What Are the Best TriZetto Provider Solutions Outsourcing Services?
Dedicated HIPAA-trained billers work your TriZetto Provider Solutions queues alongside your own PM and EMR: eligibility, claim edits, rejections, claim status, ERA enrollment, and denials, end to end. Flat weekly pricing from $299 per FTE (volume based), with a trained backup included at no charge. Live in 14 days.
The Work Your Team Does in TriZetto, We Staff
What Is TriZetto Provider Solutions?
TriZetto Provider Solutions, often shortened to TPS, is the provider-facing clearinghouse and revenue cycle arm of Cognizant. By Cognizant’s published counts it is one of the largest claim pipelines in US healthcare: 11,000+ payer connections, 650 practice management and EHR integrations, 875,000+ providers served, and more than 4 billion transactions a year, with a 98% average payer acceptance rate. Its product families cover Claims Management, including Advanced Claim Editing and Claims Processing and Follow Up, Patient Engagement tools for Eligibility, Patient Responsibility Estimation, Prior Authorization, and Patient Payments, plus Rejection and Denials Management, Credentialing, and Analytics. It should not be confused with Cognizant’s payer-side TriZetto products; this page is about the provider side.
Scale is the point, and also the problem. TPS connects your PM to nearly every payer you bill, then hands your team the follow-through: edit queues to clear, rejection reports to rework, statuses to chase, enrollments to file. The platform moves the claims; people still move the queues. That is the gap this service closes.
Who Is This For?
Practices and billing teams whose claims already flow through TriZetto Provider Solutions from their PM or EHR, which, with 650 system integrations, describes a very large share of ambulatory billing in the US. If your billers start the morning in a TPS rejection report and end the day wondering which payer enrollments are still pending, this service was designed around your week. It fits a solo practice with one overloaded biller as well as a billing company that needs a dedicated pod per client book.
Where TriZetto Practices Lose Time and Money
The claim left the PM, so billing thinks it is gone; it died in the clearinghouse, so the payer has no record. Unless someone owns the TPS rejection queue daily, those claims simply age.
See the fixMigrations onto or off a clearinghouse break payer routes and enrollments in ways nobody notices until the remits stop. The fix is a person who reconciles sent versus accepted, daily.
See the fixRemits post automatically, and denial dollars quietly disappear into contractual adjustment buckets no one reviews. Recoverable money gets written off by a setting.
See the fixTPS gives you the data to see denial patterns; most practices do not build the view. The result is the same registration and coding mistakes recycling month after month.
See the fixEligibility and Patient Responsibility Estimation
Our specialists run eligibility through your TPS Patient Engagement tools against the upcoming schedule, capture plan detail and copay, deductible, and coinsurance positions, and use Patient Responsibility Estimation where you have it enabled so front desks can collect accurately at check-in. Results are entered into your PM the same day, which is what turns an eligibility check from a lookup into a denial prevented.
Claim Submission and Advanced Claim Editing Queues
We work the daily claim cycle end to end: batches released from your PM, Advanced Claim Editing results reviewed and corrected, resubmissions pushed the same day, and the sent-versus-accepted reconciliation that catches claims that quietly failed to reach the payer. TPS clients average a 98% payer acceptance rate; the practices that actually see it are the ones whose edit queue is empty at close of business, and that is the job we take over.
Rejection and Denials Management
TPS’s own materials note that 63% of denials are recoverable; recovery is labor. Our billers own your Rejection and Denials Management queues: clearinghouse-level rejections corrected and resubmitted within one business day, payer denials categorized by reason code, appeals and corrected claims prepared, and a weekly pattern report so the upstream error, wrong plan entered, missing auth, bad NPI mapping, gets fixed at the source instead of recycling.
Claim Status Follow-Up
Claims Processing and Follow Up screens tell you where each claim stands, if someone looks. We look on a fixed cadence: unacknowledged claims chased first, pended claims tracked to decision, no-response claims escalated by phone with payer reference numbers documented in your PM. The goal is simple: no claim discovers its problems at day 90.
ERA, EFT, and EDI Enrollment
Every payer you bill through TPS needs its transaction enrollments in order: 837 claims, 835 remits, EFT agreements, and the payer-specific forms that go with them. We prepare and file the paperwork, track each enrollment to confirmation, and keep a live matrix of which payers deliver ERAs where, which matters most when you add providers, add locations, or change systems. This is the least glamorous work in billing and the most common silent failure point we find.
Remittance Posting and Reconciliation
We post 835 remits and paper EOBs into your PM with correct adjustment and denial code handling, review what auto-posting did rather than trusting it, reconcile deposits against remits daily, and route anything that posted as an adjustment but reads like a denial into the recovery queue. Clean posting is where denial recovery starts; sloppy posting is where it quietly ends.
Patient Payments and Statements
Where your practice uses TPS Patient Payments tools, our team supports the patient side of the ledger: statements prepared and sent on schedule, payment plans tracked, credit balances flagged for review, and patient balance questions answered from accurate, current data. Estimation up front plus disciplined statements behind it is what keeps patient AR from becoming the biggest payer you have.
Credentialing Support
TPS offers credentialing as a product line, and many groups still run it in-house with spreadsheets. Either way, our credentialing specialists carry the load: applications, CAQH maintenance, payer follow-up calls, and a status board that tells you exactly where each provider stands with each payer, because a claim billed before enrollment is effective is just a denial with extra steps.
Put a Dedicated Team on Your TriZetto Queues
You have seen what we cover, from the edit queues to enrollment paperwork. The next step is simple: meet us, pick the seats you need, and watch a trained team work your own TPS queues before you commit to anything.
Book Your 2-Week Free TrialHow Our Teams Train and Go Live on TriZetto
New billers learn clearinghouse work through our SOP library and supervised training on your own setup: which PM feeds your TPS account, how your edit and rejection queues are organized, which payers are enrolled for which transactions, and how your practice wants statuses and denials documented. Production starts supervised, with a QA layer reviewing output before the team runs independently, and you see a production report every evening from day one. Every specialist works under an individual HIPAA agreement with named credentials you approve, never shared logins.
Why Outsource TriZetto Work, and Why Staffingly
We do not just clear TPS queues; we finish the loop in your PM, your tracker, and your payer enrollments, so the platform and the practice finally agree.
TPS also sells outsourced billing services, priced like most RCM vendors. Our model is different by design: a flat weekly fee per dedicated specialist, never a percentage of your collections. Do the math both ways; we will help on the call.
We work inside your TPS and PM accounts under named logins you grant and can revoke. No black box, no data leaving your systems, no vendor lock created.
Live in 14 days. 2-Week Free Trial. Replace any team member in 48 hours. 800+ providers served, 4.9 Google rating you can verify on our listing.
Teams We Support on TriZetto Provider Solutions
Independent practices whose PM submits through TPS and whose one biller owns far too many queues; multi-specialty and multi-location groups that need payer-specific desks and a live enrollment matrix; billing companies running many client accounts through one TPS relationship and needing dedicated, brandable production capacity; and specialty groups with estimation-heavy front ends, where Patient Responsibility Estimation only pays off if someone actually runs it before the visit.
Process and Onboarding
20 to 30 minutes on Teams. We map your PM-to-TPS flow, queue volumes, and pain points before we meet.
Named TPS and PM user credentials per specialist, least-privilege roles, your approval on each account.
Your SOPs plus our clearinghouse playbooks; supervised production from day one.
Daily production reports, weekly KPI review, month-to-month after your 2-Week Free Trial.
Security and Compliance
HIPAA-trained staff. Business Associate Agreements executed with every client. Workflows designed to support HIPAA compliance, with SOC 2 Type II attestation, ISO 27001:2022, $5M E&O and cyber liability coverage, and named individual credentials with full audit logs. Read the complete program, including our corporate structure and evaluation framework, at HIPAA and Security at Staffingly.
Flat Weekly Pricing Per Dedicated Specialist
1 to 4 dedicated FTEs.
5 to 9 FTEs.
10+ FTEs.
45 hours of coverage for less than others charge for 40.
$399 per week works out to $8.87 per hour across 2,340 hours of coverage a year, flat. Your dedicated biller covers a 9 hour day, Monday to Friday, a full hour more than a standard shift: the day starts with the overnight rejection and edit reports and ends after the day’s resubmissions and status notes are done, so far less rolls into tomorrow. A trained backup steps in at no charge whenever they are out. Flat weekly fee per dedicated specialist, never a percentage of your collections, no setup fees.
Start with a 2-Week Free Trial. Month-to-month after, with no long-term contract.
- Salary + payroll taxes + benefits
- Recruiting + turnover replacement
- Training on your payers + clearinghouse
- PM seat + equipment + PTO coverage
Calculate Savings
TriZetto Provider Solutions Outsourcing: Frequently Asked Questions
What tasks can an outsourced biller do in TriZetto Provider Solutions?
Eligibility and Patient Responsibility Estimation runs, claim batch review, Advanced Claim Editing corrections, rejection rework and resubmission, Claims Processing and Follow Up status checks, denial categorization and appeals prep, ERA and EFT enrollment paperwork, and remit reconciliation, plus posting the results into your PM.
Do you replace TriZetto, or work inside it?
We work inside it. TPS stays your clearinghouse and your account; we supply the trained daily labor its queues need. No migration, no disruption to your payer connections.
How is this different from TriZetto’s own billing services?
TPS offers outsourced RCM services like most platform vendors. Our model is a flat weekly fee per dedicated specialist who works only your accounts, never a percentage of your collections, and covers the whole administrative surface including work that lives outside the clearinghouse.
Can you work TPS for a billing company with many clients?
Yes. Billing companies are a core client type: dedicated pods per client book, your SOPs and brand, flat weekly seat pricing that scales with your growth.
How do your staff access our TPS and PM systems?
Through named individual user accounts you approve, with least-privilege roles and full audit logging. No shared logins, no offline exports of PHI.
Which PM and EHR systems do you support alongside TPS?
TPS integrates with about 650 PM and EHR systems, and our teams are trained on the major ambulatory platforms. On the strategy call we match specialists who already know your PM; the TPS side of the workflow stays consistent regardless.
Is outsourced TriZetto work secure and HIPAA-ready?
HIPAA-trained staff, executed BAAs, workflows designed to support HIPAA compliance, SOC 2 Type II, ISO 27001:2022, and $5M in coverage. Full detail on our security page.
How fast can a dedicated TPS team start?
Typically live in 14 days: access setup, workflow training on your SOPs, then supervised production. The engagement starts with a 2-Week Free Trial.
Clearinghouse and Denial Resources for Medical Practices
From our pain-points library: the problems this service exists to fix.
Written By
Dan Nandan has spent 25+ years in IT consulting and healthcare BPO, was among the first in the US to build an RPO/BPO delivery network overseas, and has been featured in Computerworld. He runs the operations and the dedicated virtual teams behind the clearinghouse and billing workflows on this page.
Connect on LinkedInSee what a dedicated TPS team changes in 14 days.
Book a strategy meeting. Dan Nandan, CEO, joins most calls personally. Real conversation, real numbers for your practice.
Claim Your 2-Week Free TrialTriZetto and TriZetto Provider Solutions are trademarks of Cognizant TriZetto Software Group, Inc., a Cognizant company. Staffingly, Inc. is an independent outsourcing provider and is not affiliated with or endorsed by Cognizant. Staffingly works inside client-owned TriZetto Provider Solutions accounts under client-granted access.