EDI Services Restoration Update – April 24, 2024
To Every Unlimited Systems Client Leader:
Electronic claims, remittance, and insurance eligibility transactions (“EDI”) were all disrupted concurrently by the cyberattack on Change Healthcare. Incremental restoration of these discrete services via new EDI pathways required revised data routing, additional programming and testing, and the flexible adoption of temporary processes by your business office teams. With the full complement of Eligibility features offered by Unlimited Financials and g4-Centricity online at your practice, any workarounds being utilized to verify insurance coverage can be retired. This milestone, achieved via the Zenith Switch, joins previously activated Claim and Remittance pathways to complete Unlimited’s delivery of an EDI solution whose benefits in terms of resiliency, visibility, and transaction performance monitoring exceeds the legacy Change solution.
INSURANCE ELIGIBILITY TUNING & FEEDBACK
Perhaps counterintuitively, Eligibility transactions are more complex to implement and assess than Claim and Remittance processing. Insurance verification requires universal bidirectional messaging invoked in real-time by single patient prompts or via batch handling for consolidated patient groups. In comparison, a Claim file and its associated Remittance are relayed in two separate unidirectional transmissions handled several days apart with dedicated program logic for each transaction type. To ensure the quality of our Eligibility data relay, Unlimited Systems focused extensively on tuning the variables that govern your experience working in our systems including retry threshold, timeout window, response buffer sizes, and many others. We are on standby to refine client and payer-specific settings based on your feedback.
CHANGE HEALTHCARE EDI PATHWAY STATUS
Where Change Healthcare has restored payer connections, currently estimated at 80% of historic scale as per Optum, the Zenith Switch is acquiring and distributing Remittance files that continue to manifest at Change’s hub. While this volume continues to decline as payer agreements clear Availity, it demonstrates how multipath EDI infrastructure can be leveraged to your benefit. The Zenith Switch leverages both the Availity Gateway and Change Healthcare’s rebuilt environment to ensure optimal EDI outcomes and redundancy. In addition to eliminating any temporary residual backlog of Claims pending payer approval, the Change pathway option empowers our Claim Advocates to take an even more personalized and targeted approach to supporting your billing team.
AVAILITY ESSENTIALS PRO PORTAL
The Essentials Pro Portal included with the Availity pathway has been widely adopted across Unlimited’s customer base. As presented in our Recovery Best Practices webinars on April 11th and 12th, Claim tracking, Enrollment status, and Remittance trending are all available via Essentials Pro. To access the webinar recording please visit www.unlimitedsystems.com/edistatus. We encourage all current customers who have not utilized the Portal to contact us for access to this included benefit of Zenith Switch services.
PHI CONSIDERATIONS OF CYBERATTACK
UnitedHealth Group has determined that the Change Healthcare incident created data exposure for “a substantial proportion of people in America.” This risk extends to both protected health information (PHI) and personally identifiable information (PII). Yesterday’s formal notice from UnitedHealth advises that several months of analysis will be required to identify and notify impacted individuals. Questions on this subject should be directed to UnitedHealth Group’s new dedicated website: www.changecybersupport.com or call center at 1-866-262-5342.
CONCLUDING OBSERVATION
Your revenue cycle teams continue to perform admirably in the face of a disruptive event that was unprecedented in scope, scale, and impact. With Claims, Remittance and Eligibility transactions flowing in a secure, automated fashion across Unlimited’s client base – including to/from multiple EDI pathways – you can have confidence in the function of the Zenith Switch in whose resiliency and service set we continue to invest. Over the next two weeks our Claim Advocates will return focus to their regular roles as Client Consultants, Project Managers, Implementation Consultants and Customer Success Managers. We remain dedicated to ensuring a complete EDI restoration experience with a focus on any edge cases that may persist. Unlimited is committed to your success.
Thank you for your partnership.
