Delilah Greve, Lead Systems Integrity Specialist, Experity

Real-Time Eligibility (RTE) in Experity, powered by Waystar, allows practices to instantly verify a patient’s insurance coverage. This article outlines the steps and resources necessary to set up insurance companies correctly for RTE, including how to find payer IDs, interpret coverage responses, and follow best practices. 

1. Setting Up an Insurance Company in Experity for RTE

To enable RTE for an insurance company in Experity: 

1. Navigate to Admin > Insurance Companies in Experity. 

1. Add or edit an existing insurance company. 

1. Input the appropriate RTE Payer ID (obtained from Waystar). 

1. Check the box to enable eligibility checks. 

1. Ensure the insurance setup correctly reflects whether the patient is the subscriber or a dependent. 

Note: For Medicare, Medicaid, Tricare, and Aetna, you must set the patient as the subscriber. 

Refer to the full setup guide:
Experity PM RTE Setup

2. Finding the RTE Payer ID in Waystar

To find the correct payer ID: 

1. Log into your Waystar portal. 
2. Go to Eligibility > Payer List. 
3. Search for the insurance company by name. 
4. Copy the RTE Payer ID and use it in Experity. 

Refer to the detailed instructions:
Waystar RTE Integration Guide 

Important: Use the state-specific payer ID for BCBS plans. Only use the universal code Z1066 if credentialing is pending.

3. Viewing Coverage Details in Experity

Once RTE is configured and eligibility is run, Experity displays detailed coverage information, including: 

• Eligibility status 

• Coverage effective dates 

• Co-pays and deductible info 

• Plan name and type 

• Subscriber and dependent status 

Learn more here:
Patient Coverage Information in Experity 

 4. Enrollment Requirements for Payers

Some payers require enrollment through Waystar before RTE can be used. Refer to the attached payer list to confirm if enrollment is required and ensure that all paperwork is completed before testing RTE for those insurers. 

 5. Understanding RTE Symbols in Experity

Experity uses specific icons to indicate the result of an RTE check: 

Symbol	Meaning
✅	Eligible
❌	Ineligible
⏳	Pending response
	No response

See the full symbol guide:
Check Real-Time Eligibility in Experity 

 6. Tips and Best Practices

• Avoid spaces or dashes in Member IDs. 

• Always use subscriber setup for: 

• Medicare 

• Medicaid 

• Tricare 

• Aetna 

• Use state-specific payer IDs for BCBS. 

• Use Z1066 only when BCBS credentialing is pending. 

This guide ensures accurate and streamlined RTE setup in Experity, helping your clinic get real-time coverage details for smoother operations and better patient experiences.