In the wake of the Change Healthcare cybersecurity incident, many healthcare practices are contemplating a significant operational shift — changing their clearinghouse providers. While the idea might seem straightforward, the reality is anything but.

1. The Maze of Payer Mapping

One of the most daunting tasks in switching clearinghouses is the need to reconfigure payer mappings. Practices must meticulously bridge the gap between Change Healthcare's payer IDs and those of the new clearinghouse. This is not a simple one-to-one translation; payer names often do not align perfectly, and the landscape is cluttered with hundreds of similar payer names, each associated with unique IDs. The risk of submitting claims to the wrong payer ID is high, and such errors can lead to unpaid or lost claims.

2. The Enrollment Conundrum

Transitioning to a new clearinghouse necessitates completing numerous claims submission enrollments (EDI) for different payers. Understanding which payers require enrollments, mastering the enrollment process, and achieving this in a timely manner is complex. Athelas RCM stands out by leveraging established payer relationships to expedite these enrollments, smoothing over a typically bumpy road.

3. Identifying Submission Errors

A critical aspect of claims management is identifying and rectifying submission errors. When working with multiple clearinghouses, the risk of errors slipping through the cracks increases, as practices must scrutinize each submission funnel individually. Athelas RCM’s integrated approach consolidates error tracking across all clearinghouses, ensuring comprehensive error detection and resolution.

4. Guaranteeing Comprehensive Claim Submission

Building a robust submission funnel from scratch is no small feat. It demands not just technological solutions but also a team of experts to ensure that every patient encounter is accurately captured as a claim and submitted to the appropriate payer. Athelas RCM's combination of automation and expert oversight ensures that 100% of the claims are submitted.

5. Parsing Rejections and Reports

Handling the variety of rejection and report formats — 277 and 999 for rejections, 835 for ERA reports, and 837 for submissions — requires a sophisticated technical framework and deep healthcare knowledge. Each clearinghouse has its unique data formats, making the task of parsing these reports even more intricate.

6. Mastering ERA Submissions

Understanding the intricacies of Electronic Remittance Advice (ERA) submissions is crucial for efficient claims processing. Athelas RCM employs a team of experts adept at navigating payer portals and employs sophisticated EOB parsers. This capability allows for seamless integration of paper EOB information into the digital workflow, ensuring accurate remittance processing.

Conclusion

The challenges of changing clearinghouses are manifold and can pose significant operational risks for healthcare practices. The expertise and integrated solutions offered by Athelas RCM present a compelling alternative. By choosing Athelas, practices can bypass the hurdles of payer mapping, enrollment complexities, rejection and error parsing, and ensure comprehensive claim submission and accurate ERA processing. In a landscape marked by technical and regulatory complexities, partnering with Athelas RCM offers a path to streamlined, efficient, and reliable revenue cycle management.

Medical practices that have been impacted by this incident, and begin to use Athelas RCM, will be able to submit claims as quickly as one week after signing an agreement.

Reach out to our team to get started or email us at change@getathelas.com to learn more.