Update to Change Healthcare Outage

  There is not much news regarding the Change Healthcare outage.  Yesterday TherapyNotes did have a conference call with Change Healthcare.  I will paste from their blog the important info and this will apply to all of our clients, not just TherapyNotes users:

     " Change Healthcare held another conference call to discuss updates this evening.  They announced a return to operations for their pharmacy  services, but did not provide a timeline for claims, ERAs, or eligibility checks to resume functioning.  They are working with payer partners to find ways to route claims where Change Healthcare was the only available point of contact.  At this time, Change Healthcare is continuing to recommend providers use available workarounds to submit claims and obtain remittance advice."

  In addition, a Vice President of Change was recently interviewed and indicated it will be weeks before Change is functional again.  He didn't say a couple of weeks or a few weeks, but said weeks.  This leads me to believe it will be at least a month (and probably longer) before Change is functional for claims and remits.

  So what does this mean for you? 

  Claim Submissions:  As a reminder, unless you are enrolled for our Availity claim submission option, your claims are NOT being submitted.  For our TherapyNotes clients, claims are being uploaded by us to TherapyNotes as usual where they are sitting in a queue waiting to be sent by TherapyNotes once Change Healthcare is functional.  Again this only applies if you are NOT enrolled for the Availity claim submission option.

  For our non-TherapyNotes clients (and our TherapyNotes clients where billing is done in Medisoft), Revenue Performance Advisor remains unavailable and thus no claims are being submitted....unless you enroll for the Availity claim option.

  Insurance Payment Posting:  Because no ERA files can be retrieved from Change Healthcare insurance payments are paused until Change Healthcare is again functional.  We are able to obtain ERAs from select payers (such as Optum and certain other payers) but 99% of the insurance payments will not be posted until after the issue has been resolved.

  In addition, because it can take up to 6 weeks to enroll for ERAs with payers to go Availity, we are not recommending that we switch ERA enrollments...especially since we would have to switch them back to Change once Change is again functional.

Availity Option:

  As a reminder if our office has not done so already you can enroll for us to submit claims temporarily via the Availity clearinghouse.  A few things to know:

• You do NOT need an account with Availity (although it is recommended)

• There is a one-time set-up fee of $149.95 that must be paid prior to us getting you set up with Availity.
  

• There is a fee of $9.95/month for bulk claim file upload to Availity.
  

• There is a $1 per claim surcharge for each claim submitted to Availity.  This is in addition to the normal fee your office pays for claims.
  

• Your office must complete a form at www.mbpros.com/availity to enroll for the Availity claim option.
  

• Once you complete the form and pay the set-up fee, we may have to enroll you for electronic claims with some payers (such as Medicare and some Blues).  Approval time varies per payer but generally is in the 2 week time period (some are processing much faster).  But for most payers like commercial payers we can submit immediately.
  

• Once Change Healthcare has resolved the problem we will then switch back to Change Healthcare for submissions.  If we had enrolled you for electronic claims via Availity for a payer (such as Medicare) we then will have to re-enroll you for electronic claims via Change Healthcare.
  

Should You Submit Claims Yourself?

• First, do NOT send paper claims to payers.  Payers specifically are asking providers not to send paper claims.  Because of the deluge of paper claims they are receiving, there will be a big backlog in processing paper claims. 
  

• If you want to submit yourself, you can try to submit via the various payer portals.  Some providers have asked if they can submit via Availity.  Not all payers are on the basic/free payer list in Availity (for example, United Healthcare and Cigna are not).
  

• If you are using TherapyNotes and you choose to submit claims yourself via a payer portal, you must either notify us not to submit any claims for you until the Change Healthcare issue has been resolved OR you must immediately after doing the note submit the claim, change the Billing Method to In Network External and change the status to Submitted External.
  

That's all for now.  Thanks for your understanding during these difficult times.

Steve