Since February 21, 2024, medical providers using billing software integrated with Change Healthcare as the clearinghouse have been unable to transmit claims to insurance companies. A clearinghouse is like a ‘bridge’. The claim goes from the provider, over the bridge, to the insurance company. After the claim and payment are processed, the information returns over the bridge and into the provider’s software.

The bridge has been destroyed.

Without the bridge, providers are left scrambling to create their own makeshift solutions or “work arounds”. The specific approach varies across different healthcare sectors, but these solutions are time-consuming, and practices lack the meticulous manpower required to manage them effectively. Meanwhile, operational costs continue to add up without the incoming revenue needed to meet profit margins, potentially leading to the closure of healthcare providers.

Here are 4 solutions for affected practices.

1. Enroll a backup clearinghouse – This strategy serves as a safety net, preventing any interruption in billing processes. Typically, maintaining a secondary clearinghouse incurs no monthly fees. However, setting up a new clearinghouse account is a complex procedure and should be handled by professionals with extensive experience in the field.
2. Submit claims directly to payers – This can be done electronically or through the mail. Submitting claims directly to payers can help to bypass the disruption to Change Healthcare’s services. It is crucial to recognize that not all payers accept direct submissions and manually managing Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) documents could become cumbersome.
3. Check eligibility through payer portals – Each insurance company including commercial, Medicare, and Medicaid have online portals that can check patient eligibility. However, logging into different systems is tedious and prone to mistakes such as forgetting login credentials.
4. Utilize a revenue cycle management company – Leveraging the expertise of an RCM company can significantly enhance a practice’s ability to secure payments. These companies bring not only the required manpower that many practices lack but also have in place robust systems for claims submission that can mitigate the effects of a clearinghouse interruption.

METACARE’s medical clearinghouse setup service has helped Nashua Family Dental rapidly enroll a new clearinghouse in a “turnkey” manner. They will manage every step of the process and guarantee that your practice is set up for success. Contact Raymond Shih at [email protected] or call (617) 383-4063.