EDI Services Restoration Update - March 8, 2024
To Every Unlimited Systems Client Leader:
The parallel path strategy towards EDI Services restoration is yielding positive results. Despite the challenges Change Healthcare’s service disruption is creating for specialty healthcare providers, Unlimited Systems is pleased to report tangible progress. Our next live webcast on Wednesday, March 13th will provide the most current updates as of that time.
AVAILITY GATEWAY
Unlimited Systems is now fully credentialed with Availity’s production Gateway, Essentials Pro. This milestone expands the payer catalog beyond the Lifeline catalog and incorporates Medicare and the subset of Blue Shield payers who require formal enrollment. This weekend our engineering team is testing the new outbound pathway from the Zenith Switch to the Availity Gateway. We expect to shift customer claim volume to the permanent environment next week. The Availity Lifeline pathway continues to operate at maximum capacity for all clients.
PAYER AGREEMENTS/EDI ENROLLMENT
We now have access to the digital tools to initiate and route payer agreements. Beginning next week, we're initiating EDI enrollments for clients, placing special emphasis on claims agreements that require signature. Our team of EDI enrollment experts, in collaboration with your dedicated Claims Advocate, will work closely with you, ensuring smooth coordination. We appreciate your partnership in helping us obtain the necessary signatures on agreements to streamline the process effectively.
LIFELINE CLAIM RESPONSES
Over the weekend we will initiate transmission of Availity Lifeline response files to your Unlimited Financials or g4-Centricity environment. The Availity Lifeline responses may present slight variations compared to your experience with Change Healthcare. If you are familiar with the necessary steps to correct a claim, please update and resubmit. In the event of any unfamiliar rejections, our Claim Advocates will be available to offer guidance on the most appropriate course of action.
ZENITH SWITCH REGISTRATION
Activation of your practice’s credentials with the Zenith EDI Switch (zenithswitch.app) is required before we can generate Payer Agreements and transition your claim flow from Availity’s Lifeline to their Gateway platform. If your organization has not completed this step, please contact your Claims Advocate for help.
TEMPORARY FUNDING ASSISTANCE EXPANSION
On March 1st, UnitedHealth Group (UHG) announced a Temporary Funding Assistance (“TFA”) program. Because funding eligibility for this program was calculated relative to only the payments providers received from a subset of Change Healthcare-linked plans, the actual economic value was limited. UHG has now announced two meaningful expansions to the TFA: (1) short-term loan amounts are now based upon payment history for all UHG plans including Medicare Advantage; and, (2) they will consider expanded funding on a ‘case-by-case’ hardship basis. Unlimited Systems recommends that all customers consider TAP application given the enhanced available monies. UHG’s next steps and FAQs are available here.
CHANGE HEALTHCARE RESTORATION STATUS
UHG has stated that “we expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.” Publication of a date suggests progress. However, we recommend extreme caution in relying on this date to plan business decisions. In a UHG leadership call Unlimited participated in this afternoon, Dirk McMahon, UnitedHealth Group’s Chief Operating Officer, described the path to restoration as “fluid” and reminded his audience that there may be “bumps in the road.” He strongly advised taking all deliberate steps to move forward with alternate pathways. Unlimited’s multi-path approach, including the Availity Lifeline and Gateway, Optum’s Intelligent EDI Clearinghouse, and MAC portal direct submission where available, is aligned with UHG’s recommendation.
SECOND NATIONAL WEBCAST
Unlimited Systems will host its second all-customer National Webcast addressing the Optum service outage and our EDI Service Restoration efforts on behalf of customers on Wednesday, March 13th at 2 PM Eastern/11 AM Pacific. Participation requires advance registration via the following link: http://www.unlimitedsystems.com/edistatus. We look forward to updating you regarding the transition from Availity’s Lifeline service to the full production Gateway, how to engage with our Payer Agreement enrollment initiative, and the forecast for complete restoration of your EDI environment.
For every medical provider, whose service mission depends on an effective revenue cycle, the key question for business planning is restoration timing. Unlimited Systems is focused on being able to provide that guidance with confidence.
