Cognizant API
Programmatically access eligibility checks, claim submission, claim status, and ERA remittance workflows in Cognizant TriZetto with a stable REST API. Supergood builds and operates production-grade, unofficial Cognizant integrations so your team can automate critical revenue cycle and billing pipelines without heavy custom engineering. Cognizant’s TriZetto Healthcare Technology Solutions provide payer and provider software for eligibility and benefits, claims adjudication, prior authorization/utilization management, provider network management, and remittance processing. With an unofficial API, you could verify coverage and benefits before visits, submit professional and institutional claims, track claim statuses, and reconcile electronic remittances end to end. In plain English: this software is used by health plans and providers to move data like eligibility, claims, authorizations, and payments between care delivery and reimbursement. An unofficial API lets you programmatically check coverage, build and submit claims, pull back adjudication outcomes, and match payments to encounters—so you can automate the messy parts of billing.
What is Cognizant TriZetto?
Cognizant TriZetto is a suite of healthcare technology platforms that power payer core administration (e.g., Facets and QNXT), utilization management, pricing, and provider solutions. On the provider side, TriZetto Provider Solutions functions as a clearinghouse that facilitates eligibility verification (270/271), electronic claim submission (837P/I), claim status (276/277), and electronic remittance advice (835). On the payer side, TriZetto products manage members, benefits, provider networks, prior authorizations, and claim adjudication.
Core product areas include:
- Eligibility and benefits verification (270/271)
- Claims submission and adjudication support (837, pricing, edits)
- Claim status inquiry and tracking (276/277)
- Electronic remittance advice retrieval (835) and payment reconciliation
- Prior authorization and utilization management workflows
- Provider and payer directory, contract, and pricing management
Common data entities:
- Members/Patients (coverage, subscriber, plan)
- Providers (billing/rendering NPIs, taxonomy, contracts)
- Payers/Plans (IDs, programs, network rules)
- Authorizations (service codes, units, dates, status)
- Claims (837P/I service lines, diagnoses, modifiers)
- Claim Status (277 events, payor control numbers)
- Remittances (835 payments, CARC/RARC adjustments, EFT/check info)
The Cognizant Integration Challenge
Organizations rely on Cognizant TriZetto daily, but turning portal, EDI, and payer-specific workflows into automated pipelines is hard:
- Payer-specific formats and edits: Each payer enforces distinct validation rules, modifiers, and pricing logic
- Strong enterprise security: SSO/MFA and network controls complicate headless automation
- Portal/EDI-first delivery: Key workflows live in web apps or batch EDI feeds, not unified public APIs
- File interfaces and submission windows: SFTP/EDI batching, daily cutoffs, and signed artifact delivery must be respected
- Compliance nuances: Sensitive PHI, EDI retention rules, and audit trails for authorizations and claim edits
How Supergood Creates Cognizant APIs
Supergood reverse-engineers authenticated browser flows, batch interfaces, and EDI exchanges to deliver a resilient API endpoint layer.
- Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
- Maintains session continuity with automated refresh and change detection
- Normalizes eligibility (271), claims (837P/I), claim status (277), and remittance (835) objects across payers
- Aligns with customer entitlements and licensing constraints to ensure compliant access
- Bridges batch exports and SFTP/EDI flows with signed URL retrieval and delivery
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your Cognizant/TriZetto product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened Cognizant adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as Cognizant evolves.
API Endpoints
Authentication
/sessionsEstablish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.
Eligibility
/eligibility/checkSubmit an eligibility inquiry and receive normalized 271 benefits. Use this to validate coverage, copays, coinsurance, and deductible remaining prior to visit.
Claims
/claimsAssemble and submit an 837P/I claim through the clearinghouse. Supergood normalizes service lines and returns submission metadata.
Remittances
/remittancesRetrieve ERA (835) summaries for claims, including payment amounts, adjustments, and payer control numbers. Use to reconcile payments and drive denial management.
Use Cases
Real-Time Eligibility at Scheduling
- Verify coverage, copays, coinsurance, and deductible remaining before visits - Surface plan network rules and referral requirements - Maintain a single source of truth for payer and plan metadata
Authorization-Aware Order Capture
- Validate prior authorization requirements for high-cost services - Track authorization status and remaining units - Prevent scheduling or claim submission without valid authorization
Claims Generation and Submission
- Assemble 837P/I with payer-specific edits and modifiers - Submit via clearinghouse and receive submission confirmations - Automatically generate corrected or voided claims when editing encounters
Claim Status and Remittance Reconciliation
- Pull 277 status updates with payor control numbers - Retrieve 835 ERA, map CARC/RARC codes to denial reasons, and reconcile EFT/check payments - Drive dashboards for outstanding AR, denial trends, and write-off workflows
Audit and Compliance
- Export machine-readable EDI artifacts (270/271, 276/277, 835/837) - Maintain audit trails for claim corrections and authorization changes - Respect PHI handling, retention windows, and payer program rules
Technical Specifications
Authentication
Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
Response format
JSON with consistent resource schemas and pagination
Rate limits
Tuned for enterprise throughput while honoring licensing and usage controls
Session management
Automatic reauth and cookie/session rotation with health checks
Data freshness
Near real-time retrieval of eligibility, claims, status, and remittance artifacts
Security
Encrypted transport, scoped tokens, and audit logging; respects Cognizant/TriZetto entitlements and compliance requirements
Webhooks
Optional asynchronous delivery for claim status updates and ERA availability
Latency
Sub-second responses for list/detail queries under normal load
Throughput
Designed for high-volume eligibility and batch claims pipelines
Reliability
Retry logic, backoff, and idempotency keys minimize duplicate actions
Adaptation
Continuous monitoring for UI/EDI changes with rapid adapter updates
Frequently asked questions
Supergood supports workflows across commonly used TriZetto Provider Solutions and payer-facing tools, subject to your licensing and entitlements. We scope coverage (e.g., eligibility 270/271, claim submission 837P/I, claim status 276/277, remittances 835, prior auth retrieval) during integration assessment.
We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For EDI flows, we manage SFTP/EDI timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically.
Yes. You can pull ERA (835) summaries, map CARC/RARC codes, and reconcile EFT/check payments alongside claim and encounter data. We can post back reconciliation outcomes to your billing system via webhooks.