If you are using the TriZetto integration with ChiroUp, you can perform Insurance Eligibility Checks directly in your ChiroUp account. This article will walk you through how to request and view Insurance Eligibility for a patient. 

Here's how to run an Insurance Eligibility Check: 

1) Navigate to the patient's record and to the Insurance tab. 

2) Under the policy for which you'd like to run an eligibility check, click the green Verify Eligibility button. 

3) Enter Insurance Eligibility Request details:

• Provider: Select the provider under whom you'd like to run the check. Please note that each provider has a monthly limit of 1,500 eligibility checks.
• Billing Profile: Select the relevant billing profile
• Eligibility Start Date: Select the date from which you would like to start pulling eligibility.
• Service type: The default service type is 33 - Chiropractic. You can select a different service type if applicable. 

4) Click Save. 

5) You will now see the queued request at the bottom of your screen: 

Here is a summary of the request status: 

• Queued: the request has been made, but has not been automatically submitted to TriZetto yet
• Submitted: the request has been submitted to TriZetto
• Processed: TriZetto has processed the request, and the response has been received in ChiroUp
• Rejected: there is an issue with the request (the payor may not participate in eligibility checks, the member ID may be incorrect, there may be no eligibility info to return, etc) 
• Error: there was an error processing the request
• Received: TriZetto has received the eligibility request

6) Once the request is Processed, you'll click the line item request to view Insurance Eligibility details. 

Please note: Insurance eligibility requests can take anywhere from 20 minutes to 24 hours to process, depending on the payor. ChiroUp will automatically check for responses every 15 minutes. 

Open up the drop-down fields to view the eligibility details regarding info like active coverage, copay, deductible, etc. 

Please note that many payors may send eligibility details for multiple service types, not just the service type you specified. ChiroUp does not control which information is sent by the payor - all information sent by the payor will display in eligibility details. If a payor sends back eligibility for multiple service types, we recommend using the Ctrl+F (or Cmd+F) search feature on your computer to find “Chiropractic” benefit info. 

💡Pro Tip:

You can view all Eligibility requests in Billing > Eligibility.