TriZetto - Set Up Integration

A TriZetto integration allows you to submit claims to insurance without leaving your PracticeQ account. PracticeQ will capture the EOBs (Explanation of Benefits) from your payers as they become available and automatically allocate insurance payments to claims and appointments. TriZetto has a very extensive payers list and it's quite likely that all your electronic claims can be submitted through them.

At this time, PracticeQ does not offer support for secondary or institutional claims.

Before starting the integration process, we encourage you to become familiar with our Claims module. The following article will give you a thorough overview of how to create claims: How to Create a Claim.

PracticeQ does not charge fees for claim submissions; TriZetto bills you for this service. Please contact them for any questions related to their pricing.

Prepare Your TriZetto Account

• Before connecting PracticeQ to TriZetto, SFTP access needs to be enabled in your TriZetto account. Currently, this is done by contacting their support. Additionally, in order for PracticeQ to receive insurance payment information and keep the claim status up-to-date, you will need to ask them to enable ERA and 277CA reports.
• Below is a template email you can send to TriZetto.

  

• It typically takes 24-48 hours for TriZetto to enable SFTP access, and they may give you instructions on how to enable ERA reports for each payer. Some payers require pre-enrollment, which will require you to submit a form. We recommend doing that as soon as possible because some payers take 30+ days to enable ERA reports.

‼️ IMPORTANT: Without an ERA setup between each of your insurance payers and TriZetto, claims will not be updated in the PracticeQ system as they have no way to send us back the ERA. Contact TriZetto or the insurance payer for more info on setting those up.

• Regardless of how long ERA reports take to be enabled, you can connect your PracticeQ to TriZetto as soon as SFTP access has enabled. This will allow you to start submitting claims from your PracticeQ account.

Connect PracticeQ to TriZetto

If you followed the instructions in the section above, you will receive an email from TriZetto containing your SFTP user name and password. Log into your PracticeQ account and follow the steps below:

1. Navigate to More → Settings → Integrations.
2. Select TriZetto.
3. Enter the SFTP User Name and SFTP Password provided by TriZetto. 
4. Click Connect to TriZetto.
5. Once the accounts have been connected, you will be ready to submit your claims via PracticeQ.