Claims / Clearinghouses
Change Healthcare – The In’s and Out’s
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 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.
The Florida Agency for Healthcare Administration’s (AHCA) program has contracted Netsmart (Tellus) to be used for Electronic Visit Verification (EVV) in Florida Medicaid regions 9, 10, and 11. CentralReach is integrated with Netsmart (Tellus) to support seamless EVV claim submission.
Connecting CentralReach to Netsmart (Tellus)
In order to link Netsmart (Tellus) to your CentralReach account, providers need to sign up for Netsmart (Tellus). A gateway should also be set up in CentralReach for Netsmart (Tellus). Once users have an account with Netsmart (Tellus), they will have access to a portal to view the status of claims in Netsmart’s (Tellus’) claim dashboard.
Please note, if multiple services were provided for the same client on the same day, the claims should not be combined.
If billing the Florida Agency for Healthcare Administration (AHCA) as the secondary, the primary payor must use the CR Mobile workflow with visit verification enabled. Users must then receive an electronic payment from the payor and generate a secondary claim.
Rendered Service Files
CentralReach will send a rendered service file with all required fields to Netsmart (Tellus). The “Responses” section of the Claims Manager will update with an “accepted” or “rejected” status. If the file is accepted, providers can log into Netsmart’s (Tellus’) portal and release the file for Netsmart (Tellus) to generate an 837 claim to send to Medicaid. Netsmart (Tellus) may take up to 4 hours to process the file and make it available in the portal. If it does not appear in that time period, please contact Netsmart (Tellus) support. If the file is rejected, it will state the information that was incorrect. Once the file is corrected, it can be resent to Netsmart (Tellus).
Standard clearinghouse fees apply.
Click here to learn more about CR Mobile and Netsmart (Tellus).
Click here for Netsmart (Tellus) portal resources and training.