1. Primary Insurance Policy

2. Secondary Insurance Policy

3. Change filing status: Change the policy to Primary, Secondary, Tertiary or Inactivate a policy by dropping down and selecting from the list.

4. View: Displays details of the patient's insurance policy

5. Scanned Insurance Card(s): Display as tabs on the Insurance tab for reference

Click the Add New Policy button

Type-Select policy type from drop down list. (For informational purposes only)

Company-Select from list of insurance companies. This is the listing created when setting up insurance companies from Tools->Insurance Companies.

Policy Information

Policy # Type-Select Member ID-the subscriber’s identification number as assigned by the payer. (For example, Insured’s ID, Subscriber’s ID, Health Insurance Claim Number (HIC), etc.) Or select Unique Health ID-Required if the HIPAA Individual Patient Identifier is mandated use. If not required, select Member ID.

Policy #-Enter insurance information exactly as shown on patient's insurance card.

Payment Options

Co-Pay or Co-Insurance amounts. The amount entered in the Co-Pay can be viewed at a glance in the patients information bar for reference.Status-Primary, Secondary,Tertiary or Inactive.

Fee Schedule-Defaults to the fee schedule selected in the Insurance Company setup.

Insured Information

This section defaults to the patient information entered in the demographics tab. If the patient is the insured, no changes are necessary. If the insured is someone other than the patient, you will need to enter that info here. Please see next step.

If Relation to insured is changed, all data from patient demographics is cleared and information can be manually added or can be added by clicking on the Select Guarantor icon, if the insured has been added to Payer/Non-Patient Accounts. Complete policy information exactly as it appears on insureds ID card.

Relation-Choose the patient's relationship to the insured from the drop down list.

Is Person- Select Yes if the insured is a person or No if the insured is a non-person entity.

Name-Enter the insured information in the fields provided.

If patient has Medicare as a secondary policy, the Medicare Secondary Type must be specified. This option will be added to the Secondary Policy in patient Insurance demographics tab.

Click the drop down arrow to select the appropriate code/reason Medicare is not the primary payer

1. Click Check Eligibility Button to download patient insurance eligibility. Download will begin automatically. (See next step for further information on eligibility issues).

2. Click to Add Scan. For information on adding scanners, please click on the link. Scanning Set-Up & Options.

Note: Medicare requires the Eligibility enrollment be renewed once a year.  If your renewal is due, you will receive a message when checking eligibility, and will not receive the eligibility results until the enrollment renewal is performed. This can be updated on the TriZetto website. Contact TriZetto Customer service for details.

Some payers require a legacy ID or Tax ID for checking eligibility. If this message pops up when checking eligibility, please refer to step 13 in the Insurance Company Setup. Setup Insurance Company