TriZetto Provider Electronic Prior Authorization

Prior authorization is a persistent challenge for providers. Care teams spend nearly 28 hours a week on paperwork, causing revenue loss, delayed or denied claims and staff burnout. Outdated processes slow access to treatment and impact patient satisfaction.

TriZetto® Provider Electronic Prior Authorization transforms prior authorization from a barrier into an enabler of better care. By embedding Da Vinci–compliant HL7® FHIR® APIs (Coverage Requirements Discovery, Documentation Templates and Rules, and Prior Authorization Support) directly into EHR workflows, providers gain clarity and efficiency. Care teams get instant answers, guidance and a streamlined digital path to submit requests and receive responses in real time.

What sets TriZetto apart? Flexibility. TriZetto’s platform translates between legacy 278 transactions and FHIR® PAS APIs, allowing providers to modernize at their own pace. An intelligent intermediary expands the TriZetto Provider Solutions® clearinghouse, powering bilingual processing and bi-directional data exchange. Providers connect to thousands of payers through a single, future-ready solution.

Providers using TriZetto Provider Electronic Prior Authorization benefit from:

• Reduced costs and the burden of cumbersome prior authorization request
• Improved accuracy and increase turnaround time for authorization approvals
• Increased speed to care