TriZetto - Submit Electronic Claims

Here is how to submit electronic claims through TriZetto:

First, create your claim by following the instructions in the article How to Create a Claim. Then follow the instructions below. 

1. Click Lists → Claims.
2. Select your desired claim. We recommend validating it first to make sure there are no obvious mistakes.
3. Click Bulk Actions → Submit to TriZetto.

   

   Note: The above screenshot says "Office Ally." With this integration, it will simply say "TriZetto" instead.

Once a claim is sent, its status will immediately change to Submitted. Moving forward, its status will update automatically as we receive updates from your payers. The possible statuses are:

• Acknowledged: The clearinghouse (TriZetto) or the payer has received the claim submission successfully.
• Processing: The claim has been scrubbed and the payer has started to process it.
• Information Requested: The claim is being reviewed by the payer. If the status doesn't change in 10 business days, please call the payer directly.
• Pending: The claim is being reviewed by the payer. If the status doesn't change in a few days, please call the payer directly.
• Rejected: The claim has been rejected by the clearinghouse or by the payer. You can update the claim and resubmit it just like you did the first time.
• Denied: This indicated that the payer has processed the claim and denied payment. You will typically see the reason of denial when you open the claim. Contact the payer directly if the reason is not provided.
• Paid: The claim has been adjudicated and the payment has been sent.