Sunwave 9.6.2
RCM
New Clearinghouse Vendor Option: TriZetto
We have added support for TriZetto as a new clearinghouse vendor option within Practice Setup → Billing Facilities.
What’s New
TriZetto is now available as a selectable clearinghouse vendor in Practice Setup → Billing Facilities. When TriZetto is selected, a TriZetto Site ID (assigned by trizetto during credentialing) field becomes required and must be configured at the billing facility level.
Claims submitted under a billing facility configured for TriZetto are now sent in 837 EDI format instead of image files. Users can view the generated 837 file by selecting a claim and clicking the new “Print 837” button. This functionality supports both UB-04 and CMS-1500 claims.
There is an update to the insurance provider window found under billing>insurance providers. A new Payer ID for CMS - 1500.
Who This Is For
This update is intended for billing teams submitting claims through TriZetto, revenue cycle managers responsible for clearinghouse configuration, and organizations that use TriZetto as their clearinghouse partner. It is especially relevant for practices transitioning from image-based claim submission to EDI-based workflows.
How to Use It
To use this feature, navigate to Practice Setup → Billing Facilities and either create a new billing facility or edit an existing one. Select TriZetto as the clearinghouse vendor and enter the assigned TriZetto Site ID, then save the configuration. Once configured, claims submitted under this billing facility will automatically generate and transmit an 837 EDI file instead of an image file. After submission, users can open the claim and select the “Print 837” button to review the full EDI contents of the file.
Updated Claim Workflow
When TriZetto is selected, the system generates an 837 file and transmits it to TriZetto. A 277 transaction is returned to confirm receipt and acceptance or rejection at the clearinghouse level. The clearinghouse then forwards the claim to the payer, who responds with acceptance or rejection. Payments and remittance details are returned via 835 ERA files, which continue to be ingested into Sunwave without changes to the existing ERA workflow.