EDI Services Restoration Update – April 8, 2024
To Every Unlimited Systems Client Leader:
Your accelerated Claim volume to Availity’s Gateway via the Zenith Switch is evident in the filing activity sustained by your business offices during the first week in April. Last week’s trend equates to a monthly all-customer total of 3.6M claims, which is running 56% higher than the historic benchmark of 2.15M submissions. The current number is even more significant considering that it does not include the residual subset of claims being held pending approval by governmental payers. Congratulations to your billing staff who have engaged successfully with Unlimited’s Claim Advocates and are working diligently to restore practice financial health.
Positive outcomes are already manifesting from Availity pathway submissions that began ramping up four weeks ago:
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Cash flow to practices is elevating, characterized by an initial surge as previously deferred claims are paid, to be followed by settling back to normal levels.
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Electronic Remittance Advice (835 file) volume is trending up on a lagged basis relative to Claim and Payment volume. Last week’s all-customer remittance file count was fourteen times greater than the volume returned through the EDI Switch two weeks earlier. Posting those payments will enable secondary filing, patient statement production, and AR resolution – a resumption of what feels normal!
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The backlog of claims deferred due to the Change Healthcare outage will soon be exhausted. Claim, Payment, and Remittance volume will revert to historic levels, albeit adjusted higher due to the always climbing clinical volume experienced over the past few years at many of your practices.
This is a story of success emerging across Unlimited’s customer base as we cross into the second half of a hard running marathon together. It reflects your commitment to leadership and steadfastness, the dedication of your billing staff to your clinics and patients, and our ability to quickly leverage new relationships and technology together. Despite the positive indicators, there is important work remaining in the effort to bring revenue cycle operations back to normal. Unlimited Systems is focusing its resources to deliver the following:
RECOVERY BEST PRACTICES WEBINARS
Unlimited Systems will host a pair of fifty-minute webinars on Wednesday, April 10th and Thursday, April 11th at 2 PM Eastern/11 AM Pacific to share Recovery Best Practices with the revenue cycle teams we support. These identical sessions will provide instruction from our Claim Advocates regarding how to leverage key features of Unlimited Financials and g4-Centricity to organize, streamline, and track transaction activity as use of your practice management system normalizes. Registration for the webinar session you prefer will be available starting tomorrow at www.unlimitedsystems.com/edistatus.
AVAILITY ESSENTIALS PRO PORTAL
A secondary benefit of submission through the Availity Gateway is access to the Essentials Pro Portal. This self-service tool enables Claim tracking, exposes Enrollment status, and provides insight into Remittance. The Portal is available to every Unlimited Systems customer to review their Unlimited Financials or g4-Centricity EDI activity. The Essentials Pro Portal will be covered during our Recovery Best Practices Webinars. Your revenue cycle manager or the security administrator they designate will be issued primary credentials and can establish access for others at the practice.
INSURANCE ELIGIBILITY
Real-time insurance eligibility verification for all commercial insurance payers is now fully operational for Unlimited Financials customers. The scope will extend to Medicare this week as individual provider NPI’s are registered with Availity – a bulk process Unlimited is driving. As testing completes, equivalent functionality in g4-Centricity will enter production this week in addition to Batch eligibility verification, required for rule-driven advance lookups in both Financials and g4. Because Availity’s response technology is different from Change Healthcare’s, new product development was required to fully restore insurance eligibility transaction processing via the new pathway. As adoption of insurance eligibility expands, we are monitoring an increasingly broad range of responses and making further product updates as required.
HISTORIC REMITTANCE BACKLOG
Electronic Remittance Advice files generated by payers prior to redirection to Availity did not accrue at Change Healthcare because their payer connections were (and largely remain) offline. This missing information is needed to properly apply payments, generate secondary claims, and pursue carrier denials and underpayments. Unfortunately, there is not proving to be a ‘silver bullet’ that can be deployed across the payer landscape to streamline recovery. Based on progress with customers over the past few weeks our Claim Advocates are prepared to support multiple parallel efforts with you:
- Download historic 835 files from a payer or intermediary (Payspan, Zelis, etc.) website. Both Unlimited Financials and g4-Centricity include standard features to import and process remittances.
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Instruct payers to forward historic remittances to Availity. Once you secure an agreement from a payer to forward missing 835 files to Availity, please email your Claims Advocate the Payer’s company name, representative (name, phone number, and email address), and the reference number from your call with them. This information allows us to coordinate file delivery with Availity.
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Obtain an Explanation of Benefits (EOB) statement from the payor to support manual posting. Although the least desirable method in terms of automation, due to the burden of interaction and limited capability of some payers to recall prior remittance this may be the fastest route to recovery in certain cases.
We will discuss these approaches on our Recovery Best Practices Webinars. All our Claim Advocates are prepared to collaborate on each of these possible approaches.
MEDICARE CLAIMS SUCCESS TESTING
The Zenith Switch automatically suspends Medicare claims in cases where a practice-specific payer agreement remains outstanding. This process enables consistent workflows for the review and release of Claims at your business offices. We continue to maintain a recurring schedule of test submissions which have benefitted several affected customers every week in cases where verification of filing success preceded formal payer notification. This process will continue until every Unlimited customer’s Medicare claims are returned to full Production status.
CONCLUDING OBSERVATIONS
Not surprisingly, the Change Healthcare service outage and its continuing impact was a frequent discussion point at Friday’s Community Oncology Alliance spring conference in Orlando. The meeting allowed Unlimited’s attendees to check in directly with the subset of our specialty healthcare customer leadership who were present. Those customers’ confidence in the state of practice operations was inspiring and a strong reflection of what we have done and can do together.
In addition to active delivery of the resources described in this week’s restoration update, Unlimited Systems is designing and validating new customer-facing assets to bring forward to you as we complete EDI Services Restoration and enter the final stages of recovery from the Change Healthcare cyberattack. We remain fully committed to organizing collectively and interacting individually with every one of our valued customers through and past this industry event.
