Billing Claims through TriZetto

This section explains how to bill claims to insurance carriers through TriZetto (formerly Gateway EDI) in AcuityLogic Billing. Before you can use TriZetto with AcuityLogic, Eyefinity must set up and activate the integration. To integrate with TriZetto, contact Eyefinity Customer Care or your AcuityLogic account manager.

  • If a claim that you want to bill does not have the status Ready to Bill, set the status to Ready to Bill. See Setting Claim Status to Ready to Bill.
  • Only carriers whose billing mode is set to EDI 837 in the Additional Carrier Attributes module in AcuityLogic Admin can be selected for billing in the Carrier drop-down list in the Billing Claim > GatewayEDI Transmission window. See Setting Up Additional Carrier Attributes.

To bill claims through TriZetto

  1. Click Billing Claim, and select EDI Transmission.

    The Billing Claim - GatewayEDI Transmission window opens.

  2. Select claims to bill the carrier. See Searching for Claims and Selecting Results by Provider.
  3. To preview the ANSI 5010 file for the displayed claims before sending the claims to Gateway EDI, click Create EDI File.
  4. To send all displayed claims to TriZetto, click Create And Send.

    The claim status of each claim changes to Billed, and the claims are sent to TriZetto. To view TriZetto’s status of the claims, go to the TriZetto website.

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