Change Healthcare Claims Management FAQs

How will Healthie customers be able to activate this integration?

1. Registration process - Healthie collects information about users (super users, standard).
2. Payer enrollment process - Once credentials are received from Healthie, Providers will complete and track the enrollment process via web portal.
3. Claims submission - Providers can start submitting claims via Healthie and access the claims report dashboard for analytical views.

What type of claims does Healthie support?

For v1, we’ll support claims submission for CMS 1500. Future work will include support for CMS-1450/UB-04. Let us know if you need this feature.

Can I use Office Ally and Change Healthcare for direct claims management?

At this time, an integration with only one of these platforms will be supported for a single account. Integrate your account with the platform you would prefer to use for direct claims submissions. Claims can still be exported as a TXT file and uploaded to any additional clearinghouses or billing portals as needed. Example: connect your Healthie account with Change Healthcare for direct claims submission. For any claims that need to be processed, manually export those claims and import them into Office Ally directly.

Does enrolling in Change Healthcare: Claims Management mean that there won't be a need for me to re-enroll with payers I've previously billed with?

If you've billed through one of the Change clearinghouses before we may be able to assist in copying those submitters over to your new Healthie connection. If not, all of your payers will need to be enrolled through Change. Please follow the instructions carefully as not every payer follows the same enrollment process.

Do I need to enroll payers for Eligibility only?

This is payer dependent. If the payer requires an enrollment, then yes you need to enroll payers for Eligibility only. To search for payer requirements, navigate to Payer Tools > Enrollments and then click on the Payer List box in the upper left corner. On the next screen, click the Eligibility box. You'll notice that the "Requires Enrollment" box on the right is already checked. So when you click "Search" any payers that require enrollment for Eligibility AND are connected to Change, will show in the results. You may want to make note of the payers you use from that listing.

To request a connection to a payer that does NOT fall on this list, feel free to submit a "New Payer Connection Request".

If I've billed with Change Claims previously and have a connection to another EHR can I get my ERAs sent to both places?

Yes, once the copy authorization is complete ERAs can be delivered to multiple locations. Claims will only be submitted the first time they are processed.

If I obtain a submitter ID currently used with another billing platform and pass it over to the Healthie, will this ensure that Change can make a copy of the ERA and route it for any claims submitted through Healthie?

Yes, the Submitter IDs change based on which clearinghouse under Change is being used. Healthie can copy over information including payers and ERAs from all 6 digit submitter IDs, whereas all others will need to be re-enrolled directly under your new Healthie submitter ID. This is particularly useful when transitioning from another EHR like Simple Practice to Healthie.

For Healthie, is the payer enrollment for ERA's AND EDI?

Payer enrollment allows you to enroll for both ERA and EDI, yes. You will have to enroll every payer that you want an ERA from. Medicare will require enrollment 100% of the time. Medicaid depends on the state (CA and NY both require it). For some insurance companies you can enroll once for both ERA and EDI, whereas for others there will be separate paperwork required. We recommend checking this in the enrollment central. Occasionally, ERA will cover multiple payer IDs and sometimes they will only cover a single payer ID. Also note that hospital vs. professional claims are different types of transactions and may require different enrollments.

If you are already submitting electronically with all of your payers, but not through Healthie/Change, you WILL have to enroll for both EDI and ERA with your current payers.

Will Healthie take care of EDI enrollment?

No, Healthie will not take care of EDI enrollment. You will need to go in and enroll with any payers that they'd like to use. If you are already using the platform you won’t need to go through this again, as we can simply copy this information over from your prior Healthie account. Your payer list will tell you if you need to enroll (not all providers will require this). Please refer to the Change Connect Center Education portal and specifically the video about Payer Enrollments to learn more about how to enroll with payers.

Will there be a separate approval for EDI and ERA?

Approvals are payer by payer dependent. Change Healthcare establishes the connection between the payers and the providers but does not control the rules around the approvals.

Once EDI is set up in Change ConnectCenter, does this mean that we can proceed with some test claims submitted in Healthie? Will Change will post the ERA's to multiple EHRs if necessary?

Yes, Change can send the ERA to multiple EHRs. They can make a copy and send to 2 different receivers without impacting your current enrollments. As soon as Healthie completes the copy authorization, this will happen immediately.

We have a group NPI entered in. Will this group NPI work or will Change need individual provider NPIs?

The group NPI will work. The payers will know if the provider is associated with a group NPI, and ALL providers can use the same group NPI. Individual provider NPIs will be rejected.

How will different tax IDs be handled?

Depending on the claim submission, the tax ID number on the submission would change. Payers process by Tax ID and NPI and when they return remittances, they return them by Tax ID number. They need to make sure that the claims are being processed out of the appropriate location.

We can use the different submitter numbers within Change Claims to separate these (reporting needs to be separated). Once Healthie gets approval that the information can fall under one Change Healthcare account, Healthie can submit this through to Change Healthcare.

Insurance companies can only return a remittance to one location. You can submit via multiple clearinghouses but the payers will bounce any that have already been submitted.

Will we need to set up as "New" enrollment with Healthie or can we submit a "Change of Enrollment" and transfer the previous acceptance that is valid in our prior EHR?

This is dependent on the EDI form being completed through the enrollment central, and if you have ever sent electronic claims.

There are 3 clearinghouses within Change. We are using the Relay clearinghouse, and would need to know which clearinghouse you were using previously to know if you have submitted before. Claims currently being processed are within the Change Connect Center. If you have your existing submitter numbers, Healthie can do a copy authorization from any prior EHR as long as it’s a 6 digit submitter number. If there are more than 6 digits, you are likely using a different clearinghouse. If you are already approved to submit claims to a payer through this clearinghouse then you can allow a different submitter to process the claims - the clearinghouse will only let one submitter send a claim.

With either of the above enrollment options, will ERAs come into both Simple Practice and Healthie during their EHR transition time?

Change Healthcare Connect Center can make a copy of the ERA and distribute to both submitter numbers during the transition time. The payers cannot make a copy. When Healthie does the copy authorization, we let the payers know that we want claims and remittances to be sent to both submitter numbers.

If we have a test provider using Healthie, can 837 files be submitted for that provider simultaneously in both Simple Practice and Healthie?

Each submitter has their own submitter ID and mailbox. So they can submit in both at the same time. This allows you to maintain billing operations while transitioning from Simple Practice to Healthie.

As we are able to create claims in Healthie and submit them via the Change Portal, to what extent can we edit submitted claims and add attachments?

Change Connect Center will allow you to edit the claim and resend it, but Change feels it’s best to update/edit claims within the practice management software (i.e Healthie). You will NOT be able to add attachments though the Connect Center.

Can I use the Healthie/Change integration but then also work directly with Change to contract additional features?

Yes, you can absolutely contract additional products and features directly from Change Healthcare.

Do the payers need to be associated with a specific provider or can they just run it generically across all NPIs?

Generally, when filling out an enrollment, the payer should put the group NPI in that first screen. That way if multiple providers are at one facility, they're all covered with the payer.

As the address for the payer does not auto populate in the Healthie CMS 1500, does Change need the payer address on the CMS1500 or will the customer need to manually add it there? 

The payer address is not required when submitting claims electronically. It would only be required if a claim was intended to be submitted via paper (or if a payer has an edit in place for it). We route transactions based on the CPID which is the tradingPartnerServiceId that is submitted in the request.

Some payers require test claims with a submitter ID to allow claims submission. Does Healthie have a way to send test claims?

Change Healthcare does not do end to end testing with payers, and Healthie does not currently have a function that allows claims testing.

Is there a way to send corrected claims in Healthie, as well as make edits to specific loops/segments on a claim?

Yes, you can configure claim rules in Healthie and resubmit them - this is NOT something that can be done through Change.