Change Healthcare: Eligibility Checks

This article contains information on Healthie's integration with Change Healthcare for eligibility checks.

Healthie has integrated with Change Healthcare to allow providers to check the insurance benefit status for each client within Healthie. Once the Healthie + Change Healthcare: Eligibility Checks integration is enabled, providers are able to manually run a check within Healthie to verify the insurance status (active or inactive) for a specific patient, to support more efficient and accurate reimbursement.

To view more benefit details, please log into your Change ConnectCenter account. Learn more here.

Note: Healthie's integration with Change Healthcare Eligibility Checks has moved forward into our Beta testing phase. At this time, all available spots for the Closed Beta have been filled. We'll be opening up additional spots in the upcoming weeks to accommodate more participants in our exclusive testing phase. Please subscribe to our Portal Card for updates.

About Change Healthcare

Healthie's Insurance Billing feature makes it easy to create and submit CMS 1500 claims to insurers. We have also integrated with Change Healthcare's Insurance Eligibility product, which will give organizations the ability to check for eligibility of services using Change's lookup tool. 

The initial release of this integration enables providers to verify the insurance status (active or inactive) for a patient directly within Healthie. Your Change Connect Account can be also leveraged for more detailed eligibility information.

If you have feedback, or required additional functionality for your business, you can share with our team through our Product Portal, by adding a comment/insight here.

Enable Change Eligibility Checks Integration for Healthie

Healthie's integration with Change Healthcare Eligibility Checks has moved forward into our Beta testing phase. At this time, all available spots for the Closed Beta have been filled. We'll be opening up additional spots in the upcoming weeks to accommodate more participants in our exclusive testing phase. Please subscribe to our Portal Card for updates.

• An initial rollout post beta-launch for Change Eligibility Checks will be available for Enterprise Plan Healthie members only.
• If you are interested in being notified when this integration is more widely available, please subscribe to our Portal Card to be notified.
• Even if you have previously submitted a EULA for Change Labs and would like to now enroll in Claims and/or Eligibility as well, please follow the instructions here.  
• There are nominal fees associated with the Change Healthcare Eligibility integration. Healthie will bill you monthly for usage based on the following rate: $0.10 per eligibility check

Enrollment Instructions

Customers who are enrolled in our Closed Beta should have received an email with a prompt to complete an End-User License Agreement (EULA). After reviewing & signing the EULA, you will be provided with an enrollment spreadsheet by your Healthie Customer Success Manager.

Please complete all of the following required fields that are marked with an asterisk (*) and return to us at hello@gethealthie.com

• Name of Practice: The name of the practice should be the name that is being used to file claims. It would be the name that is registered with any current payers you might have. If you file paper claims today, the practice name will be the name you use in Box 33 of the CMS 1500 claim form.
• Provider Name and Email: This should be the main point of contact for your organization. It can be a provider or other professional who you will want to have access to the connect portal to submit and search for claims.
• Practice Address: If you submit claims out of multiple locations (multiple tax IDs), you will want to set up separate Change submitter IDs for each one. To do so, simply duplicate the address fields on the enrollment spreadsheet and add fill in the required information for each additional location. Please note that the practice names for each address will need to be different. You will also receive different usernames for each submitter ID.
• Phone Number (optional)
• Submitters and Additional Users: You will need to add the names and emails for every individual in your organization that you would like to have access to the Change Claims Connect Center. These will be individuals responsible for enrolling payers and reviewing eligibility and transaction history. Each user will be given their own username and login credentials. The main provider contact will also have access to all of this functionality. Once you’ve received your username and login credentials, you will need to login to the Connect Center portal to start enrolling your payers.

Updating Insurance Eligibility Settings

After Change Eligibility Check integration is enabled, navigate to Settings (top right gear icon) > Settings > Business > Insurance. You will see a setting for "Request Insurance Availability Check."

Note: Manual eligibility tracking is still critical for organizations who choose not to integrate with Change. If both manual and automatic insurance eligibility checks are available, there will be no difference between the two.

If "Request Insurance Eligibility Check" is turned OFF, click "Edit" to edit the Insurance Settings. As soon as you toggle this setting ON and click the blue "Save Changes" button, Eligibility checking will be enabled in ALL client profiles.

Run an Insurance Eligibility Check within Healthie

Navigate to Clients (left navigation sidebar) > Client Name (e.g. Demo Client 1) and scroll down to "Insurance Eligibility" box. Click on the blue "Check Eligibility" button after entering in client's insurance details.

In the event that the eligibility check succeeds, look for the following green success banner.

In the event that the eligibility check fails, you will receive a red error banner. Navigate to Actions tab > Insurance (blue toggle box). You will see a banner that indicates what specific fields requirements need to be present to run an eligibility check. You should also be able to dismiss the banner on your end. Please note that a "Missing Information" banner will appear if the provider does a check and the response has field errors.

Prevent Unauthorized Transactions by Organization Users

In the event that providers conduct checks without permission from the organizational administrator, your organization may incur charges from Healthie. To prevent this, the organizational admin can add permissions to prevent unauthorized transactions and either enable or disable the ability for users to run eligibility checks.

Navigate to Organization > Members. Click on the [...] that appears when you hover on a member's name, and select Edit Settings > Permissions (left side navigation bar). Scroll down to Billing section.

If the user has access to billing, they should automatically have the "Can request eligibility checking" permission enabled (checked).

Auto Notify Provider when Insurance Eligibility is Expiring

When "Expiry Notifications" is selected:

• If Expiry information is available, an email will be sent to you (the provider) 2 weeks before insurance expiration
• The email will include the insurance expiration date
• From here, you can message your client and/or send them the Insurance Billing form for completion. If the policy is expiring, or if the provider wants new information, you can send an automatic insurance form completion request to the client via email. Navigate to Clients (left navigation sidebar) > Client Name (e.g. Demo Client 1) and scroll down to "Insurance Eligibility" box. The provider should be able to click on [...] and see a drop-down menu. One of the menu options provide the ability to "Request Client Insurance Form." Once clicked, an automatic email with a request to provide insurance will be sent to the client. The provider will then see a banner that confirms that the email has been sent.
• Alternatively, learn how to manually request a client (or multiple clients) to submit the Insurance Form within Healthie here.

When "New Insurance Added Notifications" is selected:

• If a client's insurance is updated by the client via form, an email will be sent to the assigned provider
• The email will include the insurance expiration date

Troubleshooting Change Eligibility Checks Integration with Healthie

In the right frame, after the Change Healthcare Eligibility Checks integration has been enabled/connected, you should see the following:

• The integration status shown as "Connected"
• "View Settings" button that directs the organization administrator to the Insurance Settings page

If you need to disconnect your account or troubleshoot integration settings, please click on the "Contact the Support team" link or directly email hello@gethealthie.com.

FAQs: Change Healthcare Eligibility Checks

Find answers to frequently asked questions regarding this integration here.