EDI Services Restoration Update – March 22, 2024
To Every Unlimited Systems Client Leader:
Over the past three weeks your claim transmission volume served via the Zenith EDI Switch has ramped up significantly. After our March 1st announcement that the “Lifeline” subset of commercial payers was online and given last Friday’s confirmation that all commercial insurance claims are being advanced for every customer, we can now share news that 25% of Claim and Remittance agreements have been formally approved by regional Medicare Administrative Carriers. Every approval notice triggers release of an individual client’s backlog and initiates continuing throughput.
We are now prioritizing effort in the following areas, each of which leverages Zenith Switch functionality:
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MEDICARE CLAIMS SUCCESS TESTING – Due to the industry-wide volume of provider enrollment agreements, the MAC’s administrative notification process lags their readiness to receive claims via new pathways. In our continued effort to accelerate restoration of cash flow to support patient care operations we have implemented a Medicare claims success-testing process to mitigate notification delays.
Today we initiated and will continue next week on Monday, Wednesday, and Thursday submission of a batch of ten Medicare claims for each client who has not yet received administrative approval from their MAC. These submissions are facilitated directly from the Switch, ensuring efficiency and accuracy without your intervention. Our Claim Advocates are closely monitoring the outcome of these tests and will notify you promptly upon evidence of success. Upon confirmation, all pending claims for the respective clients will be released the same day.
Your Claims Advocate is equipped with a comprehensive list of submitted test claims and can provide you with any necessary information or updates. While this process serves as the ultimate test of MAC agreement approval, we kindly request that you forward any communication from payers regarding agreement approval or any related matters to your Claims Advocate.
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REMITTANCE PROCESSING – Coordination with you to complete payer enrollment for electronic remittance via the Availity Gateway path remains a focus for our team. The first 2,000 remittance files have already been returned by payers through the Zenith Switch. While this is only a portion of the volume that will be recognized over the next two to four weeks, it is a healthy indication that the process is working.
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INSURANCE ELIGIBILITY – Restoration of clearinghouse-dependent insurance verification features for g4-Centricity and Unlimited Financials is the final major aspect of Switch-enabled functionality that will be introduced at your practice. Eligibility transaction testing is underway. Although the initial focus on Claims and Remittance prevented prior certainty on a reactivation date, we anticipate being able to share that with you via an update next week.
Given the national attention now focused on the impact to healthcare providers resulting from the Change cyberattack, you may be receiving relevant news via other channels. Here are the most current updates regarding funding assistance, Optum IEDI, and Change Healthcare restoration:
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TEMPORARY FUNDING ASSISTANCE PROGRAMS. Over the course of several national weekly conference calls hosted by UnitedHealth Group (UHG), we have observed a striking escalation in UHG’s promotion of their Temporary Funding Assistance Program. Perhaps in response to early critique of Optum’s effort, UHG’s leadership is now emphasizing the intended generosity of their no-fee, zero interest cash distribution program. Monies available to Unlimited’s customers via this program are based on your total practice income, not just payment history from UnitedHealth Group. We want every customer to be aware of:
• Eight minute program overview video accessed via Optum’s special website.
• The Application Form available here.
• Optum’s program support phone number: 877-702-3253.
Similarly, your Medicare Administrative Contractor (MAC) will advance funds under a Covid-19 Model. Please work directly with your respective MAC on their own application form.
OPTUM IEDI PATHWAY. The Zenith Switch includes an open pathway to Optum’s ‘Intelligent EDI’ backup clearinghouse. Unfortunately, Optum’s early advertisement that IEDI-submitted Medicare claims would bypass a MAC’s payer agreement requirement has not proven true. We continue to monitor and test both these conditions and will leverage IEDI as a primary pathway if/when it becomes relevant. For now, we continue to configure IEDI as a secondary pathway option for the Zenith Switch.
CHANGE HEALTHCARE RESTORATION. This weekend the Relay Exchange clearinghouse is slated to come online. The next step will be Change Healthcare connecting with payers. This step involves the provisioning and credentialing of new connectivity to allow for the transmission of claims and receipt of remittance. Once payer connections are validated, Change Healthcare will start by flowing claims generated by their hospital-focused Assurance platform. At this point, Change Healthcare will engage with Zenith.
We have been advised that Zenith is the first priority for Change Healthcare credentialing and testing after Assurance is cleared.
Stakeholders across the specialty healthcare landscape have performed admirably over the past month. Our close connection to your business office underscores the appreciation we have for their durability, confidence, and willingness to use every tool at their disposal to secure practice income. We join you and them in that effort and look forward to an accelerating resumption of normal transaction flow.
Thank you for your continuing support and business.
