FAQs from March 26th Communication

 

I heard that clearinghouse services are back online, why can’t we reactive?

CHC offers several clearinghouse services. The clearinghouse that eIVF customers are aligned with, the largest and most feature-rich clearinghouse offered by CHC, remains offline and is undergoing testing.

 

Why can’t we just connect to another CHC clearinghouse that is already live?

Each solution is unique and offers different features. This means you would not have the same functionality as before the breach. Also, you will have to sign a new contract, receive new credentials, new payer IDs, etc. CHC does not recommend this course and may in fact take longer than waiting as they are prioritizing activating current customers on existing services. CHC continues to recommend that you use the alternative solutions until such time as your original service is restored.

 

My claims were rejected by Availity, can eIVF help resolve these issues?

Unfortunately, eIVF cannot resolve issues with claims denials through Availity. You must call Availity to resolve. Most rejections include an explanation, and we suggest you read that closely and contact Availity. Additionally, we have noticed that most denials are due to invalid Payer IDs, we suggest you look at those closely before submitting.

In addition, the second most common rejection is due to the Availity plan type chosen some payers fall under a certain platform support with Availity Essentials Plus and a transaction plan type upgrade may be necessary.  Please note that additional costs may be involved if you choose to upgrade.  Whether or not to pursue other Availity options beyond the Lifeline Solution will be a clinic decision.

FAQs from March 19th Communication

 

Change Healthcare recently announced they would begin the testing phase for connectivity to their medical claims network and software. Given this development, should we proceed with the migration to Availity’s Lifeline?

Yes, while Change Healthcare is expecting to begin testing connectivity to their claims network and software this week (March 18), they have strongly recommended that you utilize workarounds in the interim. Currently, there’s no definite timeline for when Change Healthcare’s claims network and software will be 100% fully operational.

 

We have had a number of claims rejected by Availity since migrating to the temporary Availity Lifeline Solution. Can you please comment on how we improve acceptance?

Unfortunately, eIVF is unable to provide specific reasons for claim denials. As stated previously, you should consult the claim rejection notice and reach out to Availity directly for clarification. eIVF does not have access to further details regarding claim rejections, so direct communication with Availity is essential for understanding the reasons behind a denial.

We recommend closely reviewing the payer IDs associated with your claims to verify their accuracy as Availity payer IDs. Many customers have identified incorrect payer IDs as a primary reason for claim rejections. Please remember, eIVF does not possess additional information regarding the reasons for claim denials.

 

Will we need to resubmit all claims starting from Feb 21st?

Yes.  Once the Availity Lifeline Solution is created and active for your practice, you will need to resubmit.

 

Will we receive ERAs?

The Availity Lifeline Solution is a limited, stopgap solution and does not offer a like for like solution to your normal CHC claims processing. You can explore other Availity plan options by visiting – https://www.availity.com/availity-lifeline-self-serve-resources or you can reach out to your Availity contact. Note that solutions other than the Lifeline Solution may have additional charges by Availity. Whether or not to pursue other Availity options beyond the Lifeline Solution will be a clinic decision.

FAQs from March 14th Communication

 

We have had a number of claims rejected by Availity. Can you please comment on how we improve acceptance?

We cannot comment on why a particular claim may have been rejected. As stated previously, you will need to read the claim rejection notice and contact Availity directly. We encourage you to review the payer IDs submitted with the claims to ensure that they are valid Availity payer IDs. Customers have noticed that this is a leading cause of rejections.

 

Should we sign up for the Availity EDI solution?

The decision will depend on your business requirements. Our focus has been on enabling the Availity lifeline solution and supporting automation of that solution. We cannot comment on whether you should pursue other offerings from Availity.

FAQs from March 8th Communication

 

How do we process TriZetto claims if the temporary Availity solution will not process them?

The lifeline solution from Availity is a stopgap solution and is not a “like for like” replacement for the standard Change Healthcare solution.   As such, it may not support all scenarios for all customers.  In those circumstances where specific payers or clearinghouse partners are not available or supported, you may consider dropping claims to paper, if the format is accepted, or file once Change Healthcare is restored.  The decision will have to be made by each clinic based on their unique situation.

 

What steps are necessary to switch to Availity’s Lifeline solution?

We strongly encourage you to visit eIVF’s dedicated webpage on Change Healthcare Updates – https://eivf.org/changehealthcare/. We have outlined the essential steps and information to ensure a smooth migration to the Availity Lifeline solution. Also, we further recommend that you thoroughly review the documents which include the Availity Lifeline Migration Process, the Availity Lifeline Readiness Checklist and the FAQs. Please be aware that we regularly update these documents to reflect new information as it becomes available, and recommend revisiting these documents periodically for any updates.

 

I have stopped submitting claims, but wonder if I can continue to post and save the data until Availity Lifeline is enabled? Please advise?

Yes, you can continue to post and save the data until Availity’s Lifeline is enabled.

 

If I have previously used Availity, do I still need to register for Availity’s Lifeline solution?

If you still have access to your Availity credentials, and those credentials remain active, you do not need to register for their Lifeline solutions.

 

Change Healthcare recently announced they would begin the testing phase for connectivity to their medical claims network and software. Given this development, should we proceed with the migration to Availity’s Lifeline?

Yes, while Change Healthcare is expecting to begin testing connectivity to their claims network and software on March 18th, they have strongly recommended that you utilize workarounds in the interim. At this time, there is no ETA on when Change Healthcare’s claims network and software will be fully functional.

.

FAQs from March 5th Communication

 

To maintain continuity of communication, we will augment the FAQ provided last week rather than only publish new questions.  While this may generate a lengthy update, it will ensure that all information remains available to you in each subsequent communication.  

 

Has the point of entry into the attack on Change Healthcare been determined?

 

Based on the latest update from Change Healthcare/Optum, the source of entry for the attack has not yet been determined.  Neither has the nature nor volume of data compromised been determined.  Change Healthcare/Optum continue to work with their external resources to investigate these questions.

 

Are there sources of information or updates from Change Healthcare that we can access?

 

Yes.  Optum, United Healthcare, and Change Healthcare have published the following URLs that you may access for current updates on the status of their restoral and investigation. They have also provided FAQs that you might find useful to addressing your specific circumstances depending on your broader relationship with the Optum ecosystem.

 

https://www.unitedhealthgroup.com/changehealthcarecyberresponse

https://status.changehealthcare.com/incidents/hqpjz25fn3n7

 

Is there a way to determine the status of our submitted claims before the cyber-attack?

No. For claims submitted before February 21st, Change Healthcare has stated that they cannot determine the status of the claims at this time.  Anything submitted after the 21st, may show pending but given the outage, has not been processed and is currently sitting in queue.

 

Is there a way for PracticeHwy to help us understand the number of claims that are currently being held and the dollar amount?

Currently, there isn’t a way to check the status of claims. However, you can run an AR report and use carrier portals to potentially check the status of claims submitted before February 21st.

 

Should I continue to submit claims?

No.  We recommend that you stop submitting claims immediately.  Any claims submitted using the Change Healthcare configuration will be rejected and must subsequently be resubmitted under the Availity Lifeline configuration.

 

Will we need to resubmit all claims starting from Feb 21st?

Yes.  Once the interim automation is created and active, per the process described in the attached PDF, you will need to resubmit.  Note that we cannot comment on the Availity process or how that will interact with Change Healthcare.  We suggest that if you have any questions regarding Change Healthcare claims processing you leverage the resources provided in the URLs above where Change Healthcare support resources are identified.

 

Once the interim automation is in place with Availity, will eIVF track our claims and provide status?

Claims’ SFTP responses will be available in the claim history screen. It will be the clinic’s responsibility to manage and verify the responses as part of their normal internal practice workflow.

 

Can we simply remain on Availity rather than converting back to Change Healthcare once Change Healthcare is restored?

No.  The Availity solution is a temporary, lifeline solution.  Once Change Healthcare is restored you will be required to convert back to Change Healthcare.  It is expected that the Availity lifeline solution will be terminated at some point post-restoral.  This is why it is essential that you save your Change Healthcare Payer ID configuration before you implement the Availity lifeline configurations.

 

Our priority is and will remain enabling the temporary solution to support your immediate need.  There is no migration path at this time to a permanent Availity solution.

FAQs from February 29th Communication

 

Have our eIVF systems been compromised due to the Change Healthcare cyber-attack?

No.  Our communication with Change Healthcare relies exclusively on SFTP.  We transmit text files from the eIVF premises to Change Healthcare and reciprocally retrieve text files through a cron job via SFTP.  Our application strictly adheres to a read-only policy and is limited to handling text files; it does not execute any other files.

 

Does Change Healthcare have any access to our on-premises eIVF server infrastructure?

No.  Change Healthcare does not have remote access, of any type, to eIVF on-premises servers.  eIVF drives communications and we have control over when and where data is exchanged through SFTP.  As result, Change Healthcare is unable to initiate any data transmission back to eIVF.  eIVF initiates and orchestrates that process.

 

Is there a workaround in place while Change Healthcare recovers?

Just recently, Availity launched a lifeline service for impacted Change Healthcare customers.  Details are available at the following URL:  https://www.availity.com/availity-lifeline-self-serve-resources

However, this is a lifeline service only, manual in nature, limited in features, and not currently integrated with eIVF. Customers will have to assess if this stopgap measure provided by Availity will meet current need.  We are currently working with Availity to develop an automated integration process to eIVF.  In the meantime, we recommend that customers register for the lifeline service as that registration will be required to use the automated solution once completed.

 

When will the automation with Availity be available via eIVF?

We are working with Availity to develop a design for integration.  While no timeline is available at this time, we have defined the process and requirements from the eIVF side of the connection as well as defined what actions customers will need to take to activate the connection once completed.  We have prioritized our development plan to support this urgent requirement.  Once we have more detail from Availity regarding timing, we will update our customers.