Claims Processing Updates
Page last updated: 4/19/24
Information on the Change Healthcare Cyber Response
Message to our Valuable Clients
Understanding the Impact:
The recent data breach at Change Health Care (CHC), one of the largest clearinghouses in the United States, has significantly affected many dental practices. Clearinghouses like CHC are crucial to the dental industry, handling not only claim submissions to payers but also playing a crucial role in the broader spectrum of insurance processing and payments. The impact on your practice may vary, depending on the specific Practice Management System (PMS) and claims service you use.
Assessing Your Practice’s Impact:
It’s essential to recognize that CHC’s services are deeply integrated into many dental practices, possibly in ways that are not immediately obvious. The effect of this breach could range from minimal to substantial. If you’re unsure about how your practice is affected, we urge you to contact your claims provider as a critical first step. If you are still unable to connect to a clearinghouse, please contact our partners at EDS for more information on their streamlined enrollment process.
Processes potentially impacted by CHC:
- Claims Submission
- Electronic Attachments
- Pre-Authorizations
- Eligibility and Benefit Verifications
- EFT’s – Payments
- ERA’s – Digital EOB’s
- Statements
- Insurance Processing Times
- Increase in Outstanding Claims
- Longer Hold Times
Industry Response & Support:
In response to this challenge, there has been a swift and significant response from software providers and clearinghouses, all aimed at minimizing disruption to dental practices. Our collective efforts are focused on ensuring continuity of care and support for all affected parties.
How We Can Help:
This page serves as a central resource for updates, guidance, and assistance related to the data breach. We aim to provide:
- Latest Updates: Regular updates on the situation as it evolves.
- Guidance: Steps your practice can take to assess and mitigate impact.
- Support Contacts: Direct lines to support teams ready to assist you.
Moving Forward Together:
We understand the concerns and challenges this situation presents. Rest assured, we are here to support our dental practice community through this period of uncertainty. We’re committed to transparency, support, and swift action to address the needs of our partners and their patients.
Critical Billing Processes of a Clearinghouse:
A clearinghouse, such as Change Healthcare (CHC), plays a crucial role in the
healthcare billing
and claims process by acting as an intermediary between healthcare practices, and payers. The
main function of a clearinghouse is to streamline the claims submission process, ensuring that
claims are accurate, compliant, and processed efficiently. Below is a breakdown of the
functionality of a clearinghouse, specifically focusing on CHC where applicable:
-
Claims
Submission
and
Management -
Payer
Connectivity -
Electronic
Remittance Advice (ERA) -
Electronic Funds
Transfer (EFT) -
Attachments and
Documentation -
Eligibility and
Benefits Verification -
Statement
Processing
- Transmission: Healthcare providers submit electronic claims to the
clearinghouse,
which
then checks these claims for errors and compliance with federal regulations and
payer
policies. - Correction and Verification: CHC employs sophisticated software to
automatically
detect
and notify providers of errors or missing information in claims. This step
significantly
reduces the likelihood of claim rejection or denial by payers. - Resubmission: After corrections are made, CHC resubmits claims to the
appropriate
payers, ensuring a higher rate of first-pass claim acceptance.
- Wide Network: Clearinghouses like CHC maintain extensive networks of connections
with insurance companies, government payers (like Medicare and Medicaid), and other
financial institutions, facilitating the smooth and rapid transmission of claims and
related
transactions. - Adaptation to Payer Requirements: They adapt claims to meet the specific formatting
and submission requirements of each payer, which can vary significantly, thereby
ensuring compliance and expedited processing.
- Payment Processing Information: Once a claim is processed, payers send back an ERA
through CHC, which details the payment amount, any adjustments, denials, or reasons
for non-payment. This information is crucial for healthcare providers to reconcile
their
accounts receivable and manage patient billing accurately.
- Direct Payments: CHC facilitates the direct deposit of payments from payers to
healthcare providers’ bank accounts via EFT, improving cash flow and reducing the
reliance on physical checks.
- Supporting Documents: For claims requiring additional documentation, such as dental
X-
rays or detailed procedure justifications, CHC provides a mechanism for attaching
and
submitting these documents electronically to payers, streamlining the review and
approval process.
- Pre-Service Checks: Before services are rendered, healthcare providers can use CHC
to
verify patients’ insurance eligibility and coverage details, reducing the risk of
claim
denials due to coverage issues.
- Patient Billing: Beyond processing claims with payers, CHC often assists healthcare
providers in generating and sending billing statements to patients, integrating with
providers’ practice management systems to ensure accuracy and timeliness.
Assistance Programs
You may experience a short-term delay in cash flow during this time. To learn more about
different resources visit:
