Clearinghouses Change Healthcare 101

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.

Navigation Bar

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.

Claims Claim Errors FAQ

Why does the provider not appear when I search for them in claims or when generating claims?

The provider does not appear because their claim settings were not completed.

How to create secondary claims?

Click here.

How to post orphaned data?

Click here.

Why is the “Update FTP Settings for this Gateway” error message displaying?

Click here.

Why can’t I search for an employee during claims generation to add to a claim?

If the user does not have their claims settings completed they cannot be searched for.

Why am I receiving a “Claim can Only be Paid Once” error when trying to make a secondary claim?

This means the claim has been paid more than once. You cannot make a claim from a primary claim with more than one payment. Three main rules for making secondary claims:

You can only make a secondary claim from a primary claim that has been sent out electronically.
You can only make a secondary claim from a primary claim that has been returned electronically on a payment file.
You can only make a secondary claim from a primary claim that has only been paid once.

Claims Manager

Claims Claims Module Permissions

Employees with the following permissions have various levels of access to the Claims module. These permissions can be enabled via the Permissions module.

Access
- Basic access to the Claims module
Claims > Create
- Create claims from the billing view
Claims > Manage Organization Labels
- Add, edit, and remove organization claims labels
Claims > Use Organization Labels
- Add and remove organization claim labels to and from claims
Settings > Manage
- Add, edit, or delete claim insurance settings

Click here to learn about other permissions.

Clearinghouses

Billing / Claims Completing the Payor Import

New clients must complete a payor import file before beginning implementation. The purpose of this file is to ensure clients’ payors match payors in CentralReach’s database, so that claims will be sent correctly. A spreadsheet application, such as Excel, WPS Spreadsheets, or Google Sheets, will be needed in order to open and complete the payor import.

See below for a breakdown of how to complete columns A-M of the payor import:

Column A: The name of the insurance company
Column B: The name of the specific plan under the insurance company
Columns C- F: The insurance company’s mailing address
Column G: The payor’s ID with Office Ally, which indicates where claims should be sent. The ID can be located here, by conducting a search for the payor.
- Please note, it is important that this ID is inputted correctly, so claims are submitted to the right payor. If you are unsure of the payor ID, contact the payor directly to confirm their ID.
Columns H-I: These columns indicate if pre-enrollment is required with the payor to submit claims or receive responses electronically.
- On Office Ally’s Payer List, columns ENR and ERA will be marked with Y or N. If either columns have a Y, you will need to complete the proper enrollment forms for that payor.
Columns J-M: These columns let CentralReach know how you are currently billing and how you want to bill in CentralReach.

Claims Primary and Secondary Contacts

Primary contacts, such as the below providers, automatically populate when generating claims. These fields can be assigned or edited in authorizations, claim default settings, timesheets, or while bulk-merging claims in the Billing module.

Any assigned secondary contacts entered in the authorization will also automatically prepopulate into secondary claims. If users do not assign secondary contacts, CentralReach will continue to use primary authorization information during claim generation. Secondary contacts will not be assigned or edited outside of the authorizations.

Primary contacts include:

Billing: the billing provider’s information, such as their name, address, NPI, and phone number.
Referring: the referring provider’s name and NPI.
Provider/Supplier: the name and NPI of the physician or supplier.
Facility: the name, address, NPI, and phone number of the facility/location in which the service was provided.
Ordering: the ordering provider’s name and ID.
- Enter the ordering provider’s information in the service line of claims, if the provider differs from the rendering provider.
Supervising: the supervising provider’s information, as specified in the “Supervising” tab within the “Providers” section of claims.

Settings

Billing / Authorizations / Claims The Authorization Claims Settings Tab

Authorization Claim Settings allow users to specify certain fields in electronic claims. The “Authorization and Claims Settings” tab is in the Global Authorizations page tab in an authorization and contains the following optional fields:

CRC EPSDT Referral: Identifies services that may be covered under specific state plans and informs insurance providers of the referral status specific to each payor. If there is a requirement to use a specific reason code, enter that code in the EPSDT field.
- Condition Indicator: Select the following options from the drop-down:
  - AV – Available
  - S2 – Under Treatment
  - ST – New Service Requested
  - NU – Not Used
CN1 Contract Information: These fields capture the contract number certain payors require when submitting claims.
- Contract Code Type: The contract type required for post-adjudication claims. Select the following options from the drop-down:
  - 01 Diagnosis Related Group
  - 02 Per Diem
  - 03 Variable Per Diem
  - 04 Flat
  - 05 Capitated
  - 06 Percent
  - 09 Other
- Reference Identification: For a particular transaction set or as specified by the “Reference Identification Qualifier.”
- Please note, users can have both fields completed, or just the Contract Code Type. However, if the Reference Identification field is added without the Contract Code Type, the Reference Identification field will not populate in the 837 form.
REF – Billing Provider Secondary Identification
- G2 – Provider Commercial Number
- LU – Location Number
- Please note, both fields can contain values.

When generating 837 files, “EPSDT Referral,” “Contract Type Code,” and “Reference Identification” fields in the claim details are for billers requiring a specific reason code.

Please note:

These fields will not copy over from the original claim when generating a secondary claim.
If the selected billing entries are associated with more than one authorization, the retrieved values will be from the authorization related to the first billing entry.
These values will be populated from the default values when submitting a claim. If there are no default values, information will be retrieved from the Global Authorization Settings.
If there are no values in the Authorization Claim Settings, the Claim editor fields will be empty but are editable.
- For the G2 and LU fields:
  - Values will be retrieved for the authorization.
  - If no authorization has a value, values from the Accepted Insurance will be retrieved.
  - If both are empty, the fields will be empty but editable.

Claims The Pay-To Section in Claims

When claims are generated, the “Pay-To” section is blank by default. For an organization to have this auto-populate for all claims, please contact your CSL or open a support ticket.