Getting Setup with Gateway EDI/TriZetto -- What to Expect
A brief description of the Provider Enrollment process.
(Color coding is used to denote participant roles and associated activities.)
Blue = Office
Teal = SOAPware
Black = TriZetto (Formerly known as Gateway EDI)
1. Office contacts TriZetto and signs a contract with TriZetto. (Note: This can happen before installing SOAPware CS.)
2.. Office purchases and installs SOAPware Clinical Suite and signs up for the following training sessions in exact order:
A. SOAPware Billing Setup
B. Transaction Entry and Work flow
C. Claims Processing
3. Office completes SOAPware master setup and begins practicing with the software in preparation for live use. (Note: This step can be done in conjunction with the steps shown below.)
4. TriZetto will contact the Office to complete a Provider Enrollment online. TriZetto will request provider ID numbers and Master Insurance List (MIL) from Office; provider enrollment process will begin within two days of signed contract.
5. TriZetto will generate the Enrollment packet, and the Office is given payer enrollment packet to complete.
6. Office returns enrollment packet originals to TriZetto and production date is estimated based upon projected payer approval time frames. (The Office can begin sending commercial claims as each payer approval is granted, followed by governmental approvals.)
7. TriZetto verifies accuracy and forwards payer enrollment agreements to Carriers.
8. TriZetto contacts Carriers to obtain approval dates and records dates on addendum.
9. BCBS, Medicare, and Medicaid payer approvals are obtained. The training packet, which includes a copy of the Providers Addendum (list of Provider ID numbers and payer approvals), training CD, and MIL is sent to the Office.
10. TriZetto will contact the Office to schedule an "install appointment."
HIGHLY RECOMMENDED: When the Office is ready to send the first live claim file, (with real patient claims), SOAPware recommends that the office use a one-on-one training sessionto provide assistance from SOAPware PM experts for this first filing. A SOAPware representative will inspect the setup of the system to ensure everything looks correct, and will also assist the Office with creating, scrubbing and troubleshooting the first claim file. SOAPware will also help the office prepare for their setup call with TriZetto.
11. Office sends first file with live claims to TriZetto; file is tested (two day turnaround) before TriZetto production begins.
12. Once the Office is installed and is sending claims, the Office will be contacted to schedule initial report training.
13. Report training is completed.
14. Two weeks after production begins, a second report/web training is offered to the Office.
15. Two week-stage web training is completed.
16. Each office is assigned to a TriZetto New Accounts Rep who will monitor their claims for first 30-60 day period in production to ensure that the claims acceptance rate is above 85%.
17. Office may request additional phone training with TriZetto and/or call/email with Support questions at any time.
18. TriZetto Customer Service will work with the Office to correct any errors on claims submitted. TriZetto will always be available for any insurance questions, or other questions about the reports or errors. Anything related to the generation of claims files or errors on the software side will be handled by SOAPware Tech Support via www.soapware.com/ticket
NOTE: TriZetto can provide an estimated time frame for payer approval in your state. PLEASE NOTE THAT TIME ESTIMATE BEGINS AFTER GATEWAY HAS RECEIVED YOUR COMPLETED PROVIDER ENROLLMENT PAPERWORK.
To help expedite the setup process, Office should submit completed GEDI enrollment forms as soon as possible.