EDI Services Restoration Update – March 15, 2024
To Every Unlimited Systems Client Leader:
A fully automated Claims pathway has been established between your Unlimited Financials or g4-Centricity system and the Availity Gateway. EDI Lifeline services have been superseded by a fully expanded payer catalog. Claim Status reports are already posting into your practice environment and will next be joined by electronic remittance advice as it begins to return from payers. This consequential milestone, the new focus it enables, and the ways your business office can support a return to normal operations is explained below.
OUTBOUND CLAIM RAMP UP
Production activation of the Availity Gateway restores timely visibility into claim submission status and direct identification of rejection reasons across your full claim set. Your business office can now reconcile outbound claims and resume preexisting workflows for both revision and resubmission. Do not be alarmed by a greater than historic rate of Gateway-level claim rejections over the first few days of next week. Notwithstanding electronic claim standards, the Availity Gateway, like Change Healthcare, implements proprietary format edits. Our engineering team will continue to configure new automation wherever we can to programmatically minimize claim rejections.
PAYER-SPECIFIC EDI AGREEMENTS
A crucial step to shortening the timeline for full EDI restoration is the timely submission of claims and remittance payor agreements. Our focus with you this week has been on Medicare and all other payor agreements requiring signatures. Next week our joint scope will expand to completing remittance agreements. Your prompt action in response to our team’s requests for enrollment signatures and/or payer-specific registration via web portals is invaluable. We anticipate our remittance agreement effort will require two weeks of focused effort. When you receive payor acknowledgements or approval emails resulting from this effort, please forward them to your Claim Advocate. The overall environment at insurance carriers and Medicare Administrative Contractors is understandably chaotic. By synchronizing effort and awareness around EDI we will accelerate this process together.
GOVERNMENTAL CLAIMS PENDING AGREEMENT
We seek to normalize the work of your business office staff and queue Medicare claims for expedited release post-approval. To support those outcomes, the Zenith EDI Switch is configured to review all validated claims from Unlimited Financials and g4-Centricity in real-time and categorize them as ‘release-ready’ or ‘hold pending payer agreement’ in the case of governmental payers. Release ready claims are loaded to the Availity Gateway. The Zenith Switch will temporarily suspend claims for governmental payers which require an EDI agreement until approval is granted.
ELECTRONIC REMITTANCE
While the Lifeline pathway did not handle remittance files (‘ANSI 835’, ‘ERA’, or ‘remits’), restoration of Gateway-level services via Zenith includes logic to route and process remittance. As payers approve EDI enrollment agreements, remittance files will route through Availity for delivery to your g4-Centricity or Unlimited Financials application. Both programs are prepared to receive those datasets. As remittance agreements are secured, Unlimited Systems will work with your business office to acquire any previously generated reimbursement detail files suspended at the payer during the Change Healthcare outage.
CHANGE HEALTHCARE STATUS
Unlimited’s leadership group maintains regular dialog with Optum’s representatives who seek to restore the Change Healthcare pathway. This afternoon the CEO of Optum’s Insight Software and Network business hosted a progress update call. He emphasized a three-phase approach: (1) connectivity; (2) testing; and (3) service resumption. While the week of March 18th was noted as a starting point, no firm dates were offered for these milestones. The timeline and specifics of Optum’s approach were described as “difficult to provide at this point”. Unlimited’s commitment, exemplified by our Zenith Switch, is to provide redundant pathways for EDI resiliency. While ultimate restoration of a Change Healthcare pathway supports this outcome, the prudence of rapid movement to secure Availity-specific payer agreements is clear.
OPTUM IEDI PATHWAY
Optum’s IEDI initiative, launched ten days after Change Healthcare went offline, is an effort to provide a Lifeline-equivalent service for the larger community of Change Healthcare customers. Unlimited is engaged in testing this resource. Optum is still pursuing permission from the Medicare Administrative Contractors (MACs) to bypass the need for payer enrollment. Should that be granted prior to approval of Availity-specific enrollment, Unlimited will leverage the IEDI pathway to deliver your Medicare claims.
CONCLUDING OBSERVATIONS
Your trust in our platform, and the unified response of Unlimited’s customer group has permitted rapid response. The value of informed, decisive action is reaffirmed. Thank you for the confidence you have exhibited during this stressful period – it motivates everyone at Unlimited.
In the first few days of Change’s service disruption, the challenge was limited information. Now, with many organizations geared up to assist, the new risk we face together is contradictory guidance. As with our second national webcast earlier this week, for which an FAQ page is now available at www.unlimitedsystems.com/edistatus, Unlimited Systems will continue to deliver fact-based guidance specific to our specialty healthcare revenue cycle platforms: Unlimited Financials and g4-Centricity. If you have any questions about our position, recommendations, or customer-facing solution and services please continue to reach out.
