Change Healthcare & athenaEDI Updates

With many unknowns it can be a challenge to determine what the best plan of action should be for your business. Our goal is to be transparent with what is known, what isn’t known, what options are available now, and what options will be available soon. As more becomes known we will continue to provide updates so you can make the best decisions possible with information that is available.

NOTE: These are recommendations only and apply to most of our clients, but we recognize that some practices may have necessary resources and expertise to take different approaches.

Update June 3, 3:21PM

Announcement

Over the last few weeks athenaEDI has been working towards establishing a new connect to Relay Exchange. The connection which will replace the legacy connect to Change Healthcare (Emdeon/OKC) platform.

As of 5/23/24, athena started rerouting the remaining payers, which are currently pending, to the new Relay Exchange Platform.

Please note there are a small number of payers that are not available through Relay Exchange and claims submitted to these payer IDs will be rejected. athena anticipates this will have minimal impact to most customers and recommend updating these payer IDs to route to SPRNT until an electronic solution is available through Relay Exchange. We will communicate as additional payer IDs become active.

ERA’s

You should also start receiving era’s again.

The following carriers will need era enrollments completed so that you may start to receive your payments: Cigna, Aetna, United Healthcare ( all entities) , Humana, Tricare east ( both claims and era’s), Emblem/GHI, Oxford, AARP

Please open a case with our app support team so that we can provide you the appropriate form.

Update May 16, 3:00PM

Alternate Payer Route List

Please use this link to download the current Alternate Payer Route List – Alternate Payer Route List May 16

Update May 13, 9:20AM

athenaEDI Disruptions – RESOLVED

Some clients are experiencing issues with athenaEDI UX functionality. Some clients may experience issues with sending or receiving files. athenaEDI is currently researching the root issue.

Update May 6, 10:40AM

Payer Mandate

Health Partners PA (payer ID 80142) ERA permanently moving to Echo Health (OHC8). Please open a ticket with VOW support team so that we may provide you with the necessary forms.

Update April 30, 3:51PM

Invite

Please join us for athenaEDI Talks Service Status Update on Tuesday, May 7th from 2:00-3:00pm ET.

We plan to use the entire session to provide an updated status on the EDI Transaction Service Disruption.

To join the call, please register at the link below:

https://events.teams.microsoft.com/event/b1cb5797-9936-4bb3-9676-d2cbf7b3fb0a@3d44f5c7-726e-45cd-b26c-3e58cddea376

Update April 29, 8:15AM

Rejections

Claims submitted to OPTUM 360 PROFESSIONAL received below rejections:
CLAIM LEVEL STC12: H H10913 Transaction Set Control Number ‘0001’ does not match ST02’s

A high priority case had been opened at Optum to review these rejections. We will update this page when it has been resolved.

Update April 25, 3:30PM

Alternate Payer Route List

Please use this link to download the current Alternate Payer Route List – Alternate Payer Route List April 23

Update April 22, 5:00PM

Payer Mandates: HIP – Health Insurance Plan of Greater New Yor (payer ID 55247)

athenaEDI will permanently move HIP- Health Insurance Plan of Greater New York (payer ID 55247) to the well-established direct connection with Echo Health (OHC8).

Hip Health Plan of NY Era’s have been re-routed and will require an enrollment form. Please open a ticket with VOW Support so that we may provide you the correct form.

Update April 22, 10:55AM

Payer Mandates: Humana Inc. (payer ID 61101)

Effective immediately, athenaEDI will be moving Humana, Inc., Payer ID 61101 permanently from USC2 to Availity/US60.
Claims(837)
Humana, Inc, Payer ID’s: 61101/GEC00240P/GEC00240I
Remittance(835)
Humana Inc., Payer ID’s: 61101/GEC00240R

Humana now requires an enrollment for ERA’s. Please open a ticket with VOW Support so that we may provide you the correct form.

Update April 22, 8:40AM

athenaEDI Service Disruptions

Some clients may experience issues with sending or receiving files and/or with data loading within their athenaEDI. athenaEDI is currently researching the root issue.

Update April 19, 8:30AM

Payer Mandate: UHC (multiple payer id’s)

Effective immediately, athenaEDI permanently moved UHC (all payer id’s) claims and ERA to US36 Optum. The below payers for ERA will need an enrollment completed prior to receiving the payment files. Please open a case with the VOW support team so that we can provide the correct forms.

AARP MedicareComplete thru UHC/Oxford Medica GEC90096P 87726 Claim-P
AARP MedicareComplete thru UHC/Oxford Mosaic GEC90096P 87726 Claim-P
AARP MedicareComplete thru UnitedHealthcare/ GEC90096I 87726 Claim-I
AARP MedicareComplete thru UnitedHealthcare/ GEC90096I 87726 Claim-I
AARP MedicareComplete thru UnitedHealthcare/ GEC90096I 87726 Claim-I
AARP MedicareComplete thru UnitedHealthcare/ GEC90096P 87726 Claim-P
Arnett Health Plan GEC90096I 87726 Claim-I
Arnett Health Plan GEC90096P 87726 Claim-P
OptumHealth GEC90096P 87726 Claim-P
OptumHealth/OptumHealth Behavioral Solutions GEC90096I 87726 Claim-I
OptumHealth/OptumHealth Behavioral Solutions GEC90096P 87726 Claim-P
OptumHealth Behavioral Solutions (formerly U GEC90096P 87726 Claim-P
OptumHealth Behavioral Solutions (formerly U GEC90096I 87726 Claim-I
UnitedHealthcare GEC90096P 87726 Claim-P
UnitedHealthcare/Definity Health Plan GEC90096P 87726 Claim-P
UnitedHealthcare/Empire Plan GEC90096P 87726 Claim-P
UnitedHealthcare/MAHP-MD IPA Optimum Choice GEC90096R 87726 Remit-I
UnitedHealthcare/MAHP-MD IPA Optimum Choice GEC90096R 87726 Remit-P
UnitedHealthcare/MAHP-MD IPA Optimum Choice GEC90096P 87726 Claim-P
UnitedHealthcare/MAHP-MD IPA Optimum Choice GEC90096I 87726 Claim-I
UnitedHealthcare/UnitedHealthcare Plan of Ri GEC90096P 87726 Claim-P
UnitedHealthcare/UnitedHealthcare Plan of Ri GEC90096I 87726 Claim-I
UnitedHealthcare/UnitedHealthcare West (Unit GEC90096I 87726 Claim-I
UnitedHealthcare/UnitedHealthcare West (Unit GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/DEFLHILAMDMS GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/IA hawk-i (f GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/IA hawk-i (f GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/MS CHIP (for GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/MS CHIP (for GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/NE GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/NE GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/NE (formerly GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/NY (formerly GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/UnitedHealth GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/UnitedHealth GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/UnitedHealth GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/UnitedHealth GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan of Louisiana GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan of Louisiana GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/DEFLHILAMDMS GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/DEFLHILAMDMS GEC90096P 87726 Claim-P
UnitedHealthcare Community Plan/FLHILAMDMS C GEC90096I 87726 Claim-I
UnitedHealthcare Community Plan/FLHILAMDMS C GEC90096P 87726 Claim-P
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096P 87726 Claim-P
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096I 87726 Claim-I
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096I 87726 Claim-I
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096P 87726 Claim-P
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096P 87726 Claim-P
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096I 87726 Claim-I
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096I 87726 Claim-I
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096P 87726 Claim-P
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096I 87726 Claim-I
UnitedHealthcare Medicare Solutions/UnitedHe GEC90096P 87726 Claim-P
UnitedHealthcare West/formerly PacifiCare AZ GEC90096R 87726 Remit-I
UnitedHealthcare West/formerly PacifiCare AZ GEC90096R 87726 Remit-P
AARP Hospital Indemnity Plans insured by Uni GEC91607I 36273 Claim-I
AARP Hospital Indemnity Plans insured by Uni GEC91607P 36273 Claim-P
AARP Hospital Indemnity Plans insured by Uni GEC91607R 36273 Remit-I
AARP Hospital Indemnity Plans insured by Uni GEC91607R 36273 Remit-P
AARP Medicare Supplement Plans insured by Un GEC91607I 36273 Claim-I
AARP Medicare Supplement Plans insured by Un GEC91607P 36273 Claim-P
AARP Medicare Supplement Plans insured by Un GEC91607R 36273 Remit-I
AARP Medicare Supplement Plans insured by Un GEC91607R 36273 Remit-P
Optum ? Complex Medical Conditions (CMC) (fo GEC91313P 41194 Claim-P
Optum ? Complex Medical Conditions (CMC) (fo GEC91313I 41194 Claim-I
OptumHealth Care Solutions (formerly United GEC91313I 41194 Claim-I
OptumHealth Care Solutions (formerly United GEC91313P 41194 Claim-P
OptumHealth Care Solutions (formerly United GEC91313R 41194 Remit-I
OptumHealth Care Solutions (formerly United GEC91313R 41194 Remit-P
Health Plan of Nevada GEC91181R 76342 Remit-I
Health Plan of Nevada GEC91181P 76342 Claim-P
Health Plan of Nevada GEC91181R 76342 Remit-P
Health Plan of Nevada GEC91181I 76342 Claim-I
Sierra Health and Life GEC91181R 76342 Remit-I
Sierra Health and Life GEC91181I 76342 Claim-I
Sierra Health and Life GEC91181R 76342 Remit-P
Sierra Health and Life GEC91181P 76342 Claim-P
UMR GEC90526P 39026 Claim-P
UMR GEC90526I 39026 Claim-I
UMR (formerly UMR Wausau) GEC90526R 39026 Remit-P
UMR (formerly UMR Wausau) GEC90526R 39026 Remit-I
UnitedHealthcare/UHIS-UnitedHealth Integrate GEC90526I 39026 Claim-I
UnitedHealthcare/UHIS-UnitedHealth Integrate GEC90526P 39026 Claim-P
UnitedHealthCare/All Savers Alternate Fundin GEC90098I 81400 Claim-I
UnitedHealthCare/All Savers Alternate Fundin GEC90098P 81400 Claim-P
UnitedHealthcare/All Savers Insurance GEC90098R 81400 Remit-P
UnitedHealthOne/PacifiCare Life and Health I GEC90098I 81400 Claim-I
UnitedHealthOne/PacifiCare Life and Health I GEC90098P 81400 Claim-P
UnitedHealthOne/PacifiCare Life and Health I GEC90098R 81400 Remit-I
UnitedHealthOne/UnitedHealthcare Life Insura GEC90098R 81400 Remit-I
UnitedHealthcare West/UnitedHealthcare of CA GEC91030I 95959 Claim-I
UnitedHealthcare West/UnitedHealthcare of CA GEC91030P 95959 Claim-P
UnitedHealthcare West/UnitedHealthcare of CA GEC91030R 95959 Remit-P
UnitedHealthcare West/UnitedHealthcare of CA GEC91030R 95959 Remit-I
UnitedHealthcare Community Plan/AZ (formerly GEC90149I 03432 Claim-I
UnitedHealthcare Community Plan/AZ (formerly GEC90149R 03432 Remit-I
UnitedHealthcare Community Plan/AZ (formerly GEC90149R 03432 Remit-P
UnitedHealthcare Community Plan/AZ (formerly GEC90149P 03432 Claim-P
Neighborhood Health Partnership GEC90784R 95378 Remit-I
Neighborhood Health Partnership GEC90784R 95378 Remit-P
UnitedHealthcare/UnitedHealthcare Plan of Ri GEC90784I 95378 Claim-I
UnitedHealthcare/UnitedHealthcare Plan of Ri GEC90784P 95378 Claim-P
UnitedHealthcare Community Plan/IA hawk-i GEC90784R 95378 Remit-I
UnitedHealthcare Community Plan/IA hawk-i GEC90784R 95378 Remit-P
UnitedHealthcare Community Plan/IA hawk-i (f GEC90784P 95378 Claim-P
UnitedHealthcare Community Plan/IA hawk-i (f GEC90784I 95378 Claim-I
UnitedHealthcare Community Plan/MS CAN & CHI GEC90784R 95378 Remit-P
UnitedHealthcare Community Plan/MS CAN & CHI GEC90784R 95378 Remit-I
UnitedHealthcare Community Plan/MS CHIP (for GEC90784P 95378 Claim-P
UnitedHealthcare Community Plan/MS CHIP (for GEC90784I 95378 Claim-I
UnitedHealthcare Community Plan/TN GEC90784R 95378 Remit-I
UnitedHealthcare Community Plan/TN GEC90784R 95378 Remit-P
UnitedHealthcare Community Plan/TN (formerly GEC90784P 95378 Claim-P
UnitedHealthcare Community Plan/TN (formerly GEC90784I 95378 Claim-I
UnitedHealthcare Plan of the River Valley GEC90784R 95378 Remit-I
UnitedHealthcare Plan of the River Valley GEC90784R 95378 Remit-P
UnitedHealthcare Community Plan/MI (formerly GEC90614I 95467 Claim-I
UnitedHealthcare Community Plan/MI (formerly GEC90614P 95467 Claim-P
UnitedHealthcare Community Plan/MI (formerly GEC90614R 95467 Remit-I
UnitedHealthcare Community Plan/MI (formerly GEC90614R 95467 Remit-P
UnitedHealthcare Community Plan/NE GEC98662R UFNEP Remit-P
UnitedHealthcare Community Plan/NE GEC98662R UFNEP Remit-I
UnitedHealthcare Community Plan/NJ GEC90109I 86047 Claim-I
UnitedHealthcare Community Plan/NJ GEC90109P 86047 Claim-P
UnitedHealthcare Community Plan/NJ (formerly GEC90109R 86047 Remit-P
UnitedHealthcare Community Plan/NJ (formerly GEC90109R 86047 Remit-I
UnitedHealthcare Community Plan/NYU GEC92706R NYU01 Remit-I
UnitedHealthcare Community Plan/NYU GEC92706R NYU01 Remit-P
UnitedHealthcare Community Plan/TX GEC93800R TEX01 Remit-I
UnitedHealthcare Community Plan/TX GEC93800R TEX01 Remit-P
UnitedHealthcare Community Plan/WI GEC97345R WID01 Remit-P
UnitedHealthcare Community Plan/WI GEC97345R WID01 Remit-I
United Healthcare community Plan of Florida GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan/DE LA MD OH GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan/DE LA MD OH GEC93788R 04567 Remit-P
UnitedHealthcare Community Plan/DE MD OH PA GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan of Delaware GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan of Louisiana GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan of Louisiana GEC93788R 04567 Remit-P
UnitedHealthcare Community Plan of Maryland GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan of Pennsylva GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan of Washingto GEC93788R 04567 Remit-I
UnitedHealthcare Community Plan/KS (KanCare) GEC92420R 96385 Remit-I
UnitedHealthcare Community Plan/KS (KanCare) GEC92420I 96385 Claim-I
UnitedHealthcare Community Plan/KS (KanCare) GEC92420P 96385 Claim-P
UnitedHealthcare Community Plan/KS (KanCare) GEC92420R 96385 Remit-P
UnitedHealthcare Community Plan/MO GEC93623R 86050 Remit-I
UnitedHealthcare Community Plan/MO GEC93623R 86050 Remit-P
UnitedHealthcare Community Plan/MO GEC93623P 86050 Claim-P
UnitedHealthcare Community Plan/MO GEC93623I 86050 Claim-I
UnitedHealthcare StudentResources GEC90898I 74227 Claim-I
UnitedHealthcare StudentResources GEC90898P 74227 Claim-P
UnitedHealthcare StudentResources GEC90898R 74227 Remit-I
UnitedHealthcare StudentResources GEC90898R 74227 Remit-P
AARP MedicareComplete thru UnitedHealthcare/ GEC91025I 06111 Claim-I
AARP MedicareComplete thru UnitedHealthcare/ GEC91025P 06111 Claim-P
AARP MedicareComplete thru UnitedHealthcare/ GEC91025I 06111 Claim-I
AARP MedicareComplete thru UnitedHealthcare/ GEC91025P 06111 Claim-P
UnitedHealthcare (Oxford Health Plans) GEC91025R 06111 Remit-I
UnitedHealthcare (Oxford Health Plans) GEC91025R 06111 Remit-P
UnitedHealthcare/Oxford GEC91025I 06111 Claim-I
UnitedHealthcare/Oxford GEC91025P 06111 Claim-P
UnitedHealthOne/Golden Rule GEC90068I 37602 Claim-I
UnitedHealthOne/Golden Rule GEC90068P 37602 Claim-P
UnitedHealthOne/Golden Rule GEC90068R 37602 Remit-P
UnitedHealthOne/Golden Rule GEC90068R 37602 Remit-I

4/11/2026: Added the following payers to this list:
Harvard Pilgrim Health Care GEC00085R 04271 Remit-P moved to MAC1
Harvard Pilgrim Health Care GEC00085R 04271 Remit-I moved to MAC1
Harvard Pilgrim Health Care GEC00085P 04271 Claim-P
Harvard Pilgrim Health Care GEC00085I 04271 Claim-I
Bind (PreferredOne) GEC05908R 25463 Remit-I
Bind (PreferredOne) GEC05908R 25463 Remit-P
Bind (PreferredOne) GEC05908I 25463 Claim-I
Bind (PreferredOne) GEC05908P 25463 Claim-P
OptumHealth Physical Health GEC90088P 41161 Claim-P
OptumHealth Physical Health GEC90088I 41161 Claim-I
OptumHealth Physical Health GEC90088R 41161 Remit-P
OptumHealth Physical Health GEC90088R 41161 Remit-I
Preferred Care Partners Florida GEC91088P 65088 Claim-P
Preferred Care Partners Florida GEC91088I 65088 Claim-I
Preferred Care Partners GEC91088R 65088 Remit-P
Preferred Care Partners GEC91088R 65088 Remit-I
Sierra Health and Life GEC91181P 76342 Claim-P
Sierra Health and Life GEC91181I 76342 Claim-I
Sierra Health and Life GEC91181R 76342 Remit-P
Sierra Health and Life GEC91181R 76342 Remit-I
Medica Health Care Plan (Florida) GEC91569P 78857 Claim-P
Medica Health Care Plan (Florida) GEC91569I 78857 Claim-I
Medica HealthCare Plan (Florida) GEC91569R 78857 Remit-P
Medica HealthCare Plan (Florida) GEC91569R 78857 Remit-I
Medica (UHC) GEC90864P 94265 Claim-P
Medica (UHC) GEC90864I 94265 Claim-I
Medica (UHC) GEC90864R 94265 Remit-P
Medica (UHC) GEC90864R 94265 Remit-I
The Alliance GEC91944P 88461 Claim-P (ERA unavailable, sent from end payer)
The Alliance GEC91944I 88461 Claim-I (ERA unavailable, sent from end payer)
Optum Medical Network / AZ UT (formerly Lifeprint Network) GEC92227I LIFE1 Claim-I
Optum Medical Network / AZ UT (formerly Lifeprint Network) GEC92227P LIFE1 Claim-P
Optum Medical Network / AZ UT (VPay) GEC92227R LIFE1 Remit-P (ERA route unchanged)
Optum Medical Network / AZ UT (VPay) GEC92227R LIFE1 Remit-I (ERA route unchanged)
US Network and Administrative Services GEC06015P USN01 Claim-P
US Network and Administrative Services GEC06015I USN01 Claim-I
WellMed GEC92605I WELM2 Claim-I
WellMed GEC92605P WELM2 Claim-P
WellMed GEC92605R WELM2 Remit-P moved to OHC8
WellMed GEC92605R WELM2 Remit-I moved to OHC8
HealthSCOPE UMR GEC06086I 40026 Claim-I
HealthSCOPE UMR GEC06086P 40026 Claim-P
HealthSCOPE UMR GEC06086R 40026 Remit-P moved to OHC8
HealthSCOPE UMR GEC06086R 40026 Remit-I moved to OHC8
UnitedHealthcare/Spectera Eyecare Networks GEC92386P 00773 Claim-P
UnitedHealthcare/Spectera Eyecare Networks GEC92386R 00773 Remit-P

Update April 17, 9:15AM

Payer Mandate: Emblem Health (GHI- New York Group Health Inc.) (payer ID 13551)

athenaEDI will permanently move Emblem Health (GHI-New York Group Health Inc.) (payer ID 13551) to the well-established direct connection with Echo Health (OHC8) and will require an enrollment form. Please open a ticket with VOW Support so that we may provide you with the forms you will need.

Update April 16, 8:30AM

Rejections

athenaEDI has identified an alternate connection for the following impacted Payer IDs. Please reprocess the rejected claims.

35245 COC1 CONTINENTAL BENEFIT CB400 US53 – Office Ally 15-Apr
81883 COC1 MUNICIPAL HEALTH BENEFIT FUND M US53 – Office Ally 15-Apr
03036 MNC4 BLUE BENEFIT ADMINISTRATORS US53 – Office Ally 15-Apr
20172 COC1 SENIOR LIFE JOHNSTOWN US53 – Office Ally 15-Apr
88067 COC1 FIRST HEALTH US53 – Office Ally 15-Apr
37290 COC1 HEALTH SERVICES FOR CHILDREN W SP US53 – Office Ally 15-Apr
84131 COC1 DENVER HEALTH CHOICE MEDICARE US53 – Office Ally 15-Apr
81079 ILC5 MCR BAYCARE PLUS US53 – Office Ally 15-Apr
SX155 COC1 UNIVERSITY OF UTAH HEALTHPLAN UT US36 – Optum 5-Apr
84323 COC1 BANNER MCR ADV PRIME HMO US53 – Office Ally 12-Apr
80142 COC1 HEALTH PARTNERS MEDICARE US64 – Smart Data Solution 25-Mar
38259 COC1 SMART HEALTH US64 – Smart Data Solution 29-Mar
00046 COC1 HILL PHYS CIGNA US53 – Office Ally 28-Mar
58234 COC1 ALLIANT HEALTH PLANS OF GEORGIA US53 – Office Ally 12-Apr
35162 COC1 AUTOMATED GRP SIGNATURE CARE 210 US53 – Office Ally 12-Apr
94320 COC1 KAISER PERMANENTE US53 – Office Ally 12-Apr
12X42 COC1 AARP MED CMPLTE BANNER NETWORK US40 – SSI ClaimsNet 11-Apr
99660 COC1 FRESNO PACE US64 – Smart Data Solution 29-Mar
59144 COC1 CULINARY HEALTH FUND US53 – Office Ally 12-Apr
62179 COC1 HEALTH CHOICE MCD 52033 US53 – Office Ally 12-Apr
56089 COC1 TRILLIUM HEALTH RESOURCES MCD US53 – Office Ally 12-Apr
34158 COC1 OHIO HEALTHY 2022 CLAIMS US53 – Office Ally 12-Apr
75130 COC1 LOCAL COUNTY INDIGENT US53 – Office Ally 12-Apr
84133 COC1 DENVER HEALTH US53 – Office Ally 12-Apr

Update April 15, 5PM

Alternate Payer Route List

Please use this link to download the current Alternate Payer Route List – Alternate Payer Route List April 15

Update April 15, 5PM

Payer Mandate: Cigna

Cigna ERA’s have been moved to an alternate route and will require an enrollment form. Please open a ticket with VOW Support so that we may provide you with the forms you will need.

Update April 11, 4:45pm

Payer Mandate: Medicare Railroad

On April 18^th Railroad Medicare will move to a new route. Enrollments for both Claims and Remittances are required. Please open a ticket with VOW Support so that we may provide you with the forms you will need.

Update April 11, 9am

Payer Mandate: HealthFirst Health Place

Effective immediately, athenaEDI permanently moved HealthFirst Health Plan (Payer ID 80141) claims and ERA to US60 Availity. There is no enrollment needed for claims, but please create a support ticket if you need to enroll for era’s.

Update April 10, 9AM

Alternate Payer Route List

Please use this link to download the current Alternate Payer Route List – Alternate Payer Route List April 10

Update April 9, 5:21PM

Payer Mandate: Tricare East Claims

If you have submitted claims to Tricare East, there is a new enrollment that will need to be completed due to the new routes. Please open a ticket with app support and indicate you would like the Tricare East Claim Enrollment Form. The form will be generated for you and then emailed to you with the instructions on how to complete it.

Update April 9, 2024 5:19PM

Payer Mandate: UHC (multiple payer id’s) moved permanently to US36 Optum

Effective immediately, athenaEDI permanently moved UHC (all payer id’s) claims and ERA to US36 Optum. Review the list below and provide the 5 digit payer ID. If you were receiving era’s prior to the CHC incident, you will need to enroll again to obtain the 835’s. Please open a ticket with VOW Support so that we can provide you the correct enrollment form. Review the list below and provide the 5 digit payer ID to VOW Support to obtain the correct enrollment form.

Section Last update March 8, 10:13am ET.

What happened?
On Wednesday, February 21, we were made aware that Change Healthcare (a subsidiary of Optum), experienced a cybersecurity event (cyberattack). As of this the posting of this FAQ, Change Healthcare has confirmed its Medical Network and Medical Network API systems are unavailable.

When did the security incident happen?
Change Healthcare identified the attack very early on Wednesday, February 21, 2024, and shut down systems at about 5am EST.

What type of cyberattack took place?
Change Healthcare has reported to partners and the media that they experienced a sophisticated cyberattack that is consistent with state-sponsored cyberterrorism. The ransomware that caused the incident has been reported by news media as ALPHV BlackCat.

What Change Healthcare systems were impacted by the cyberattack?
Change Healthcare indicated the attack directly impacted its “internal systems.” We’re told the production systems were not directly impacted, but connections were shut down out of an abundance of caution.

Where is the best place to stay informed?
You can subscribe to status updates on Optum’s website – Click Here to subscribe.

What is the relationship between Change Healthcare, UnitedHealth, and Optum?
UnitedHealth Group and its subsidiary, Optum, acquired Change Healthcare when it was a separate company in a deal that was closed in 2022. Change Healthcare is now part of Optum, the health services division of Minnesota-based UnitedHealth.

Change Healthcare is owned by Optum, which is a subsidiary of UnitedHealth Group. Were any Optum or UnitedHealth systems impacted?
From the Change Healthcare status page: “We have a high-level of confidence that Optum, UnitedHealthcare and UnitedHealth Group systems have not been affected by this issue.” Source: Optum Solutions Status – Update: Some applications are experiencing connectivity issues.

Was any patient data (PHI) exposed in the attack?
Change Healthcare indicated that it is too early in the investigation to say whether any PHI was exposed in this attack. Change Healthcare has assured us that it will provide an assessment as soon as possible.

What is Change Healthcare doing to remediate this incident?
UnitedHealth Group has assembled “three of the best security forensics companies in the world” to help its internal experts diagnose the issue, determine scope of the impact, remediate the incident, and provide an impact report to customers, including athenahealth. UnitedHealth has assured us that it has all available resources working 24 hours a day (in two 12-hour shifts) until remediation is complete.

Is there any risk to athenahealth servers and databases?
There is no VPN or other continuous connection between athenahealth and Change Healthcare, and any data that is exchanged between the two platforms is pushed or pulled. Change Healthcare has no mechanism to push data into the athenaPractice solution. Also, Change Healthcare shut down all services as soon as the attack was identified, which minimized the interaction with Change Healthcare after the incident took place.

What is athenaFlex?
athenaFlex is the name of the product suite that includes athenaPractice™, athenaFlow™ (EMR), and athenaEDI™.

What services are impacted (such as claim submissions, EDIs, ERAs)?
See the Change Healthcare status page. The main areas of interest for our customers are Medical Network and Medical Network APIs.

What athenaPractice services are impacted (such as claim submissions, EDIs, ERAs)?

Practice Management Services

Eligibility
Claims and Claim Attachments
ERAs (electronic remittance advice)
Claim Status
ExpressBill Statements

E-Prescribing Services

The SureScripts reported outage due to Change Healthcare Pharmacy Connectivity Issue which began on 02/21/2024 has been resolved as of 3/4/24. All prescribers can resume normal e-Prescribing and EPCS workflows in accordance with your system configuration.

You may continue to receive the following error code when prescribing controlled substances.

Error 202-02-2999 could occur for one of the following reasons:

The Action dropdown field in the prescription’s sig is blank. Edit the prescription sig to include ‘Take’ in the Action dropdown and attempt to send prescription again.
An invalid character in the patient’s demographics, such as an ~ over an n. Access the affected patient’s Registration Patient demographics data and review for any special characters in any of the fields. Delete any special characters found and attempt to send prescription again.

Have any claims been submitted to Change Healthcare since the start of the incident?
The Change Healthcare claim submission services have been shut down. It is not possible to submit claims since then.

Claims – athenaEDI
Starting Tuesday, 3/1/24, athenaEDI began turning on alternative EDI pathways to transmit claims to payers, so they are beginning to submit to payers via connections that were previously stalled. This will continue over the next several days as we activate additional connections. For a minority of the claims that historically have been transmitted by Change Healthcare, athenaEDI has not yet found an alternative electronic pathway. They continue to explore options, often directly with payers. You also can find more information on the Success Community.

Do not change your payer ID numbers. Continue to send claims to those carriers that have been updated.

Claims – RelayHealth – UPDATED
Any practices that utilize RelayHealth to process claims currently are unable to process claims because RelayHealth is Change Healthcare. Change Healthcare expects to begin testing and reestablish connectivity to their claims network and software the week of March 18, restoring service through that week. Your options are to wait out the outage or switch clearinghouses which could take 4 to 6 weeks.

Claims – Etactics
Practices using Etactics can log into their online portal account to see any updates. Any payers that would allow for a direct submission have been fixed and re-directed to the payer. When you log in, you will see the payers that have been redirected and Change Healthcare updates.

Pending Claims – athenaEDI
Throughout the week of 2/26/24, athenaEDI has configured alternate payer routes for claims pending Change Healthcare processing. athenaEDI will be implementing claim reprocessing to address the claim files which are currently queued. This began Friday, March 1st, in the afternoon.

athenaEDI will reprocess files in date order beginning with files from February 21, the beginning of the Change Healthcare downtime.

Claims, where a new connection is now available, will be redirected.

Payers which have not been identified to have an alternate connection will continue to show a Pending status. The team continues to analyze options to address these pending payers.

VOW has emailed the latest list of claim and eligibility carriers that have been moved to direct routes bypassing Change Healthcare. You also can find more information on the Success Community.

Pending Claims – RelayHealth – UPDATED
Unfortunately, we have not received any information as to how RelayHealth is going to handle Pending claims. Although, Change Healthcare expects to begin testing and reestablish connectivity to their claims network and software the week of March 18, restoring service through that week.

Remits / ERAs
Currently this is still a manual process. You can download your ERAs from the carrier sites and post manually until other options are made available or the outage is resolved.

Statements – ExpressBill
Practices using ExpressBill to run their statements are unable to send electronic statements at this time. You do have the ability to print paper statements and mail them. Another option would be to change your statement vendor. Our other two partners we work with do not utilize Change Healthcare and are able to send electronic statements. However, this option could take a few weeks to implement.

Was there any impact to PHI? If so, how do I know if my practice or patients were impacted?
This question comes up on every security call. Change Healthcare is not prepared to answer this question yet, but the company has assured us that we will be notified as soon as there is enough forensic evidence to provide a clear and accurate answer.

What is the expected resolution date?
Change Healthcare has not yet provided an expected resolution time or date. athena maintains regular communication with Change Healthcare and holds daily meetings to ensure we have up-to-date information and to facilitate a smooth and efficient resumption of services as they become available.

Is my data secure?
For our Hosted Customers, the answer is Yes! For our customers in our hosting environment, we have taken all the necessary precautions in protecting our customers’ data. We have regularly scheduled maintenance to update all systems and software with the required security patches. We implemented Geo-blocking to eliminate IP addresses from outside the country and we instituted Two-factor authentication (2FA) for all internal password changes just to name a few. We will continue to make additional updates as necessary whenever a threat is identified, and we are following the Change Healthcare situation closely.

For our Non-Hosted or On-Prem customers or customers hosted elsewhere, Please check with your IT Department/company or hosted company to see what steps they have taken to secure your network and data.

Is the data coming back to my system from Change Healthcare safe?
Change Healthcare leadership has indicated that no systems will be turned back on until they can be absolutely sure there is no risk to practices and partners.

What should we do now?

Are carriers accepting paper submissions?
Please reach out to your carriers for more information on if and how they accept paper claims.

Are there alternatives to Change Healthcare or alternate options to submit claims?
Starting Tuesday, 3/1/24, athenaEDI began turning on alternative EDI pathways to transmit claims to payers, so they are beginning to submit to payers via connections that were previously stalled. This will continue over the next several days as we activate additional connections. For a minority of the claims that historically have been transmitted by Change Healthcare, we have not yet found an alternative electronic pathway. We continue to explore options, often directly with payers. You also can find more information on the Success Community.

Has Change Healthcare provided the priority it will use to restore services? In what order will services be restored?
Change Healthcare senior leaders have indicated that dedicated teams are working on all systems in parallel. This means that individual services can be restored at any time as soon as they are tested and deemed safe. However, Change Healthcare is placing the highest priority on services like
e-Prescribing that have direct impact on patient safety. Next in order are services that have a significant impact on revenue, like claims and preauthorization.

What will happen when services are restored?

What can I expect when Change Healthcare services are restored?
athenahealth expects that as services are restored, their systems will start processing the backlog of EDI transactions. Some delays can be expected.

Will Change Healthcare and athenahealth be able to handle the large volume of claims being processed when services are restored?
Some delays can be expected.

What will happen with Eligibility and Claims Status Inquiries once services are restored?
Eligibility requests will continue to generate for new appointments based on your system default setting.

NOTE: Responses will not be received until services are back up and running.