Cognizant API
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 benefi
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.