EDI Services Restoration Update – March 28, 2024
To Every Unlimited Systems Client Leader:
Several major steps towards full EDI Services restoration occurred during the month of March, including additional progress over the past week. Despite that, Unlimited Systems is highly aware that the consequences of the Optum/Change Healthcare outage remain very impactful for most customers, as they do for our own operations. Providing you with clear updates and an organized plan to increase success as we transition from March into April together is crucial.
In the interest of remaining concise and providing directly actionable guidance, these recurring communications intentionally build on information summarized in prior releases rather than repeating earlier guidance. For greater context on any topic below, please see the full archive at www.unlimitedsystems.com/edistatus where today’s update complements eight prior relevant distributions.
MEDICARE CLAIMS SUCCESS TESTING
Recurring, controlled release of small sets of Medicare claims from the Zenith EDI Switch for all customers whose payer agreement status has yet to indicate submission approval has proven valuable. That process, scaled out to all customers on March 22nd, was timed to start one week after our March 13th delivery of Medicare enrollment agreements to every practice. Test submissions over the past week revealed multiple client instances where a MAC’s readiness to exchange EDI transactions preceded their release of formal notification. In every such case we immediately activated full volume through the Switch. We will continue Medicare Claims Success Testing for as long as necessary during April to prevent any MAC’s communication overload from unnecessarily delaying the restart of claim and remittance delivery.
REMITTANCE PROCESSING
Distribution of remittance files via the Zenith EDI Switch is escalating dramatically, though there is still a significant gap from historic levels. Our collaboration with your practice drove a 700% week-over-week increase in remittance files over the past seven days. Consistent with the two to four week ramp up window forecast by our March 22nd customer guidance, we expect additional material escalation next week. Although the process delays inherent to ERA enrollment are frustrating and present genuine business challenges, the process is at least established and reasonably predictable.
INSURANCE ELIGIBLITY
While less significant to immediate cash flow than restoration of claims and remittance, real-time and batch insurance eligibility verification remain important aspects of your revenue cycle. The testing of these mechanisms via Availity initiated last week and extended successfully through the weekend and over the past few days. For some payers the precision of Availity’s responses appear to be of higher quality than the information previously sourced through Change Healthcare. We are projecting that eligibility transaction processing will be restored by the second half of next week.
CHANGE HEALTHCARE RESTORATION
Earlier this week the Zenith EDI Switch was successfully and securely connected to Optum’s rebuilt environment. Two cybersecurity consulting firms retained by UnitedHealth Group, BishopFox (https://www.bishopfox.com) and Mandiant (https://www.mandiant.com), provided formal Security Incident Attestation reports certifying that Change Healthcare’s prior intrusion has been fully resolved. Given your and our joint interest in the security and confidentiality of g4-Centricity and Unlimited Financials, these statements are essential.
After successfully completing early week testing, Zenith’s connection to Change Healthcare was converted to Production status on Wednesday, March 27th. This pathway will theoretically permit access to any historic remittance that was ‘in transit’ at Change when their systems were disconnected. It could also unlock an ongoing stream of remittance files prior to approval of your Availity Gateway-based agreements. However, Change Healthcare’s operation is only valuable if a critical mass of insurance carriers also choose to reconnect. Currently the list of payers who have reestablished connections to Change Healthcare is very limited. While Optum is pressing on Medicare Administrative Contractors and other government payors to permit reconnection without requiring new payor agreements, an initiative Unlimited Systems endeavored to promote to CMS in partnership with the Community Oncology Alliance in late February (and since), this effort is moving forward slowly.
We are continuously monitoring the active Change Healthcare payor list and will immediately release your claims via the Change pathway for any payer not presently served via Availity. The Zenith EDI Switch sweeps Change Healthcare daily for any remittance files that manifest unexpectedly because of a payer reconnection.
MANAGING THROUGH APRIL
March’s early focus on establishing new resilient inbound and outbound EDI pathways complemented an aggressive effort to secure priority for our customer base with Availity. The extremely limited capability of Change Healthcare more than five weeks after their initial service outage confirms the prudence of moving quickly to stand up new technology and secure alternative routes. Thank you for aligning with us in that effort. That infrastructure and common focus has enabled wins across the specialty healthcare community. Our collaboration with you permitted the mid-month shift to submitting payer agreements for claims and remittance. Now Unlimited is working alongside you through the congested and at-times circular and conflicted process of pushing payer agreements through to completion.
As April starts, our management team is focused on identifying EDI enrollment best practices relevant to the current disrupted environment that have emerged consistently across our client base over the past two weeks. We will be sharing those with you and reproducing them at scale for the benefit of all customers. There have been sufficient breakthroughs, acceleration, and individual customer success in March to suggest our effort will be productive. Unlimited’s Claim Advocates will share this information and continue instructing you how to take maximum advantage of the effort to accelerate recovery.
CLOSING UPDATE
Good Friday has been an observed holiday at Unlimited Systems since the company’s founding. However, given the significance of the industry’s EDI Services disruption, its impact on your effort to fund critical patient care services, and to maintain momentum with you in our joint ongoing efforts to reach full EDI Services Restoration, our customer-facing teams will remain available to you tomorrow, March 29th, during the full range of standard operating hours.
