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Automate Configuration of Benefits and Provider Data to any Claims Admin platform

Improve accuracy, time to implement, and reduce testing for all Claims configurations
Resolve claims configuration challenges with intelligent data ingestion, validation-ready pipelines, and seamless deployment into TriZetto® Facets® and QNXT™, NASCO, enGen, and home grown Claims Admin systems.
Claims1™ eliminates manual errors, reduces rework, and transforms benefits and provider data into claims-consumable formats—enabling faster go-lives, improved compliance, and scalable operations at every stage.
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Seamless Integration
with TriZetto®
Configuration Orchestrator

Claims1™ integrates seamlessly with TriZetto® Configuration Orchestrator, automating the ingestion and transformation of benefit and provider data from Benefits1™ and Provider1™ into Facets® and QNXT™. This bi-directional integration ensures data consistency, eliminates manual rework, and accelerates configuration processes, significantly reducing errors and improving operational efficiency.
Explore Our Partnership with Cognizant  »

Build Intelligence Into Every Claims Configuration

Unifying Data Ingestion, Validation, and Transformation Across the Claims Lifecycle
Configurable Logic. Pre-Built QA. Built-In Compliance.

Automated Claims Configuration

Transform Incoming Data Into Claims-Ready Outputs—Consistently.

Ingest benefit and provider data from trusted sources and automate its conversion into a format your Core-admin systems can process—quickly, accurately, and at scale.

  • Data Aggregation and Structuring
    Intake structured and semi-structured data from Benefits1™, Provider1™, or external systems and normalize it for claims setup.
  • Cross-System Data Mapping
    Apply rules-based transformations to match claims platform requirements—reducing manual mapping and logic duplication.
  • Validation and Exception Handling
    Automate quality checks and trigger exceptions when incoming data doesn’t meet configuration or business rules.
  • Version Control and Audit Trails
    Maintain traceable logs of each configuration cycle—supporting QA and compliance workflows.
  • Scalable Across Platforms and LOBs
    Reuse rules and templates to support multiple systems and product lines without starting from scratch each time.

Configurable QA and Validation

Prevent Claims Errors Before They Occur.

Automate quality checks with no-code, rules-based validation across all configuration inputs and outputs.

  • Reusable QA Rule Library
    Leverage prebuilt and custom validation rules for benefits, provider, and contract data.
  • Dynamic Audits
    Flag issues in real-time and route them for review before they hit claims systems.
  • No-Code QA Configuration
    Empower business teams to modify validation logic without relying on IT or code changes.
  • Test Coverage and Reporting
    Track validation performance and coverage across claims transformation workflows.

Real-Time Testing and Simulation

Test Faster. Deploy with Confidence.

Validate configurations in a sandboxed environment before they go live—ensuring system compatibility and data accuracy.

  • Simulation Mode for Config Changes
    Test benefit and provider configuration logic before pushing to production.
  • Golden Record Comparison
    Match generated claims entries against expected standards for faster QA approval.
  • Automated Regression Testing
    Detect changes or regressions when updating logic or inputs.
  • Role-Based Access for Test Cycles
    Enable collaboration between business and IT teams while maintaining data security.

Multi-System Interoperability

Integrate Once. Operate Everywhere.

Ensure seamless bi-directional benefits and provider data flow from sources of truth like Benefits1™ , Provider1™ and external systems to TriZetto® Facets® and QNXT™, and other Core-admin platforms.

  • Plug-and-Play Connectors
    Prebuilt integrations for Facets® and QNXT™ through the TriZetto® Configuration Orchestrator.
  • Customizations
    Integrate with other commercial or custom developed core claims systems.
  • Upstream and Downstream Sync
    Keep systems aligned with bi-directional configuration updates and validations.
  • Event-Driven Triggers and APIs
    Sync changes in real time or batch—based on your operational model.
  • Unified Logic Layer
    Maintain consistent mapping and transformation rules across systems.

Rapid Deployment and Maintenance

Go Live in Weeks, Not Months.

Accelerate time-to-value with modular architecture, low-code setup, and business-user enablement.

  • Admin-Ready Dashboards
    Give power users control to monitor, test, and manage configurations independently.
  • Low-Code Rule Editing
    Make changes quickly without writing code or opening IT tickets.
  • Prebuilt Templates and Workflows
    Reuse logic across markets, lines of business, or systems—speeding up deployment.
  • Ongoing Optimization Support
    Enable continuous improvement with analytics and feedback loops.

Compelling Business Case. Proven Value. ROI in Year One.

Claims1™ helps health plans eliminate configuration delays, reduce manual interventions, and scale claims operations with speed, accuracy, and control.
Department Cards

Claims Operations Teams

  • Convert benefits and provider data into claims-ready format automatically
  • Replace manual configuration with guided, rules-based automation
  • Reduce downstream errors and eliminate deployment delays

Configuration QA & Testing Teams

  • Run automated validations before updates go live
  • Catch mismatches early with built-in exception logic
  • Log, test, and approve changes with full traceability

Compliance and Oversight

  • Maintain version history of all configurations and edits
  • Ensure every change is audit-ready and aligned with regulatory rules
  • Reduce non-compliance risks from ad hoc updates

Business and Product Owners

  • Launch new plans and updates faster with reusable configuration logic
  • Track performance metrics across deployment cycles
  • Enable business users to manage without IT bottlenecks

IT and Admin System Teams

  • Integrate seamlessly with TriZetto® Facets® and QNXT™, or any other Core-admin platforms
  • Ensure consistent data flow across upstream and downstream systems
  • Reduce development effort with low-code configuration tools

Provider and Benefits Teams

  • Streamline updates from Provider1™ and Benefits1™ (or any other source of truth) directly into claims
  • Keep provider rosters and benefit designs in sync across systems
  • Improve claims accuracy by eliminating data discrepancies

Automate Code Set Updates Across All Claims Systems

Claims1™.Codesets automates the ingestion, validation, and deployment of healthcare industry code sets, such as CMS- and AMA-issued code updates, removing manual work and streamlining updates across every line of business and claims system.
Explore Claims1™.Codesets

Leading Plans Are Already Transforming Claims Configuration. See How.

Top payers have moved beyond spreadsheets, manual workflows, and custom scripts—using Claims1™ to automate configuration, eliminate errors, and optimize claims management.
Explore how they accelerated implementation, eliminated rework, and ensured compliance with one powerful platform.

Leading Plans Are Already Transforming Claims Configuration. See How.

Top payers have moved beyond spreadsheets, manual workflows, and custom scripts—using Claims1™ to automate configuration, eliminate errors, and optimize claims management.
Explore how they accelerated implementation, eliminated rework, and ensured compliance with one powerful platform.

Ready to Rethink Claims Configuration?

Claims1™ is helping leading health plans streamline benefit and provider data ingestion, transformation, and configuration—automatically, accurately, and at scale. Discover how you can improve speed, eliminate errors, and modernize how claims systems are configured.
See It in Action

Experience the Power of a Connected Ecosystem

Claims1™ is just one part of a smarter, integrated platform. Connect with Simplify Healthcare’s full suite of solutions—spanning product, provider, documents, and custom apps—to streamline configuration and ensure alignment across every system.

Simplify Product and Benefits Lifecycle

Accelerate health plan operations with AI-powered sales enablement, configurable plan design, automated filings, and CMS-compliant document generation.

Explore Benefits1™ →

Simplify Provider Lifecycle

Streamline network adequacy, contracting, credentialing, roster files, data management, and claims config with an advanced, modular solution that delivers efficiency and effectiveness.

Explore Provider1™ →

Simplify Benefits Inquiry Experience

Deliver accurate, consistent benefits information across all channels—powered by AI-enhanced guidance that improves member experience and boosts NPS.

Explore Xperience1™→

Simplify Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

Explore Simplify Docs™ →

Simplify Custom App Development

Design and deploy custom apps faster with embedded AI and low-code development—tailored to your organization’s unique needs.

Explore SimplifyX™ →

We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What payers want to know before automating claims configuration with Claims1™

How does Claims1™ ensure consistency across claims systems?

It standardizes benefit and provider data using shared transformation logic, so every claim configuration is aligned—whether targeting TriZetto® Facets® and QNXT™, or other commercial or home-grown Core-admin platforms.

Can it support both upstream and downstream sync?

Yes. Claims1™ supports bi-directional configuration sync—ensuring data stays accurate across source systems, admin platforms, and downstream consumers.

Can we tailor rules by LOB or market?

Absolutely. Claims1™ allows configuration rules to be customized by line of business, geography, or market-specific requirements—without hardcoding.

How is accuracy maintained over time?

With version-controlled updates, reusable validation rules, and exception monitoring, Claims1™ ensures every change is logged, tested, and tracked for quality assurance.

How does it support audit readiness and compliance?

Every change is logged with full version history and audit trails, making it easy to trace configurations, demonstrate compliance, and support regulatory reviews.

How long does implementation take?

Claims1™ deploys fast—typically within weeks—thanks to prebuilt connectors, reusable templates, and a low-code architecture designed for scale.

Does it integrate with our current ecosystem?

Yes. Claims1™ connects seamlessly via API, batch, or ETL to other platforms. 

Can non-technical teams manage logic and validation?

Yes. Business users can configure and test logic without writing code—using a no-code interface to manage transformations, QA rules, and workflows.