Healthcare in the United States is a trillion-dollar ecosystem with payers—health insurance companies—at the center of member services, claims adjudication, and regulatory compliance. With increasing complexity around Medicare, Medicaid, ACA, and commercial plans, payer organizations rely on advanced platforms like Cognizant’s TriZetto Facets to manage operations. Facets, now at version 4.51 (released in August 2025), offers AI integration, modular enhancements, and deep interoperability with CRM, care management, and ECM systems.
In this exclusive interview, Monika Vashishtha, President & COO of GHIT Digital, shares her insights with a leading healthcare technology magazine on how Facets is reshaping payer transformation.
A1: The payer industry in the U.S. covers over 300 million insured lives and drives more than $1.3 trillion in annual revenues. Payers are not just insurance providers; they are the backbone of risk management, regulatory compliance, and member experience. They ensure claims are processed, care is coordinated, and value-based models succeed. The industry’s importance has only grown post-pandemic with CMS mandates, digital-first engagement, and rising cost containment pressures.
A2: Facets 4.51, released in August 2025, introduced more than 100 enhancements across productivity, administration, and compliance. Key features include split billing, FSA workflow automation, multi-language support, and keyword benefit search. Most importantly, the launch of the TriZetto AI Gateway brings generative AI into the ecosystem—embedding AI assistants into Facets for guided workflows, real-time configuration, and operational intelligence.
A3: TPMs play a crucial role in aligning payer executives, compliance officers, and IT teams. They establish governance frameworks, design phased rollouts, and manage dependencies like infrastructure readiness and CMS mandates. For example, in Medicaid implementations, TPMs balance regulatory compliance with operational efficiency—often using dry runs, automation templates, and AI-assisted onboarding to reduce risk.
A4: Certainly. Split billing allows payers to distribute premium charges across CMS, employers, and members. FSA workflow automation routes exceptions seamlessly. Debit card corrections in CDHP plans simplify member interactions. Screen-view customization personalizes UI for different roles, while keyword benefit search accelerates call center productivity.
A5: The AI Gateway enables governed, enterprise-grade AI adoption across TriZetto products. TriZetto Assistant, built on this gateway, provides contextual guidance inside Facets—summarizing benefit rules, suggesting configuration templates, or automating claims workflows. Early adopters are already reporting faster onboarding, reduced claim handling times, and higher accuracy in adjudication.
A6: Integration is a strength of Facets. The Open Access Solution provides 300+ web services exposing real-time data for interoperability. We’ve integrated Salesforce for member engagement, care management platforms for utilization reviews, and ECM systems like NewgenONE for document workflows. Financially, Facets syncs with ERP/GL systems for split-billing reconciliation. This ensures that payer operations run as part of an enterprise ecosystem, not in silos.
A7: We use ETL pipelines for legacy-to-Facets data transformation and perform extensive dry runs. Parallel validations ensure claim accuracy, eligibility syncing, and accumulator balancing. Dashboards give visibility to executives, while APIs maintain real-time reconciliation across CRM and care management.
A8: Payer technology is moving toward AI-first, low-code, and cloud-native platforms. Facets is evolving with AI assistants, RPA-enabled claims handling, and interoperability. Future payers will run on ecosystems where CRM, care management, ECM, and analytics platforms work in concert—improving member experience while reducing administrative spend. Companies like GHIT Digital are helping clients bridge this future by combining deep domain expertise with implementation excellence.
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