ELECTRONIC DATA INTERCHANGE STATUS

4/11/24 Webinar Recording: Recovery Best Practices – Optimizing Revenue Cycle Management

Our Revenue Cycle Consultant leaders reviewed the most efficient strategies to reinstate comprehensive revenue cycle management following the Change outage. Guidance was provided on accessing and using the Availity Essentials Pro Portal, along with key updates on EDI Enrollments (Claims, Remittance, and Eligibility). Participants benefited from a full review of best practices for refiling stagnant claims and securing remittances. Registration is required to view the recording.

4/11/24 Webinar Q&A
With Change Healthcare coming back online, will the Switch direct claims to that pathway?

Yes, as Change Healthcare restoration progresses and Change claim pathways come online, we will route claims to Change for payer’s that cannot be filed to through Availity, and for payers that are not approved for submission via the Availity gateway.

When Change Healthcare remittance pathways are re-established, will I receive the 835 files from Change?

Yes, Change Healthcare remittance pathways are in place and live. As Change forwards new remittance files we are relaying them to g4-Centricity and Unlimited Financials.

If we can download 835 files from one of the alternate ERA options (PaySpan, Zelis, Echo), once imported into g4-Centricity or Unlimited Financials will they process automatically?

Yes, for g4-Centricity, 835 files can be imported into EDI Response Management. They will then populate in Resolve for the auto-processing. For Unlimited Financials, 835 files can be saved to the Z drive and will then populate in the Bank Reconciliation workflow.

If my Medicare EDI enrollment is still pending yet I have received Availity Essentials Pro Portal access, can I submit my Medicare claims through the portal for now?

No, Medicare would reject these claims for not having an approved EDI enrollment with Availity. We recommend calling your MAC to understand the status of the enrollment and whether there are additional steps that need to be taken in order to receive approval. If needed, our team can assist with this conversation. In the meantime, we will continue sending small batches of claims through to Medicare to test for approval.

We see some claims in Sent status for more than 10 days now for payors whose enrollment is completed. What should we do?

If the enrollment is approved and you have other claims that have successfully made it on file with the carrier, please move forward with refiling these claims. If the enrollment is approved but you have yet to experience success on any claim submission, whether that be no acknowledgement or possibly rejections, we recommend reaching out to the payer to validate the enrollment is truly approved for the NPI, Tax ID, and PTAN combination before resubmitting any claims.

When creating new plans in Centricity or Unlimited Financials, should I use the Change Healthcare CPID or Availity’s payer ID? Where can I get the list?

For now continue to configure new plans with the Change Healthcare CPID. The Switch includes functionality that leverages the Change CPID to route traffic to the appropriate Gateway. The ChangeHealthcare CPIDs list is accessible here.

What is the timeline for eligibility being back online?

In Unlimited Financials, the functionality for on-demand requests for non-Medicare eligibility inquiries went into production this week. We anticipate the ability to send on demand Medicare inquiries out of Unlimited Financials and all on demand requests out of g4 in the coming days. Nightly, batch eligibility requests driven by your practice schedule will follow. We anticipate all eligibility functionality being online early next week.


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