- Change Healthcare Real-Time
- Change Healthcare Hosted Real-Time
- Change Healthcare Patient Responsibility Estimator®
- Change Healthcare Third-Party Liability Analysis
- Change Healthcare Medicare Crossover
- Change Healthcare Provider Web ConnectSM
- Change Healthcare CareComm
Member Eligibility Management
Change Healthcare Member Eligibility Management services offer a unique upstream approach for efficient management and utilization of member eligibility data that achieves downstream administrative and medical cost savings. Our suite of member information-driven solutions helps payers strengthen provider self-service, improve member care management, increase auto-adjudication rates, comply with government benefit reporting mandates and facilitate HIPAA and CORE compliance.
Eligibility, authorizations, claim status and other related inquiries are often viewed as just another communication requirement for interaction with providers. Change Healthcare changes that through our ability to take your member information and not only enable real-time transactions through both direct connections and hosted solutions, but also capitalize on our broad solution set to enable efficiencies in downstream healthcare costs by addressing upstream challenges, deploying more solutions with one benefit data set, faster, with minimal risk and greater return on investment.
As always, our nationwide electronic network reach allows us to connect to any system for all payer-to-provider HIPAA-mandated transactions, but the value goes far beyond facilitating traditional pre-care inquiries. By reinventing the approach to member eligibility data management, Change Healthcare enables you to not only serve your provider networks in the best way possible, we are helping improve member health, facilitate regulatory compliance, increase revenue and reduce costs.
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Change Healthcare Real-Time provides Change Healthcare network connection via the HIPAA-standard ASC X12N format, supporting eligibility inquiry and response (270/271), claims status (276/277), find provider (274), healthcare services review request and response (278 x 094), healthcare services review inquiry and response (278 x 059) and claim financial inquiry (277/835).
Change Healthcare Hosted Real-Time offers payer organizations the functionality for real-time healthcare transaction exchange in HIPAA compliant formats and enables real-time eligibility and benefits inquiry and response capability.
The Change Healthcare Patient Responsibility Estimator® is an innovative tool that improves payer-provider relationships by offering providers reliable, convenient, real-time estimates of patients' out-of-pocket responsibility.
Provider WebConnectSM offers payers their own internet-based portal that enables their submitting providers to login and submit batch claims, perform real-time eligibility and benefit verification, referrals, pre-certifications, authorizations and claim status inquiries, with no hardware or software requirements.
Change Healthcare Third-Party Liability Analysis seamlessly manages the process of mapping Medicaid claim data to commercial payers' eligibility rosters. By identifying commercial payers with primary COB responsibility, Change Healthcare Third-Party Liability Analysis helps Medicaid recover overpaid claim dollars and limit future overpayments.
Processing more than 35 million Medicare Crossover transactions annually, Change Healthcare offers guidance and resources that help payers simplify Medicare Crossover claim processing. Change Healthcare's existing payer connectivity to GHI eliminates payer requirements for implementing individual connectivity and workflows. Change Healthcare Medicare Crossover offers payers accelerated COBA readiness, minimized implementation costs and increased claim acceptance rates.
Change Healthcare CareComm is a care communication tool for improving healthcare decision-making. It enables health plans to engage their provider network through pre-care messaging that leverages a real-time eligibility connection, as well as engage their member population post-care through print messaging. CareComm helps convey important patient health history and analytics at the right point in time to improve the health of your member population.