TriZetto Billing Services
Complete medical billing run through TriZetto — claims, remits and denials moving through the clearinghouse your practice already uses: you keep your EHR and your workflows; we supply the billing team.
TriZetto, a Cognizant company, is known on both sides of healthcare transactions. Payers know it for core administration systems; providers know TriZetto Provider Solutions — the clearinghouse business descended from Gateway EDI — which moves claims, eligibility inquiries and electronic remittances between practices and thousands of payers. If your claims already travel through TriZetto Provider Solutions, Elite Bill Care runs your billing through that same connection: you keep your EHR and your workflows; we supply the billing team that works the clearinghouse every day.
What we do with TriZetto
- Eligibility verification run through TriZetto's payer connections before visits, so coverage problems surface early (see eligibility verification).
- Claim submission and rejection management — claims tracked through acceptance, and clearinghouse rejections corrected and resubmitted quickly (see clearinghouse rejection management).
- ERA posting and reconciliation — remits delivered through TriZetto posted promptly and matched to deposits (see payment posting).
- Denials and AR follow-up — denials categorized, appealed and worked to resolution (see denial management and appeals).
- Reporting — collections, aging and denial trends reported on a regular rhythm (see reporting and analytics).
Platform-specific workflow
On the provider side, TriZetto is a transaction pipe with its own work queues: payer responses, rejection reports and remits land in the clearinghouse whether or not they are visible inside your EHR. We work those queues daily — correcting and resubmitting rejected claims, matching 835 remits to the deposits they belong to, and confirming each payer's ERA enrollment stays active so remittances keep flowing to the right place instead of reverting to paper. That includes the unglamorous failure mode of clearinghouses: a remit that arrives for a claim nobody posted, or a rejection report that was generated but never opened. Daily queue work means both are caught within days, while the trail is still warm.
Claim status inquiries through TriZetto close the loop on claims that payers have neither paid nor denied — typically the oldest dollars in any aging report, and the ones no report surfaces on its own.
We also keep your submitter information and payer enrollments current inside TriZetto, so when a payer changes its connection requirements or a new plan is added, claims keep moving instead of failing silently at the front door. New payer connections are tested with live transactions before volume moves, so an enrollment is proven working rather than assumed.
No migration, no disruption
There is no clearinghouse switch and no EHR change: we work through your existing TriZetto Provider Solutions connection, with named-user access under our Business Associate Agreement, on the same path your claims already travel. See the full operation on our medical billing services page, or the other platforms on our software page.
Frequently asked questions
Do we need to change clearinghouses to work with you through TriZetto?
No. If your claims already move through TriZetto Provider Solutions, we work through that existing connection — your EHR, your submitter setup and your payer enrollments stay as they are. You provide named-user access under our Business Associate Agreement, and our team runs the daily billing work inside your clearinghouse account. Your team keeps full visibility into the account and all activity in it throughout.
We hear TriZetto makes payer software like Facets — is that the system we would be using?
No, and the distinction matters. Facets and QNXT are TriZetto's payer-side core administration platforms — health plans use them, not practices. The provider side of the business is TriZetto Provider Solutions, the clearinghouse your claims, eligibility checks and remits move through. Our billing work happens entirely on that provider side. It is a distinction worth knowing when a payer mentions TriZetto on a call — they are usually describing their system, not yours.
Can you clean up the rejection backlog in our TriZetto account?
Yes. We work the rejection and response queues in your TriZetto account, correct and resubmit what is fixable, and identify the patterns behind repeat rejections — typically a data issue from the EHR, a lapsed payer enrollment or a submitter configuration problem — then fix the cause so the backlog does not rebuild. The cleanup normally runs alongside live billing, so current claims never pause while the old ones are cleared.