enhance efficiency and provide the flexibility to administer diverse plan designs. TriZetto's solutions integrate with third-party solutions and adapt easily to a rapidly changing business and regulatory environment.

    Care Management

    Medicaid plans need technology solutions that can identify, prioritize and help manage members who have ongoing health conditions. The CareAdvance Enterprise application is a secure, Web-based communication platform that automatically identifies members who should be included in care management programs, and monitors their health status while effectively engaging members in their own care. The solution supports utilization, case, disease and population management and helps payers meet federal and state requirements for quality initiatives and care improvement.

    Network Management

    Our comprehensive network-management solution helps enhance the value of your provider networks, negotiate more favorable contracts and reduce administrative costs. The NetworX Pricer® application automates claims pricing so you can administer provider contracts more quickly and accurately. The NetworX Modeler® application helps you model and evaluate the financial implications of proposed rates and contractual terms. NetworX Modeler With Analytics™ solution lets you dive deeper into “what if” scenarios when analyzing provider contracts. The NetworX Payment Bundling Administration™ solution automates episode-of-care reimbursement, prospectively aggregating claims into bundles for processing and payment.


  • TriZetto Services

    Our world-class services include application hosting and management, business process services, and consulting. TriZetto’s application hosting and management are delivered via cloud technologies to give clients flexible and scalable business services. Our global team of experienced professionals possesses deep knowledge of both the healthcare industry and TriZetto solutions, helping clients solve their unique business challenges and achieve results more quickly.