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How to add/remove EDI Service Holds from a Provider Profile
Any Account Manager can add or remove an EDI Hold from a Provider Profile whenever desired. To remove holds from a Provider Profile: Go to Settings > Providers Select the Provider and click Edit Provider Scroll to the Provider Hold section and click ...
Can a claim have multiple authorizations?
Guidelines for Item 23 ( Prior Authorization Number ) : NOTE: Item 23 can contain only one condition. Any additional conditions should be reported on a separate Form CMS-1500. This is the condition with respect to CMS-1500 guidelines, hence Item 23 ...
NUCC 02-12 Form 837 Crosswalk
Great information to get the the loops and segments that you need when speaking to EDI or an insurance company.
TriZetto Paper Claim Charges
To research Paper Claims Printing charges on your invoice: 1. Go to ProviderSuite > Billing tab > EDI Portal > Manage Claims > Search Claim History 2. Select Advanced Search from the Search By drop-down menu 3. Enter the desired date range in the ...
TriZetto ERA Request
We have forwarded the information to our contact at TriZetto. Please allow two business days for a response to the status of this request. We will email you with any information received and advise when you can expect to see this ERA for posting in ...
Timely Filing Documentation
A report from within the EDI Portal can be used as documentation of timely filing. Login to ProviderSuite and go to the Billing tab Click the option for EDI Portal In the EDI Portal, click the Manage Claims tab Select "Search Claim History" Enter a ...
Plan Updated to Go EDI
This plan has been updated for claims to go EDI. Please close Billing Manager and relaunch. You can then resubmit these claims as new and they will update into the "Awating EDI Submission" bucket.
EDI Rejection - provide more info
Please provide more details regarding your EDI rejection inquiry. Please provide patient account number examples along with the exact rejection message so that we can research this for you.
EDI Provider Hold
We have removed the EDI Provider Holds for this provider and you may resend the claims that are in your On Hold bucket.
EDI Provider Claims Approval
Your providers --- have been approved to send claims for the following payers. Aetna Cigna Humana United Healthcare Please re-release claims from the EDI Provider hold bucket or begin entering at your convenience.
EDI Error: Electronic COB
The error is happening because all the details needed to electronically COB the claim are not available. In order to COB an electronic claim, the primary payment must have transactions that list the patients responsibility, how much the primary ...
Introduction to ERAs
The American Medical Association has an excellent overview of ERAs with guides on how to get started with ERAs, how to enroll for ERAs with payers, and tips on processing ERAs. ...
Are your claims in Awaiting Printing for Brickstreet Mutual Insurance?
Question- Why are my claims for Brickstreet Mutual Insurance going to the Awaiting Printing bucket? Answer- Per our clearinghouse partner Trizetto Brickstreet Mutual Insurance (Payer ID BRICK) Effective 9/11/2014, Brickstreet Mutual Insurance ...
Popular Articles
EDI Rejection: Medicare only accepts claim frequency code of 1
Medicare does not accept claims marked as corrected or voided. If you have claim rejections for "Medicare only accepts claim frequency code of 1", you will need to re-release the claim and select New, not Corrected or Voided. New should be selected ...
Strategic enrollment manager (STEM) manual and FAQs
Strategic Enrollment Manager (STEM) is a portal within Madaket Health, an enrollment partner of TriZetto Provider Solutions. This portal allows you to: Enter your administrative, practice, provider and payer information for enrollments. View ...
UB-04 facility billing Bill Type - why does it end with 7, instead of 1?
The Bill type is officially a four-digit field, but historically users have known it as a three-digit field, hence the usage of the bill type '711'. If however you print a UB-04 for a claim with a 711 bill type (a new claim), you will see it prints ...
Can a claim have multiple authorizations?
Guidelines for Item 23 ( Prior Authorization Number ) : NOTE: Item 23 can contain only one condition. Any additional conditions should be reported on a separate Form CMS-1500. This is the condition with respect to CMS-1500 guidelines, hence Item 23 ...
Posting an Unprocessed ERA
Here are the steps to Manually post an Unprocessed ERA. Watch our Training Video. From the Billing Manager > Payment Application > ERA's > Unprocessed> Refresh ERA List> Double Click on the Aetna ERA If the ERA does not need to be posted as it is a ...