To use Change Healthcare, our partner for electronic claims clearinghouse, please contact your account manager or email firstname.lastname@example.org.
Once CentralReach has set you up with a Change Healthcare ConnectCenterTM login, an admin user can create new user accounts:
- In an Admin account, click Admin and User Management
- Click Create
- Enter all required user information
- Click Create User
- Return to the list of user IDs and select the new user
- Select the Access Features tab
- Update the new user’s access features and click Update User
Click here to learn more about Change Healthcare.
Claims / Clearinghouses
Change Healthcare Enrollment Worksheet
To enroll in Change Healthcare:
- List all payor(s) you use by name.
- Login to Change Healthcare ConnectCenter (CHC), and use the Payer Tools > Payer Search screen, to search for your payor(s).
- Identify whether enrollment is required for Claims, Remittance, and Eligibility. Only short letters will display (C, R, CS, E, ARS), so use the legend below.
- C – Claims
- R – Remittance
- CS – Claim Status
- E – Eligibility
- ARS – Authorization/Referral Status
- Fill out the form to track which payors you must enroll with. Note: submitting enrollment is a one step. Please also confirm that the payor accepted your enrollment.
Important! If a payor requires claims enrollment, do not submit claims through Change Healthcare until enrollment is confirmed.
Important! If a payor requires remits but not claims enrollment, users can submit claims through Change Healthcare. However, you will not receive your ERA back through Change until enrollment is complete.
Important! Please read the Enrollments completely and thoroughly. While there are no trick questions, many require items to be on your company letterhead, or have steps that need to be completed after other steps, or steps to be done at other websites, or may require EFT enrollment/updates to be completed, etc., to be processed. If you do not complete all steps in order it could delay your ability to submit claims and/or receive remit.
Click here for more information and a table explaining the enrollment process.
Claims / Clearinghouses
Enrolling Payors on Change Healthcare
When using a clearinghouse, many payors require that you enroll with them to state where your claims are sent through, and especially where your ERA should be sent to. Most payors require enrollment at least for remit.
To enroll payors on Change Healthcare:
- Log in to the ConnectCenter and click Payer Search
- This shows which payors require enrollment for which products.
- Click enrollment wizard to enroll with the payors.
- The questions asked are designed to help users quickly and efficiently complete several payor forms at once. Click here for step-by-step instructions.
Claims / Clearinghouses
How to Switch to Another Clearinghouse Gateway
To switch to another clearinghouse:
- Reach out to your Account Manager and provide contractual documentation that you are signing up with the desired clearinghouse.
- Once documentation is provided the Account Manager will activate the clearinghouse.
- Only Office Ally, Zirmed/Waystar, or Change healthcare can be activated.
- Retrieve SFTP details from the clearinghouse. Users should contact the clearinghouse if they do not have the following information:
- SFTP User ID
- SFTP Password
- Once enabled:
- Navigate to the Claims module and select Settings
- Click Gateways and select Edit next to a gateway
- Click the SFTP Settings tab on the left-hand side
- Enter the SFTP credentials and click TEST CONNECTION & SAVE
- The connection will be green if it passes or red if it fails.
Please note, these instructions are for PC users only. This is not yet available for Mac users.
To print an ERA as a text file:
- Navigate to https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/AccesstoDataApplication/MedicareRemitEasyPrint and download Medicare Remit Easy Print – Version 4.6 (ZIP). Follow the installation instructions.
- Open “Medicare Remit EasyPrintv4.6”
- Navigate back to the Claims module in CentralReach and select ERA List
- Find the ERA that needs to be downloaded and view using the Remit Tool
- In the ERA screen, scroll to the right-hand side and select 1 file in the “Files” column
- Click the cloud icon to download the AV version
- Open the Easy Remit Tool and click Import in the upper left-hand side
- Select the downloaded file
- Select the desired line item with the correct payor, EFT number, etc. Click View and then Claims List.
- Select the checkbox next to the client’s name and click View and then Claim Details. This allows users to view the text version.
- Select Print on the left-hand side to print the PDF version
Claims / Clearinghouses
Issues Receiving ERA’s back from a Clearinghouse or Payor
If you are sending claims electronically within CentralReach, but are not receiving any responses, it is due to the following reasons:
- Your 277 and 999 communication channels are not turned on within your clearinghouse account. Typically, you will have to request Office Ally or Waystar (ZirMed) to turn on the 277 and 999 files
- 835 ERA requirements missing: check with your payor to see if they have any requirements with regards to 835/ERAs. We advise that you check with each of your funding sources to see if they have any requirements before they send 835 files back to your clearinghouse, which in turn is downloaded into CentralReach
- Payor is not registered with clearinghouse: ensure the payor is registered with the clearinghouse. Payors can send checks, but without registration, they will not send the ERA
- The clearinghouse is not permitted to receive ERAs from the payor: this can be payor specific, but usually, payors require you to call them after completing the registration process to turn on the 835 files
- The ERA was sent to the clearinghouse in an incompatible format: the clearinghouse can convert these to 5010, but this is not turned on by default. Request the clearinghouse to turn on automatic conversion per payor and request them to convert any 4010s they currently have and put back in the outbox
- The ERA never made it to the clearinghouse and they simply do not have it: a request must be made to the payor to send that ERA again
To help troubleshoot the issue, we recommend you to follow these steps:
- Contact the Payor: the ERA registration rules vary per payor and many payors require you to call them and confirm the registration after submitting the forms. ERA registrations also expire for certain payors, so it is very important to first confirm that the payor is sending this information and that they are registered with the clearinghouse.
- What to ask the payor
- Am I registered to receive ERAs?
- Was the ERA sent to my clearinghouse?
- Can you provide the full file name of the 835-file sent to clearinghouse?
- Example: 123456789_ERA_STATUS_4010zip
- This file is in an incompatible format, and therefore, you can then call your clearinghouse and ask them to convert these to 5010 by default
- Contact the clearinghouse
- Confirm the 277 and 999 files are turned on
- If the payor confirmed the file type is 4010, ask the clearinghouse to convert these to 5010, and any older 4010 requests that are in the queue
- If you have a check number, ask the clearinghouse if they can locate the 835 (ERA) file in their system and ask for a complete file name
- Confirm or request the ERA’s are sent back via your SFTP account in a 5010 format
- Open a support ticket with CentralReach
- If the clearinghouse indicates they have the ERA in proper format and it still is not in the ERA list, create a support ticket with the following information:
- Claim ID
- Check #
- File Name
- Example: 123456789_ERA_STATUS_5010zip
Generic gateways are specific to payors that do not participate with electronic billing. To set up a gateway within CentralReach, information is needed from the clearinghouse.
To set up a generic gateway:
- Navigate to the Claims module and click Settings
- Click Activate next to the clearinghouse to make active
- Click the Journal, Export, Drop off, and Pick up checkboxes as needed
- Gateway name: edit only for generic gateways
- Journal: sends a copy of 837 files to another gateway
- Export: allows users to download a claim file (e.g. 837 file)
- Dropoff: sends claims to a gateway
- Pick up: CentralReach picks up the claim payments (835/ ERA files) and responses from the clearinghouse
- If this box is unchecked, CentralReach will not attempt to pick up any files from the clearinghouse.
- This is automatically unchecked by the clearinghouse when a connection is turned off, to avoid too many attempts.
- Within the “Edit Gateway” tab, complete the Receiver, Sender, Submitter, and Journal tabs:
- Receiver ID Type (ISA07): the clearinghouse itself and is normally the 30 – U.S. Federal Tax identification number, but this must be confirmed.
- Receiver ID (ISA08): the ID to correlate with the above type.
- App Receiver Code (GS03): the ID to correlate with the above type.
- Sender ID Type (ISA05): correlates with how the organization registered with the clearinghouse. It is normally 30 – U.S. Federal Tax Identification Number, but this must be confirmed with the clearinghouse.
- Sender ID (ISA06): the ID to correlate with the above type (e.g. Tax ID)
- App Sender Code (GS02): the ID to correlate with the above type (e.g. Tax ID)
- Organization Name (1000A NM103): the organization’s name
- ID (1000A NM 109): the organization’s Tax ID number
- Contact Name (1000A PER02): the name of the employee to be sent along with the claim as a contact
- Phone: the contact name’s phone number
- Email: the contact name’s email address
- Click the Send copy to second gateway (journal) checkbox to send a copy of the 837 to another gateway
- Select the second gateway from the Gateway drop-down
- Complete the SFTP Settings tab:
- SFTP user: normally the username from the clearinghouse account.
- For example, with an Office Ally login, place the username here, not the website username.
- SFTP password: the password received from the clearinghouse once the account for SFTP has been activated
- Please note, SFTP credentials cannot be edited without entering your password.
- Click Test Connection & Save. If there is no confirmation for the connection, there is an error.
Claims / Clearinghouses
Claim Processing Clearinghouse Enrollment and Set Up
CentralReach supports electronic claim submissions, so claims can be sent electronically to most commercial insurance companies and government payors. To set up your organization for electronic claim submissions, must subscribe to CentralReach’s clearinghouses partner, Change Healthcare, as further detailed below.
- Subscribe to Change Healthcare. CentralReach offer preferred, wholesale pricing to our customers. Contact your Account Manager or reach out to email@example.com to request a Change Healthcare subscription.
- Get Change Healthcare Credentials. (business days 1-2) CentralReach will set up your Change Healthcare ConnectCenter™ customer portal & set up your Change Healthcare gateway in CentralReach. Once your portal is set up, you may add users.
- Enroll with payors. (business days 2-14) On Change Healthcare’s ConnectCenter portal, use the enrollment wizard to sign up with all your payors so you can submit & receive claim information via Change Healthcare.
- Existing customers can continue to use Office Ally or Waystar until your payors are set up in Change Healthcare. Please note, charges may be incurred for transactions through these legacy gateways.
- Use Change Healthcare for Claims. (business days 15-45+) Once payors are in, use Change Healthcare.
- Customers using legacy clearinghouse (Office Ally or Zirmed/Waystar) can leave on “pickup” for your legacy gateway. This will help to track outstanding claims, while avoiding incurring charges from your legacy gateway. Most payors pay within 45 days. Follow up with any who do not.
- When your organization has chased down past-due payments from legacy clearinghouse submissions, you can completely turn off the legacy Office Ally or Zirmed/Waystar gateway and use Change Healthcare exclusively for submission, pickup, and more.