CentralReach sends claims electronically to clearinghouses, using a standard 837P file in a 5010 format that is HIPAA compliant. Return files from the clearinghouses and payors themselves will include 277, 999, and 835 files. Typically, only the 277 and 999 files need to be requested to be turned on. Please confirm if the 835 requires enrollment.
The 277 and 999 are acknowledgment files from the clearinghouse, stating the claim was received, accepted, sent to the payor, etc. When calling to activate the account for SFTP, ask the clearinghouse what needs to be done to receive these types of files, such as requesting them to turn this function on.
The 835/ERA is a file from the payor that includes payment, denial, etc. information. Simply stated, it is an electronic EOB. Contact each funding source to see if they have any requirements before they send 835 files back to your clearinghouse, which in turn is downloaded into CentralReach.
Benefits of Setting up a Clearinghouse
There are two main benefits when connecting a CentralReach account to a clearinghouse. First, users can send out claims electronically within CentralReach. No need to do this on third-party websites or portals. Second, users can receive payments, in the form of an ERA (electronic remittance advice), directly in their CentralReach account. Users can then view, observe, notate, reconcile and ultimately post payments.
With our clearinghouse partner, Change Healthcare, users have two additional tools to support billing success. Users can electronically verify eligibility, in which they check that a client’s insurance is valid and receive information back from the payor regarding covered services. Users can also complete live claim status checks to find out what is happening with their claim. No need to spend time on the phone with payors, or to do this on payor websites.
Connecting CentralReach to Change Healthcare
To get started please contact your CentralReach account manager and subscribe to Change Healthcare. CentralReach will set up your SFTP gateway in the platform (to send claims and receive ERAs) and will set up your Change Healthcare ConnectCenter portal.
Click here to learn how to enroll payors on Change Healthcare.
Click here to learn how to add users to Change Healthcare.
Click here to learn more about Change Healthcare support.
Click here for the “Change Healthcare In’s and Out’s” course.
When logging into the Change Healthcare Portal, users will see the home screen and navigation bar.
Change Healthcare Home Screen
- Task Summary: shows the number of active claims that require work completed. Once a claim has been worked, they will be removed from this list. Claims may appear in multiple lists (i.e. a claim can be in the “All Claims” list and the “Warnings” list).
- All Claims: redirects users to a list of all claims that need work.
- Denied Claims: redirects to a list of claims that have been denied by either Change Healthcare or the payor. View a specific claim for more information about the denial reason.
- Rejected Claims: provides a list of claims that were rejected by either Change Healthcare or the payor. View a specific claim for more information about the rejection reason.
- Warnings: provides a list of claims that have a warning and shows potential errors that may cause the claim to be rejected/denied later by the payor.
- Incomplete Claims: displays claims that have been started and saved in Change Healthcare, but not sent for processing.
- Please note, if an organization had to resubmit a prior claim by submitting a whole new claim, they will need to manually delete the original claim from the “All Claims” list.
- Claim Health Vitals: displays statistics based on the initial submission of claims from CentralReach to Change Healthcare.
- View a different date range by selecting the date options.
- Click on the pie chart to see a list of the claims being calculated.
- Please note, these numbers do not change if you update/fix a claim that was initially rejected or denied.
- Home: redirects to the main screen with Task Summary and Claim Health Vitals.
- Worklist: redirects to the list of claims that require additional attention.
- Verification: allows users to submit client eligibility requests and verify benefits for a client’s insurance.
- Claims: allows users to review past claims, search for claims from CentralReach, and create new claims if needed.
- Remits: search for ERA’s/EOB’s received from payors.
- Reports: search for various reports, including payor reports and claim reports.
- Payer Tools: search for payors to ensure proper payor ID and complete enrollments.
- Admin: manage users and their access to Change Healthcare.
When enrolling with Change Healthcare, the following needs to be completed:
- After receiving credentials, users should verify that they can log in. For issues logging in, contact support.
- A CPIDD # needs to be entered in CR for every payor.
- Users need to have a Member ID
- Please note, certain special characters, symbols, and spaces are not allowed.
- When using generic contacts, the following information needs to be completed in CR:
- Company name
- Email address
- Tax ID
- NPI number
- Contact Name
- Phone number AND extension (if none, please enter “1”)
- Zip code
For issues regarding a Change Healthcare account, create a case in CentralReach Community. CentralReach will support claims and ERA questions directly.
Claims / Clearinghouses
Checking Client Eligibility on Change Healthcare
CentralReach users can check client eligibility / insurance verification on the Change Healthcare portal, ConnectCenter. Please log in to the ConnectCenter and click Verification > New Eligibility Requests.
For step-by-step instructions on the five steps to client eligibility, log in to the ConnectCenter and read the help article here. Please note, Eligibility response data can be viewed and copied in either a human readable or 271 format. Also, eligibility responses can be stored and saved for up to 6 months.