Overview

The Eligibility page is comprised of three tabs:

The Eligibility / Payer Mappings tab is used to view and map your full Eligibility payer list of TriZetto payers and their corresponding payer mappings. Eligibility requests are sent through the TriZetto clearinghouse. If you do not use the TriZetto clearinghouse, it will be necessary to map your clearinghouse payers/plans to a TriZetto Payer ID in order to use this functionality.

The tab also provides a quick view of which payers require additional enrollment.

How to Get Here?

From the Home Page:From the Menus:
  1. Click Eligibility from the Admin list. 
  2. Click the Payer Mappings tab.
  1. Open the Admin menu and select Eligibility.
  2. Click the Payer Mappings tab.

 


Field Definitions

Field

Type

Required 

Description

TriZetto Payer ID

Display Only

(pulled from system)

Yes 

The TriZetto Payer ID used by the TriZetto clearinghouse to identify the payer.

TriZetto Payer

Display Only

(pulled from system)

Yes

The TriZetto Payer Name tied to the associate TriZetto Payer ID.

Enrollment RequiredSystem-generated checkmarkNo

Designation to identify if the Payer requires additional enrollment to use.

Clearinghouse

Display Only

(pulled from created/updated Payer Mappings)

Yes

The name of the clearinghouse associated with payer/plan mapped to the TriZetto payer.

Payer/Plan

Display Only

(pulled from created/updated Payer Mappings)

Yes

The name of the payer/plan mapped to the TriZetto payer.

Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Create[Alt] + [C]Map a payer/plan to a TriZetto Payer ID.Creating Payer Mappings
Update[Alt] + [U]Update a payer/plan to TriZetto Payer mapping.
  1. Select the mapping to be updated.
  2. Click Update. The Update Payer Mapping window opens with the Payer/Plan, Clearinghouse, Clearinghouse Payer ID, and Clearinghouse Payer auto-populated based on the record selected.
  3. Enter either a TriZetto Payer ID or Name to search for the TriZetto Payer to map the payer/plan.
  4. Click Search. A list of TriZetto payers are displayed that meet the search criteria.
  5. Select the relevant item to update the mapping from the list of search results.
  6. Click Save.
Delete[Alt] + [D]Remove a mapped payer/plan.
  1. Select the Payer Mapping to be removed.
  2. Click Delete. The Delete Payer Mapping confirmation window opens.
  3. Click Yes. The payer mapping is removed from the Eligibility Payer List table.





 

Related Topics

Eligibility

Eligibility / Configuration Tab

Eligibility / Excluded Payers Tab

Creating Payer Mappings



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