Getting Started with TriZetto

Before using TriZetto to for the first time, you need to verify that all necessary information is set up in Eyefinity Practice Management and then submit a test batch to TriZetto.

This topic includes:

• Verifying Required Information
• Submitting a Test Batch
• Correcting a Failed Test Batch

Verifying Required Information

The TriZetto integration requires that you have your NPI information entered correctly in Eyefinity Practice Management and that you have entered your office and payer information on the TriZetto website.

Verify your NPI information in the following locations:

• Check the Office Information screen to verify that your Office NPI is entered correctly. The Office NPI appears in box 32 on the CMS 1500 form. For more information, see Setting Up Office Information
• Check the Claims Information screen in Office Setup to make sure you have entered your office Billing NPI#. The Billing NPI# appears in box 33a on the CMS 1500 form. For more information, see Setting Up Office Claims Information.
• Check that all the relevant providers have the correct Provider NPI# listed in Provider Setup. The Provider NPI # appears in box 24J on the CMS 1500 form. For more information, see Adding Providers
• If you need to use different NPIs for specific carriers, go to Setting Up Provider Insurance Details for Individual Carriers.

To set up your TriZetto account with your office and payer information, go to the TriZetto website. For information on which payers are compatible with TriZetto, see TriZetto's Payer List.

Submitting a Test Batch

The first batch of claims you send to TriZetto is a test batch to confirm that the integration is working correctly. Your test batch must meet the following criteria:

• Your test batch should include a minimum of 15 claims for three different non-vision carriers that your practice is credentialed with.
• All claims must be in Ready to Bill status. For more information, go to Setting the Claim Status to Ready to Bill.

To submit the test batch:

1. Open Claims Management.
2. Click Billing Claims and select EDI Transmission.
3. From the Carrier drop-down list, select the insurance carriers.

   All carriers are selected by default.

   Only carriers with the Electronic Claim Submission check box selected in Administration display in the Carrier drop-down list.
4. Select a specific Provider, if necessary. All providers are selected by default.
5. In the Service Date From and Service Date To text boxes, enter or select the date range.

   To search for all claims for the carrier, leave the date text boxes blank.

6. Click Search.

   All claims with the Ready to Bill status that meet your search criteria appear.

7. Select the check box next to each claim you want to bill (a minimum of 15).
8. To send the selected claims to TriZetto, click Create And Send.

   The claims are transmitted to TriZetto as a test batch. TriZetto sends you an email notifying you of the result.

   • If the test batch was successful, TriZetto confirms that your integration is now live and you are ready to submit claims. TriZetto deletes the test batch, and the included claims are not processed. If you want to process them, create a new batch and resend them. For more information, go to Submitting Claims Through TriZetto.
   • If one or more claims in the batch were rejected due to errors, TriZetto lists the errors so you can correct them and retry the test batch. You cannot begin using TriZetto until you have successfully sent the test batch. See Correcting a Failed Test Batch.

Correcting a Failed Test Batch

1. Locate the rejected claim. See Searching for Claims.
2. Set the claim status to On Hold. See Putting Claims on Hold.
3. Edit the claim to correct the error. See Editing Claims.
4. Change the claim status to Ready to Bill. See Setting the Claim Status to Ready to Bill.
5. Repeat steps 1-4 for each rejected claim in your test batch.
6. Once all errors have been corrected, resend the test batch.