eClaims - Change Healthcare Revenue Performance Portal
- Dylan Nigh
This article walks you through the layout of the Change Healthcare Revenue Performance Portal (RPA Portal for short.)
Administration Tab
The administration tab allows an office administrator to view reports and daily activity as well as configure each user, profile or service. There are quite a few options in this tab and not all will be used.
It will be helpful to know what each part of this tab does.
My Profile
The My Profile section of the Administration tab allows for management of portal user information. The name on the account, email/password information, and security questions for password reset. The main display page can be defaulted from this menu as well.
Default Profile - This will not change unless the office has multiple client IDs. If the office has multiple client IDs then a default office can be selected.
Default Service - Here the default page that initially comes up after log in can be set. Select the profile from the dropdown, and select the default log in page. Selected page will be denoted with a star.
After a selection is made, changes will need to be confirmed.
My Information - This tab is used to enter/change the username, email address, login ID, and password. Change Healthcare requires that the password be reset every 60 days, but can be changed at any time.
User Q and A - This tab is used to set up security questions and answers. This is the information that will be entered if the Change Healthcare password is forgotten.
Audit Logs & Activity Report
The Audit Log & Activity Report will typically be used by office administrators to keep track of what users are doing though the portal.
The Audit Log is a detailed history showing exactly when and what users are accessing and searching for on the portal.
Within the Audit Log, use the filters to narrow down search results. The Log Start & End Dates are usually set within 7 days from the current date. This date would specify the date of the users actions.
The Services pop up is where to select the particular service that needs audited.
Logs Per Page, Sort By and Sort Order aren't filters but are pop ups that allow manipulation of the view of the data.
The Activity Report has less detail and just shows the service accessed and how many times within the date range selected.
The Log Start & End Dates are usually set within 7 days from the current date. The report will specify how many times a particular service has been accessed within this timeframe.
Profile Management
Profiles Management is where users can create custom profiles, configure/add services to your profile, remove user privileges, allow/remove administrators, update dashboard or standard reports and set privileges to determine which services they can access.
The majority of the items within profile management are already. To look at items that can be changed within profile management, click the Edit link next to the profile you wish to edit.
The Services tab should already be configured for services that are available. Services can be selected and removed if necessary. Some of the services are Claim Status, Dashboard, Eligibility, Revenue Cycle Management, and so on.
The Add Services tab functions in the same way the Services tab does. These are services that have not been configured. If none show up on the list, that means all services have been configured that are available.
The Access tab designates whether a client has a single tax ID or multiple tax IDs, Group NPIs or client IDs. Only Change Healthcare can change this.
The Add Users tab allows for the addition of new users by the portal administrator.
The Remove Sites tab allows for the removal a user.
The Admin Rights tab is where a user can be set as a profile administrator under the particular site. Check or uncheck the Profile Admin checkbox and click Update User Roles, this will add/remove the user from being a profile administrator. Profile administrators aren't always portal administrators but portal administrators are always profile administrators. There are a few differences between portal and profile administrators. One difference that is noteworthy, only the portal administrator can add or remove services from a profile but a profile administrator can configure them.
The Reports tab allows for set up of custom production reports (Standard and Dashboard Reports) and have them emailed or posted on the portal dashboard. Dashboard Reports are set up here and are graphical production reports that can be calculated daily, weekly or monthly. The Production reports can be viewed on portal under the Services tab. As these reports are set up, they will require a Submitter ID which is always located in the upper left of this same window listed as Client ID. Submitter ID and client ID are the same thing.
The Remove/Add Users to Services tabs allow you to add or remove services for particular users under this profile.
User Management
User Management is where the portal administrator can add new users, deactivate old users, unlock users (by resetting their password), as well as resetting users' security questions and answers.
Â
To add a new user, click the Add User button which will bring up a new page to enter user information. Enter First and Last Name, email address, login ID (username), password and confirm the password. This is the only place a user can be set as a Portal Administrator.
Once the user is saved you will need to contact MacPractice to have a user changed to or from portal administrator. Also, select the profile (if there are multiple) under which the user to be added. The password set for this user is only a temporary password; once they log in with their portal credentials for the first time, they will need to change their password.
After creating a new user (or initially selecting User Management) there will be a list of all users under the account, their User IDs, Status, User Role, User Type, Profiles they are associated with and any action that can be taken with this user (see information on the Status column for a list of actions). Under User Name/User ID there will be a user specified for the EDI team at MacPractice. This log in (for the EDI team) will allow MacPractice to reset passwords for you, if necessary.
The Status column shows whether users are Active, Deactivated or Locked Out. If a user is Active they can log in to portal with their credentials with no problem.
If a user is Locked Out, that either means they have tried to log in with incorrect credentials more than 3 times, or their password is expired and they did not change it within 10 days after expiration. Regardless, if a user has this status the account will need to be unlocked. Click Change, then Unlock in the menu. After selecting Unlock it will prompt for a temporary password for the user to use to log in.
If a user is Deactivated, that means that an administrator has manually set this status. To re-activate the user, click Change and then Reactivate. Again this will prompt for a temporary password for this user to log in.
If a user is Active, clicking Change will give options for resetting the users password, their security questions/answers, option to deactivate the account, or to edit their information.
Services
Below is a list of services provided by Change Healthcare for reporting and revenue cycle management.
Dashboard
Dashboard allows the user to view custom graphical production reports based on information set in Profile Management. The dashboard reports can show top payers, top payer rejections, top errors from Change Healthcare, and so on.
Â
Mailbox
Mailbox is a centralized location for reports and messages:
Messages from Change Healthcare (also in the upper right of the window next to Logout). Occasionally Change Healthcare sends out notifications to all portal users specifying system upgrades, maintenance, downtime, portal webinars and even important payer/claim notifications. Please be sure to view the messages when a new one is received as these may answer simple rejection or claim submission questions.
Reports - Under the Reports tab is an option for Portal Reports. These are the reports from the inbox that are ready to view (same as the reports that can show up on the dashboard).
Reports can also be scheduled to run, and are viewable from the Scheduled Reports tab.
Remittance Inbox - The Remittance tab contains the inbox for all remittances that have been received received if they have not been archived. This can be very overwhelming to see all of them at one time for every payer which is why we also have an area for remittance tracking. That will be covered under Revenue Cycle Management.
Archived Remittances - Under Workflow Information there is a dropdown where Archived can be selected. After searching, all archived remittances can be viewed.
Claims and Tracking
The Claims and Tracking tab allows a user to search for individual or batch claims sent, run a processed claims report, submit/view eligibility and CSI (Claim Status Inquiry) checks for individual or batch claims, view paid claims, and utilize filters for specific remittance tracking.
Find Claim Batches Tab
The Find Claim Batches tab under Claims and Tracking is used to find claims by searching for a particular batch. The search criteria and filers are as follows.
NOTE: The more specific the search criteria, the more limited the results will be.
Inbound File Date - This is the date that the file is received by Change Healthcare. The default date range is the last 7 days. Claims can be searched for the past 24 months; however, only in 3 month increments.
Status - This allows for filtering by Change Healthcare Status. This only pertains to batches and selectable options are: Created, Committed or Rolled Back. Most of the time batches will be labeled with Committed as a status.Â
Number of Batches Per Page - This specifies the number of batches to be displayed per page. Options include 25, 50, 100, and 500.
Sort by & Sort Order - These options allow for sorting by batch date, batch status, client ID, file name and file size in ascending or descending order.
Client ID/Submitter ID - This is the account number that is assigned by Change Healthcare. This should be automatically set in the search criteria unless there are multiple client IDs.
Client Status - This allows the user to search for a batch with a status that has manually been set. Options include: Archived, All, Open, Complete, Research, and Hold.Â
Batch ID & File Name - These are rarely used as search criteria unless the exact batch ID or file name is known. The batch ID and file name will be assigned by Change Healthcare; not the one assigned by the payer.
After entering search criteria and pressing the Search button, a list of batches that meet that specific criteria will be displayed. There are quite a few fields in this table view:
Batch Date and Batch ID/File Name - This is the date the batch was submitted to Change Healthcare (if it is after business hours, please remember the batch could be received the day after it was sent). The batch ID and file name are assigned by Change Healthcare.
Type -Â This column shows what type of claims are in the batch. Most cases it will always say Professional Claims however there are a few instances where clients send institutional and worker's comp claims.
Client IDÂ - This column shows what client ID the batch was sent under. Most of the time this will not change if the office has only one client ID. If there are multiple IDs they will be viewed in this column.
Total - This column tallies the number of claims submitted in the batch.
Change Healthcare - This column tallies how many claims in the batch passed Change Healthcare's edits . Change Healthcare shows sub-columns under it to specify claims Pending at Change Healthcare, claims rejected as Duplicated by Change Healthcare, claims rejected on the front end by Change Healthcare and claims that were accepted by Change Healthcare and forwarded onto the payer.
Payer - This column shows how many claims are either Accepted or Acknowledged (ACK) by the payer or Rejected by the payer. The numbers under these columns can be clicked to view the claims that are flagged for each status; shows in a separate window. This window is actually the Claims Tracking view and will be covered after Batch Tracking.
Batch Status/Client Status - Batch status states whether a batch is Created, Committed or Rolled Back. As stated above, if anything other than Committed is shown please call MacPractice so we can look into it. The client status is again the status that you can set for each batch internally on portal. See above description for client status.
Find Claims Tab
Find Claims is used to search for individual claims by an array of filters and search criteria. When viewing the detail of a unique claim there is also the capability for most claims with a payer acknowledgement to print Letters of Appeal and Timely Filing. The search criteria descriptions are as follows:
Change Healthcare Trace ID - This is probably the most important search criteria on this page. Change Healthcare assigns a unique number to every single claim. This can typically be found when a claim is selected in the eClaims ability in MacPractice. Searching by the 15 digit trace number will pull up the exact claim matching the trace. This is the most specific search available. A trace number is viewable at portal for 24 months after the claim was posted at Change Healthcare.
Claims Per Page - This specifies the number of claims to be displayed per page. Options include 10, 50, 100, and 500.
Sort by & Sort Order - These fields allow for sorting by date processed, date of service, first name, last name, patient account #, payer ID, client ID, provider tax ID and CAP status in ascending or descending order.
Change Healthcare Status - This is the status that is labeled by Change Healthcare to a given claim. Claims can be searched by all claims, claims accepted by Change Healthcare, claims rejected as duplicates by Change Healthcare, claims rejected on the front end by Change Healthcare, claims pending at Change Healthcare, claims labeled corrected at Change Healthcare and accepted, rejected, and all claims resubmitted from or to Change Healthcare.
Payer Status - This is the status that is sent from the payer. Can be filtered by all, acknowledged, no response or rejected. For payer statuses, not all payers return an acknowledgement or claim acceptance so please take note of that when wanting to use this as search criteria.
Process Start & End Dates - This is the date that the file is received by Change Healthcare. The default date range is the last 7 days. Claims can be searched for the past 24 months; however, only in 3 month increments.
Eligibility Status - This allows for the filtering of claims based upon a received eligibility response. Search options include active, inactive, not active, and error response.
Neither Change Healthcare nor MacPractice has any control over what information is provided by an eligibility response. This information is provided entirely by the payer responding to the eligibility request.
Remit Status - This allows for searching based on the remittance status. Search options include not paid, paid, zero paid, and non-zero paid. This is all dependent on whether an Electronic Remittance Advice (ERA) is received from the payer, and whether the ERA has been tied to the claims at Change Healthcare.
Commonly used search fields:
Payer ID - Enter the payer ID of the insurance company. Refer to the Payer List if the Payer ID is unknown.
Patient First/Last Name
Date of Service
Simple Search
Advanced Search
Save To My Tasks
If a user often uses the same filters for searches, the user can choose to save the filter settings by clicking the "Save To My Tasks" Button, beneath the search criteria. In the image below, the user is opting to save the settings of CH Processing Date Range of Previous 7 Days, for Payer ID '87726', as "7 Day UHC".
By clicking Continue in the Save to My Tasks box, this saves the item "7 Day UHC" to My Tasks.Â
The Home icon, at the top of the page, will bring up "My Tasks ". The user can then click on the title of the task. Portal will then run the search automatically, based on the saved filter criteria.
Â
Timely Filing
To create a Timely Filing Letter, search for a claim, then open it to view the claim details. In the lower right corner, there will be an Appeal link. Click this, and select "Create a letter of Timely Filing", as shown below. If there is no appeal link, contact MacPractice (877-220-8418). An EDI specialist will need to contact the clearinghouse to get the timely filing letter created.
Â
Enter the Contact Name and Phone #, and a letter will be automatically generated. The letter can be sent along with the resubmitted (paper) claim. If the payer does not accept paper claims, please call them to determine how the letter of timely filing should be submitted.
Processed Claims Report
Processed Claim Report provides a list of billed payers with a summary of claim processing information for each one.
The report includes information like: total claim value, total of claims accepted, rejected, duplicate, and so on. Results can be refined by a specific payer using the Payer iD. The report view menu allows the results to be refined by Change Healthcare or payer, whereas the default view gives you both.
Eligibility
Eligibility inquiries are only available if enrollment has been completed (payer specific)Â and is based on provider participation. Contact MacPractice Enrollments to enroll for additional eligibility payers.
This portal service is used to check eligibility based on each payer's eligibility search requirements. Multiple patients can be checked at once with a batch request. Enter the required search criteria (noted with an *). Available search fields include: Member ID, Patient DOB, Patient Last Name, Gender, Dat of Service, etc. Click Check Eligibility button to perform a single check. Use the Add to Batch button for multiple requests; up to 50 inquiries can be submitted at one time.
Payments and Billing
Find Remittance/EOB/Check: Used to locate ERAs that have been sent to Change Healthcare from the payer.Â
Use the drop down lists and entry fields to better define search results. (Processed Date, Payer ID, etc.)
Use the optional search fields, as needed, to refine the search. (EFT/Check Date, EFT/Check #, Patient First/Last Name, etc.)
Existing Enrollments
Listed within Services > Existing Enrollments are the current and pending enrollments for the selected Client ID (if more than one). Results can be filtered by payer and type of transaction (Prof. Claims, Inst. Claims, ERA, Elig., etc.). The status column will show where the enrollment process is at. If Approved, then that specific transaction can be utilized. If Pending, the enrollment has not been approved and the transaction cannot be utilized yet. If Cancelled, the enrollment had been started but never completed. If Denied, the payer denied the enrollment usually for missing/invalid/incomplete information.
