We now offer separate modules to satisfy Customer-requested functionality for Claims and Eligibility. Change Healthcare Claims provides claims service, while Change Healthcare Eligibility offers Real-Time Eligibility, either alone or with Batch Eligibility.
If your agency is spending too much time and money on manual eligibility verification, Change Healthcare’s Eligibility Modules can help.
- Eligibility verification is the first step in the insurance-reimbursement process.
- Fast eligibility verification speeds up workflows, improves client experience and facilitates accurate claims for quicker, more accurate payment.
Real-Time Eligibility Verification
With Change Healthcare’s Real-Time Eligibility Verification Module, you can check client insurance eligibility on-demand, from within the EHR platform. This saves time for staff and providers, eliminates obstacles to care, and facilitates a clean claim-generation process for accurate and reliable reimbursement for services billed. Benefits include:
- Decrease time to payment by sending more clean claims, more quickly, and receiving fewer denials
- Save staff time and time to payment by verifying eligibility before claims are filed
- Deliver a better intake and check-in experience by informing clients of out-of-pocket costs at the point of care
- Reduce front-office overhead
Batch Eligibility Verification
Change Healthcare’s Batch Eligibility Verification Module allows you to check client eligibility in groups. This invaluable time-saving tool for providers enables staff to enter the next day’s client schedule ahead of time, to verify eligibility in advance for a more efficient front desk process. Benefits include:
- Prevent payment issues before they arise, with pre-eligibility screening
- Spend less time verifying eligibility and more time serving clients
- Simplify staff and provider workflows
- Drive client satisfaction, with quicker service and a smoother care process
Change Healthcare Eligibility Module Specifications
Change Healthcare’s Eligibility Verification Modules use an Electronic Data Interchange (EDI) interface. Real-time and batch exchanges go through secured channels such as SFTP. The system uses a transaction engine to manage the X12 transactions. Industry standards (270 and 271) are used to connect providers and payers across platforms.
Change Healthcare Service Definitions
(a) “Payers” shall mean those entities that receive Transactions submitted by Customer through the Services, as identified from time to time by Company. (b) “Change Healthcare Available Payers” shall mean Payers which are included in the Change Healthcare Available Payer List (a document which is available online at the Change Healthcare website [www.changehealthcare.com]) and can be accessed via the Change Healthcare network for the purpose of Electronic Data Interchange (EDI). (c) “Change Healthcare EDI Service” includes the following services to Change Healthcare Available Payers: electronic claims submission and payment advice (837/835 Files) and claims management services. These Change Healthcare EDI Services are available to the Customer and will be performed by Qualifacts + Credible from time to time for Customer through use of the Change Healthcare EDI Network. (d) “Transactions” shall mean batch and real-time healthcare transactions submitted by Customer via the Change Healthcare EDI Service for transmission to a Payer, whether or not a Payer accepts or favorably adjudicates such transactions. Customer will be billed each month for actual number of unique rendering NPIs that have submitted a claim in their production environment, to be assessed one month in arrears of services delivered. Please contact aeteam@qualifacts.com for more information and pricing.