Who TriZetto Provider Solutions is best for
TriZetto Provider Solutions (TPS) is the provider-facing revenue cycle business of Cognizant, with division headquarters in Earth City, Missouri; it still operates the Gateway EDI, ClaimLogic and NHXS portals. Its core product is a claims clearinghouse that TPS says connects to 650+ practice management and EHR systems; its homepage cites 11,000+ payer connections, while its claims management page says 8,000+. Around it sit eligibility, estimates, prior authorization, denial and contract management tools, plus outsourced billing, coding and credentialing services.
Best for
- Independent practices whose PM system already supports TriZetto as a clearinghouse
- Medical billing companies that need one clearinghouse across many client systems
- Practices that may later want to outsource billing, coding or credentialing to the same vendor
Not ideal for
- Practices seeking an all-in-one EHR and practice management system
- Buyers who want transparent, published pricing
- Organizations unwilling to accept a vendor with a recent large-scale breach without additional assurances
TriZetto Provider Solutions pros and cons
Pros
- Large payer network; TPS cites 8,000+ to 11,000+ payer connections on different pages and publishes a payer list
- Broad PM and EHR connectivity (650+ integrations, vendor figure)
- Claim editing, eligibility, patient estimates, prior authorization and denial recovery from one vendor
- Contract Manager and Advanced Reimbursement Manager Pro check payments against payer contracts
- States SOC 2, EHNAC and HITRUST certification
Cons
- No published pricing; costs depend on your PM vendor relationship and modules
- A breach of its web portal, detected October 2, 2025, with unauthorized access dating to November 2024; state filings indicate more than 3.6 million people affected
- Not an EHR or full PM system, so it adds a separate vendor to manage
TriZetto Provider Solutions pricing
TPS does not publish prices as of October 2026; its site routes to a demo request. Clearinghouse pricing in this market is typically a monthly per-provider fee, per-claim fees, or a bundle arranged through your PM or EHR vendor, and add-ons such as eligibility, estimates, denial management and contract management are often priced separately. Outsourced billing services are usually priced as a percentage of collections.
Key features
- Claims Management: Advanced Claim Editing, claims processing and follow-up, and claim payments (ERA)
- Patient Engagement: eligibility, patient responsibility estimation, prior authorization and patient payments
- Rejection and Denials Management: rejection and denial prevention, and denial recovery
- Contract Management: Contract Manager and Advanced Reimbursement Manager Pro (ARM) to find underpaid and denied claims and support payer negotiations
- Revenue Cycle Management Services: billing services, coding, revenue recovery, and anesthesia billing software
- Interoperability Solutions: electronic prior authorization, clinical data exchange, care gaps and data access with payers
HIPAA, security and integrations
TPS says it is SOC 2, EHNAC and HITRUST certified, and as a clearinghouse and billing services vendor it operates as a HIPAA business associate. It does not publish a public BAA template. TPS detected suspicious activity in its web portal on October 2, 2025, and determined that an unauthorized actor had been accessing records related to insurance eligibility verification transactions since November 2024. TPS reported 3,433,965 affected individuals to the Oregon Department of Justice; HIPAA Journal (updated March 2, 2026) reports that the Oregon, Texas and New Hampshire filings together indicate more than 3.6 million people. Exposed data included names, addresses, birth dates, Social Security numbers and health insurance information. TPS lists 650+ direct PM and EHR integrations but does not name them on its homepage; it runs a partner marketplace and payer list.
TriZetto Provider Solutions alternatives
- Waystar — clearinghouse and RCM platform with strong denial and patient payment tools, sold directly to providers.
- Office Ally — low-cost clearinghouse and PM option often used by small practices.
- Inovalon — provider claims and eligibility tools backed by a large payer data network.
- The SSI Group — claims and RCM software aimed mainly at hospitals and health systems.
- Stedi — API-first clearinghouse for software teams building their own billing workflows.
