Change Healthcare Eligibility Checks FAQs

What client data is required for an eligibility check?

Please refer to screenshots of Change ConnectCenter below.

Can Change Healthcare: Eligibility Checks be enabled in the Healthie staging account?

At this moment, Change Healthcare Eligibility Checks cannot be enabled within the Healthie staging account.

How can Healthie customers start the process to enroll in Optum (Change Healthcare) Eligibility Checks?

While Optum (Change Healthcare) Eligibility is not a Closed Beta in the sense that customers cannot be added, it is available to select pilot customers who Healthie has a chance to discuss customer needs and expectations with — prior to the customer filling out the enrollment form. The Eligibility results returned into Healthie are very specific, and could require that parts of your workflow include searching outside of Healthie, directly in the Optum (Change Healthcare) Connect Center.

Here is some additional information so Healthie can decide if the current Optum (Change Healthcare) Eligibility Checks pilot functionality is what you need. Right now, checking eligibility is a manual step, and the data points that Change Eligibility Checking returns to Healthie are:

1) Whether or not the insurance policy is active,

2) Expiration date of the insurance policy.

If you want any other information, such as copay, etc., your team would need to go directly to the Optum (Change Healthcare) portal to run the Eligibility check again (fee per check applies). You can get a feel for what that process entails by checking out our help documentation here, and following this link to Getting Started with Eligibility Connect Center.

Is there currently a demo video of the Eligibility Checks integration within Healthie?

As this integration is still in our Beta testing phase, we do not yet have a demo video to share. We'll update this documentation when a demo video is available.

What fields will be returned to provider/admin after checking a client's eligibility through Change Healthcare?

• Healthie will receive:
  • Service Type Code (for now this is likely always 30, which is general coverage)
  • Change Trading Partner Service ID (which will identify the payer)
• Healthie can currently provide you with: 1) whether or not the insurance policy is active, 2) expiration date of the insurance policy. If you would like additional information regarding the insurance policy, please visit the Change ConnectCenter.
• Note: As per Change Healthcare: "You may receive lengthy responses to our Medical Network APIs, due to the many data points that a payer or trading partner provides in the query response. It reflects the needs to inform the provider about the various financial components of the patient's insurance coverage — existence of copays and co-insurance payments; deductible amounts; possible dependents information; coverage levels, and much more."

How can I locate enrolled payers in the Change ConnectCenter?

First, you log into the Change Connect Center and can see your submitter number at the top of the screen. Navigate to Payer Tools > Enrollments, enter in your submitter number, and click validate. On the next screen, highlight the submitter number (if more than one) and click Apply. Click on the 'Search Submitted Enrollments' box at the top of the screen.

Here, you can either:

1. Put in search criteria, such as NPI #
2. Look for specific types (Eligibility, Remittance, etc) by clicking the drop down under 'Document Type' 
3. Just click 'Search' in the middle of the screen to see ALL enrollments

How quickly does eligibility data come back into Healthie?

Eligibility data comes back into Healthie in real time.

Can this be set up to be automatic so the providers do not have to manually check each client?

At the moment, eligibility checks cannot be set up to be automatic, however, if you would want automatic eligibility checks to happen in the future, please add that as an insight on our Product Portal and it’ll be considered as a future update.

Learn how to add comments and submit feedback to our Roadmap here. 

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".