Check coverage with Zaya

Check your coverage with Zaya
This form allows your to check eligibility for one client at a time. To check eligibility for multiple clients at once, submit this template to support@zayacare.com.

Zaya will share results of the eligibility check with you within 7 days.
Provider Name

FirstLast
Client Information
Name*

First Last
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
State*
Insurance*
Member ID*
Date of Birth*

MonthDayYear
Date
Primary diagnosis (ICD-10 code)
Additional diagnoses (ICD-10 code)
Up to 3
Zip Code*
Photo of the front and back of insurance card (optional)

Cancelof
Should be Empty:

Check your coverage with Zaya