Change Healthcare Outage FAQ

How long will the outage last? Last updated: March 19, 2024 – 8:22 am MST

According to the latest information from Change Healthcare’s update page, Beginning the week of March 18, we will begin bringing up the claims system for reconnection and testing in a phased manner.” And then this: “While we are making progress, we strongly recommend pursuing multiple paths and solutions, including the previously mentioned iEDI claim submission system and alternative clearinghouses.”

The above statement(s) from Change Healthcare leaves many questions unanswered. We currently do not know when or if the legacy platforms called “Relay Health” or “Capario”, which are the platforms that Lytec users send to, will be operational again. We are unable to know if Change Healthcare will be “testing” those systems the week of the 18th or if they are referring to some of their other platforms, nor does the term “phased manner” allow us to know a time frame. We are actively working to get answers to these questions and will provide that information here as we obtain it.

Updates continue to be provided through the UnitedHealth Group website.

Should I wait for Change Healthcare or do I move forward with a change of clearinghouse? Last updated: March 19, 2024 – 8:22 am MST

Given the many unknowns of when Lytec users will be able to start submitting claims to Change Healthcare, we are recommending to our clients that a move to eMEDIX is most likely the best option at this time. As of March 18th, eMEDIX was reporting 98% (and growing) of claims being transmitted to the payers. While switching clearinghouses is a process, we believe this is the best path forward to receiving payments again in the shortest amount of time. While some carriers do require approval, many commercial insurances can be submitted very quickly, even hours after your enrollment with eMedix is completed.

Can I switch to a new clearinghouse like Availity or Office Ally and be sending claims the same day? New: March 12, 2024

During this time of uncertainty and great need, we understand that some clearinghouses are actively marketing and advertising the ability to “create your account and send claims the same day” or “enroll and start submitting claims today.” However, in our experience, such language represents only a portion of the complete story, with critical information being left out.

While it is true that any clearinghouse, including eMEDIX, can swiftly create your account, possibly even on the same day, it’s crucial to note that this does not automatically configure your Lytec billing software for claims submission to that clearinghouse. The mere creation of your account with a clearinghouse doesn’t set up your Lytec properly to send claims. Configuring your Lytec involves various steps, such as creating a new “connection,” setting parameters, and updating payer IDs, among other essential tasks.

Regardless of the clearinghouse you choose, each one necessitates configuring a connection within Lytec. Considering the current circumstances resulting from the Change Healthcare outage, we are directing all our resources toward aiding customers in promptly and efficiently transitioning to eMEDIX. This includes providing self-help tools and resources. As a consequence, scheduling appointments for configuring Lytec to send to third-party clearinghouses like Availity or Office Ally is presently extending well into the future. We firmly believe that the quickest way to enroll with a clearinghouse and resume claim submissions is through eMEDIX. Furthermore, due to the time commitment, it is more cost-effective to get configured for eMEDIX than a different clearinghouse.

Lastly, over the past few years, Lytec has been developed to seamlessly integrate to eMEDIX. Numerous highly useful tools have been integrated into Lytec, in partnership with eMEDIX, including Claim Status Inquiries, Eligibility Verifications, Patient Responsibility Estimator, and more. For various reasons, we consider eMEDIX to be the optimal solution both in the short-term and the long-term.

What alternatives are there for sending my claims?

In short, eMEDIX, also known as “Lytec EDI,” is a fully-featured, fully-integrated EDI clearinghouse solution as an alternative to Change Healthcare. It is more integrated with your Lytec than any other EDI solution, meaning there are some great tools and features that you didn’t have previously. Over the past couple of years, as some customers have moved from Change Healthcare to Lytec EDI, the common feedback we receive is that Lytec EDI/eMEDIX clearinghouse is a better overall solution (better web portal, better management tools, better reports, and more features).

What steps are involved, and how long does the process take to move to Lytec EDI/eMEDIX? Updated: March 19, 2024 – 8:22 AM MST

An overview of the steps is provided below. Depending on your individual needs we may be able to adapt or rearrange steps to help you possibly send claims quicker. We will evolve our processes as best as possible to accommodate individual needs by providing both self-help tools and scheduled appointments with our EDI specialists.

  1. Approve the pricing for eMEDIX by signing the quote provided by an account manager.
  2. Complete the eMEDIX enrollment form electronically.
  3. Once eMEDIX has processed your initial enrollment and provided your submitter ID (in many cases, the within the same day), we will send an email with your login and password to the eMEDIX portal. We will also include links to self-help videos for onboarding along with onboarding classes.

We are actively working to make the process as quick as possible. Most of the time, obtaining an eMEDIX account happens the same day. After your eMEDIX account is created, you will have the ability to follow the provided instructions to configure your Lytec and begin sending claims. Because we know the situation is urgent, we will help everyone through the process in the shortest possible timeframe.

How soon can I start sending claims through Lytec EDI? Last Updated: March 19, 2024 – 8:22 AM MST

Some insurances, like many commercial payers, can be sent almost immediately, while other carriers (mostly government payers) require approval. The answer to this question can be different for each customer. It depends on which insurances you send (for example, government vs commercial), which carriers require approvals prior to sending, and how quickly those carriers provide approvals. As the situation evolves, some carriers that currently require approvals are looking at ways to modify or remove the approval process. As mentioned above, eMEDIX accounts are being created the same day, in most cases.

What is the pricing for Lytec EDI?

The large majority of our customers (about 90%) can maintain the same pricing they currently have with Change Healthcare. For a smaller number of customers, we can actually reduce the monthly price. In only a couple of rare instances has pricing increased.

Even if I switch, does Lytec EDI/eMEDIX route claims through Change Healthcare? Last updated: March 19, 2024 – 8:22 am MST

As of this document’s updating on 3/19/2024, 98% of payers using eMEDIX are not routed through Change Healthcare, and we expect that number to continue to grow in the coming days. In the past, regardless of the clearinghouse you submit to, potential existed for EDI transactions to be routed through Change Healthcare to specific payers. eMEDIX has a project underway and is tirelessly working to reroute any payers through alternate paths whenever there is an opportunity to do so. Again, currently, 98% of claims are being routed to payers.

What happened to claims submitted prior to the outage? 

Claims that had already been forwarded to payers should now be in their adjudication systems and those without issues processed and paid per the payer’s policies. Those payments should still be received via EFT or other methods normally used between your practice and the payer.

What about ERAs for payments? 

ERAs that are routed through Change to our systems will not be available while their system is down. You will be able to go to payer portals that provide these and download from those sites and then upload into your practice management systems. Keep in mind that once ERAs start coming through automatically, you will need to ensure these ERAs are not posted. Please contact Support for assistance if you do not know how to import or revoke automatically posted remits.

Should I send paper claims? 

Lytec can submit paper claims in CMS-1500 and CMS-1450 formats, if a payer accepts paper claims by mail (print) or via their online portals (print to file). You will need to review the options available by payer. Lytec will still mark claims as submitted and typically sets the method to “Paper” so you can avoid duplicate submission.

What happened?

On February 20th, 2024, Change Healthcare (“Change”) notified the industry that it was experiencing a network interruption related to a cyber security issue. Change communicated that it immediately disconnected systems to prevent further impact. The disruption has continued since then and has impacted numerous Change and third-party systems connected to Change that our customers use either directly or through back-end connectivity. Numerous other healthcare industry entities are impacted, including pharmacies, that are unable to look up patient benefits and which you may have learned about from your patients.

What is the Temporary Funding Assistance Program?

New information is emerging about a “Temporary Funding Assistance Program” offered by Optum, the parent company of Change Healthcare. More information can be found on Optum’s website by clicking here: Optum TFAP.

Will Change Healthcare issue a refund?

At this point, it’s too early to have any specific information about refunds. Currently, all efforts and energy are focused on getting services up and running. Once the situation has been resolved, we would expect Change Healthcare to address any questions regarding your EDI services invoice. We will communicate information as we receive it.

Call Now Button Skip to content