Submitting Claims through Optum's Clearinghouse (iEDI)

An ongoing Change Healthcare (CHC) outage is blocking clearinghouse connectivity, including connections for claims, ERAs, printed statements, and eligibility. While the disruption continues, we understand that establishing a claim submission workaround is key to restoring the flow of funds to your practice or business. As such, we are excited to introduce Optum’s Intelligent EDI (IEDI) clearinghouse as a temporary workaround for claim submission only.   

The claim submission workaround detailed below will allow you to send claims via the RXNT product using Optum’s Intelligent EDI (IEDI) clearinghouse. You do not need to contact Change Healthcare to take advantage of this option, as the workaround will be available directly within RXNT. 

Please make note of these key details: 

    • The IEDI workaround is temporary and is for claim submission only.
      • Dental claims are not included in this workaround.
      • Avoid sending claims to payers where enrollment is required. To check if enrollment is required, click here to view Optum’s payer list. Further instructions on payers requiring enrollment will be made available as they are received.
      • Do not make changes to the payer IDs in your RXNT account, as doing so will result in issues when the Change Healthcare connection is re-established. All IEDI payer IDs have been mapped to CHC payer IDs, so all you need to do is start sending claims. 
      • If you were already enrolled with a payer on the Medicare Dual Enrollment List prior to the Change Healthcare Outage, you can submit Medicare claims to the entities on this listing through IEDI without the need for enrollment. This listing includes all Medicare entities that are dual enrolled with both Change Healthcare and IEDI. 
      • If you choose to use the IEDI workaround, you will still need to access payer sites to collect ERAs or 835 files and upload the payments into RXNT manually. For instructions on ERA imports, click here.
      • Claim rejections and acceptance notices will be made available to you directly within RXNT. You should also correct and resubmit claims that are rejected directly within RXNT. This workflow mirrors the workflow you were accustomed to when reworking claims using the Change Healthcare connection.

It’s important to keep in mind that once you choose to send a claim to IEDI, any rejections or rework for that specific claim must continue to go through the IEDI clearinghouse. RXNT has already accounted for this by ensuring reworked claims will be resubmitted to the clearinghouse for which they originated. 

This means that after the Change Healthcare connection for claims is re-established, the following will be true: 

      • Claims sent to IEDI will not be visible in Change Healthcare.
      • ERAs related to claims sent via IEDI will need to be collected directly from the payer site.

Submitting claims

Sending Claims through IEDI:

We have added a new Send to Optum button on the To Send Electronic tab from the Claims screen, as well as the Encounter screen.

To send claims to Optum from the To Send Electronic tab, select the claims you’d like to send, then select the Send to Optum button. Note that the existing Send Selected button will send claims to Change Healthcare, and it will not be successfully processed during the outage.

        • Claim rejections and acceptance notices will be made available to you directly within RXNT. You should also correct and resubmit claims that are rejected directly within RXNT. This workflow mirrors the Change Healthcare workflow you are accustomed to.
        • RXNT has ensured that reworked claims will be resubmitted to the clearinghouse for which they originated. Meaning that if you’ve sent a claim to IEDI, reworking that claim will route it back to IEDI.
        • On the Claims screen, the clearinghouse for each claim will be listed in a new column titled Clearinghouse. CHC indicates the claim was sent to the Change Healthcare clearinghouse while OPTUM indicates the claim was sent to the Optum Intelligent EDI clearinghouse.

        • ERAs will not be received in RXNT or available through the IEDI portal. You will need to access payer sites to collect ERAs or 835 files and upload the payments into RXNT manually.

To send claims to Optum from the Encounters screen, select the Send to Optum button when viewing an encounter. Note that the existing Send Claim button will send the claim to Change Healthcare, and it will not be successfully processed during the outage.

        • Claims will first process through RXNT’s claim scrubber. Be advised that claims may stay in the Scrubbing for Errors tab longer than normal—this is expected and not a cause for concern.
        • Claim rejections and acceptance notices will be made available to you directly within RXNT. You should also correct and resubmit claims that are rejected directly within RXNT. This workflow mirrors the Change Healthcare workflow you are accustomed to.
        • RXNT has ensured that reworked claims will be resubmitted to the clearinghouse for which they originated. Meaning that if you’ve sent a claim to IEDI, reworking that claim will route it back to IEDI.
        • On the Claims screen, the clearinghouse for each claim will be listed in a new column titled Clearinghouse. CHC indicates the claim was sent to the Change Healthcare clearinghouse while OPTUM indicates the claim was sent to the Optum Intelligent EDI clearinghouse.

        • ERAs will not be received in RXNT or through the IEDI portal. You will need to access payer sites to collect ERAs or 835 files and upload the payments into RXNT manually.

Encounters tab

If there are any previous claims in the Scrubbing for Errors tab that were not canceled and moved to To Send Electronic before the release, they will not be sent out to Optum automatically. Clients will need to follow these steps:

Navigate to the Encounters tab located in the top navigation bar and select Scrubbing for Errors

To cancel encounters, you can either individually select them by clicking the box next to each encounter number or choose to select all encounters by clicking the box in the header.

Click Cancel Send.

This will move the claim to the Claims tab under the To Send Electronic tab. 

To send claims to Optum, you can either individually select them by clicking the box next to each encounter number or choose to select all claims by clicking the box in the header.

Click Send to Optum.

Claims tab

For existing claims in the Pending, Rejected, and No Response tabs on the Claims screen, the original clearinghouse that the claim was sent to will be listed in the Clearinghouse column.

Claims that were originally sent to IEDI will be routed back to IEDI when reworked and sent via the existing Send Selected button.

 

Claims that were originally sent to Change Healthcare will be routed back to Change Healthcare when reworked and sent via the existing Send Selected button, and will not be successfully processed as a result of the outage

 

If you’d like to send claims originally sent to CHC to IEDI, you have two options based on the original Claim Filing Method

 

Print Claims:

From the Pending, Rejected, or No Response tabs, select the claims you’d like to send, then select Send Selected.

This will move the claims to the To Send Electronic tab of the Claims screen, where those claims can be selected and sent to Optum via the new Send to Optum button.

 

Electronic Claims:

From the Pending, Rejected, or No Response tabs, select the claims you’d like to send, then select Send Selected.

The selected claims can be retrieved from the Scrubbing for Errors tab on the Encounters screen by selecting the encounters, and selecting the Cancel Send button.

This will move the claims to the To Send Electronic tab of the Claims screen, where those claims can be selected and sent to Optum via the new Send to Optum button.

 

 

It is important to note that the IEDI portal will not be available to customers, but you will be able to view claim statuses in RXNT. If you need help surrounding a claim status, use of the IEDI workaround, or other topics covered in this article, contact RXNT’s Customer Service Team for assistance.

Still, need help? Contact us!

Have a great idea? Tell us about it!




Was this article helpful?
1 out of 1 found this helpful