QNXT™ Lines of Business and Specialty Product Support

  • medium-three-computer-right-jpg-362x246The QNXT core system helps you drive efficiency, increase accuracy and enhance cost-effectiveness across your organization's lines of business.

    The TriZetto® QNXT™ Core Administration System can be used to help increase competitiveness, improve efficiency and drive performance for payers managing the following lines of business:

    Commercial and Individual

    The QNXT system is scalable to meet the demands of payers of any size, from small community plans to organizations that serve millions of members.


    The QNXT system provides capabilities for:

    • Claim re-pricing
    • External billing
    • Healthcare claim processing
    • Comprehensive consumer-directed health programs
    • Advanced HSA/HRA functionality
    • Integrated care management
    • Care planning
    • Predictive modeling
    • Branching logic
    • Support for specialty services such as mental health


    QNXT Dental functionality enables payer organizations to successfully administer all lines of dental business. QNXT Dental enables you to:

    • Easily manage the complex relationships between the health plan, its members and providers
    • Process predeterminations and convert them to claims
    • Increase efficiency in the claims-payment process by reducing manual labor and eliminating potential errors
    • Manage dental provider information more efficiently
    • Ensure that duplicate services aren't performed during a defined period of time

    Consumer-Directed Health

    QNXT consumer-directed health (CDH) functionality provides automated, cost-effective and accurate administration of FSA, HRA and HSA benefit plans. With the QNXT system, payers can:

    • Manage consumer funds more easily
    • Provide consumers with Web-based tools for health and wellness education
    • Integrate plan benefits, debit cards, and financial institutions together in one system to enable real-time administration

    Medicare and Medicaid Solutions

    For payers with members in Medicare or Medicaid, TriZetto’s QNXT system provides the functionality needed for handling enrollments, processing claims and managing care.


    QNXT provides comprehensive functionality for administering Medicare lines of business and integrates easily with TriZetto Medicare Solutions. When the QNXT system is used with TriZetto Medicare Solutions to automate key processes, this powerful combination can help you:

    • Increase revenues through growth
    • Improve administrative efficiency
    • Be better positioned to meet regulatory compliance requirements
    • Scale Medicare plans for growth
    • Manage complex enrollment and reconciliation requirements
    • Maintain a workflow similar to that of your non-Medicare lines of business


    The QNXT system also provides rich functionality for plans serving Medicaid members. Using QNXT to serve your Medicaid population, you can efficiently handle claims processing, enrollment, medical management and workflow processes that are unique to Medicaid. Additionally, pairing the QNXT system with TriZetto’s CareAdvance Enterprise® solution delivers comprehensive support for disease management and care coordination, helping improve outcomes and reduce costs.