TriZetto® Payer Electronic Prior Authorization
par Cognizant
Deliver the prior authorization processes per CMS 0057 mandate
Prior authorization is an essential utilization management function, yet it remains a costly administrative burden and frequent source of friction across providers, payers, and members. The Centers for Medicare & Medicaid Services (CMS) is addressing these challenges through the Advancing Interoperability and Improving Prior Authorization Processes Final Rule (CMS-0057-F). Beginning January 1, 2026 and continuing through January 1, 2027, impacted payers must enhance APIs and adopt standardized workflows to enable more efficient, transparent prior authorization processes aligned to HL7® Da Vinci FHIR® frameworks.
Cognizant’s TriZetto® Payer Electronic Prior Authorization (ePA) solution helps organizations meet these requirements by delivering accurate, automated prior authorization workflows that streamline eligibility validation, authorization determination, and clinical information exchange. Built on Microsoft Azure, the solution provides scalable, secure, and cloud-native interoperability aligned to evolving regulatory mandates. It supports Da Vinci FHIR-based frameworks to enable seamless data exchange across payer-provider ecosystems.
Additionally, customers and partners can transact through the Microsoft Commercial Marketplace, allowing them to leverage existing Azure commitments to accelerate adoption and maximize investment value. Together, these capabilities help reduce administrative burden, improve provider experience, and enable faster access to appropriate care.
