EDI Portal Feature Overview

EDI Portal Feature Overview

EDI Portal Feature Overview

The EDI Portal is accessed from the ProviderSuite Web Site - Billing tab > EDI Portal

The new EDI Portal operates off of tabs, much like PracticeAdmin does. The following information touches on the main features this portal can provide you and will best assist you.

 “Home” tab includes a few features you may find useful. “My Work Flow” includes tasks that you can assign either daily, weekly or monthly to assist you in operating the EDI Portal. At the bottom of each of the tasks tabs you can click on “Customize Your Work Flow” and you may change each task to daily to weekly or to monthly. These will set as reminders for you to review each portal area.   Next you will find “Performance at a Glance” which you may review and compare how your account stacks up against the clearinghouse average in rejections, claim volume, remits and more.  Below this is “News” and clearinghouse will place their news events as well as industry news items here for your review.

“Reports” tab offers a couple unique summaries.  “Analyze Rejections” is useful to identify your most common rejection reasons. “Run Transaction Summary” offers a snapshot of your claim volume. GEDI Rejection rates as well as Payer Claim error rates by provider.

“Manage Claims” tab offers ability to review claim processing. “Work Rejected Claims” shows you the details of why your most recent claims rejected. “Search Claim Status” provides you a way to locate  claims by account # or by patient name. “View Claim File Reconciliation” provides a list of each claim file they receive from PA and how many claims were in it. You may click anywhere on one of the files and it will open a new screen showing you additional details like what payers the claims in the file are being submitted to.

“Manage Payments” tab is where you go to locate ERA details. “View Insurance Payments (Remittanices)” allows you to view all recent ERA’s or you can choose to do an advanced search and view ERA’s for a particular payer and/or a particular time period. Once an ERA is pulled up in detail you may print it out or even separate an individual’s claim and print it separate for secondary claim billing.

“Manage Patients” tab is to view patient eligibility.  The "Check Patient Eligibility” feature in the EDI Portal complements the Check Eligibility feature in Practice Manager. Any checks requested through the EDI portal are charged the same fee as done through the Practice Manager software.

“Resources” tab has several different reference tools available. “Provider Look-up” enables you to look up providers NPI #’s, UPIN #’s. “Payer List” is a tool where you can search by payer name or by payer id # to see what payers clearinghouse supports and also allows you to see if ERA’s or eligibility is available. Once you pull up a payer you may click on the payer name and it will take you to the payers website. “Best Practices” reviews the Daily, Weekly and Monthly tasks.

“My Account” tab offers the ability to review your individual providers' enrollment setup. By clicking on “View Provider Details and Enrollment Status” you will be provided a list of your providers in that account you are logged into, then by click on any of the providers listed you will be provided a list of payers that the provider is in the processing of being enrolled for or has already been enrolled.




    • Related Articles

    • EDI Portal Enrollment Status

      You can find this information by following these steps: Click on the Claims Tab Click on EDI Portal Hover over the "My Account" tab to the right of the page. Select "Manage Practices"  Click the " View Enrollment Status" tab to the left of the screen ...
    • EDI Portal Overview

      Search Claim History Lookup any patient, submission dates, or date of service to see if your claim has been accepted by the carrier or rejected and why. Many carriers will accept an acknowledgment of acceptance from claims status as proof of timely ...
    • How to Check Patient Eligibility via the EDI Portal

      The steps below are for running an eligibility check from the EDI Portal.  Go to the Claims Tab Click on EDI Portal Click on Manage Patients Click on Check Patient Eligibility Option Click on "Run indivudual Eligibility Inquiry" Click on Payer or ...
    • How to look Up a Payer ID number in the EDI Portal

      Here are the steps to research payer ID numbers and payer information: Go To the Claims Tab >  EDI Portal Click on the Resources Tab Select Payer list Now click the Blue link "Professional Payer" (for UB-04 claims, click Institutional Payers) For ...
    • EDI Portal requesting username

      This may be happening because you need to add the TriZetto EDI Portal web site as a trusted site to your computer.   You can do this by  1. Clicking on the "Seeing a login screen below? Click here to fix the problem." link under  "EDI Portal",   2. ...