Five weeks into the Change Healthcare outage, the decision has changed shape. Optum said on March 7 that it expected to begin testing and reconnecting its claims network the week of March 18, and connections have been coming back since then, payer by payer and vendor by vendor. Practices that moved to a new clearinghouse in early March now have two working routes and a choice. Practices that waited have a restored route and a memory. Both groups are asking us the same question: should we switch, switch back, or keep both?
We have moved practices between clearinghouses many times, in calmer conditions than these. The mechanics are not hard. The time is in payer enrollment, and the mistakes are in the details nobody thinks about until a claim rejects. Here is the whole process, followed by our honest view on when switching is the wrong decision.
Key takeaways
- A clearinghouse migration is mostly payer enrollment: Medicare EDI, Medicaid trading partner agreements and ERA redirection for every payer, each on its own clock.
- ERA enrollment is the step that gets skipped. Claims enrollment gets you paid; ERA enrollment gets payments posted.
- Payer IDs are assigned by each clearinghouse. Every plan record in your practice management system needs checking before the first batch.
- Run both routes for at least two weeks and reconcile every claim to an acknowledgement before closing the old account.
- Do not switch in anger. The right outcome of this outage is two enrolled routes and a written switch procedure, not a new single point of failure.
What a clearinghouse migration actually involves
| Step | Typical time | What goes wrong |
|---|---|---|
| Contract and account setup with the new clearinghouse | 1 to 5 days | Per-claim pricing that excludes ERA, eligibility or statements; auto-renewal terms |
| Practice management system connection (SFTP or API, file format, response file mapping) | 3 to 10 days | PM vendor charges a setup fee or supports only one clearinghouse |
| Medicare EDI enrollment with your MAC (submitter ID, 837 and 835 authorization) | Normally 2 to 4 weeks; MACs are expediting during the outage | Forms signed by someone who is not the authorized official; PTAN and NPI mismatch |
| Medicaid trading partner agreement and enrollment | 2 to 6 weeks depending on the state | Separate enrollment for each Medicaid managed care plan |
| Commercial payer claims enrollment | Many payers require none; some require a form per TIN | Payer IDs differ between clearinghouses and must be remapped |
| ERA (835) enrollment per payer | 1 to 6 weeks per payer | The old clearinghouse keeps receiving your ERAs until each payer is redirected; auto-posting stops |
| Test batch and first live batch | 2 to 5 days | Rejections for missing taxonomy, wrong payer ID or address formatting on the new edit set |
The step everyone underestimates is ERA redirection. Claims enrollment gets the practice paid. ERA enrollment gets the payments posted. A practice that switches claims routes in a week and forgets ERA will spend the next two months posting manually from portals while remittances pile up at the old vendor. Enroll ERA with the top ten payers on the same day you enroll claims, and keep access to the old clearinghouse's ERA files until every payer has redirected.
What a clean cutover looks like, week by week
For a practice that has decided to move, here is the sequence we follow. The dates assume the new clearinghouse contract is signed on a Monday and the MAC is expediting.
- Week 1. Sign the contract. Submit Medicare EDI enrollment the same day, with the authorized official's signature checked against the PECOS record. Submit Medicaid trading partner paperwork. Export the plan table from the PM system and start the payer ID remap. Ask the PM vendor for the connection setup and the file format specification.
- Week 2. Complete the PM connection and send a test batch of five to ten claims to a commercial payer that requires no enrollment. Work the rejections; expect them. Submit ERA enrollment for the top ten payers, and keep the old clearinghouse's ERA access alive.
- Week 3. Medicare EDI approval arrives if the MAC is moving quickly. Send the first live Medicare batch. Move commercial claims to the new route in full. Continue receiving acknowledgements and ERAs from the old route for claims in flight.
- Weeks 4 to 6. Medicaid and managed care approvals trickle in; move each payer as it is approved. Watch ERA redirection payer by payer; when a payer's 835 arrives at the new route, mark it done. Reconcile daily.
- Week 7 or later. When the old route has been silent for two weeks, close it, keeping any ERA archives you may need for posting or audits.
Payer IDs are not universal
Each clearinghouse assigns its own payer ID list. Aetna might be one five-character code at the old vendor and a different code at the new one. When you switch, every insurance plan record in your practice management system needs its payer ID checked against the new clearinghouse's list. Practices with 200 plan records find this out one rejection at a time unless someone does it as a project first. Export the plan table, match it to the new list, fix the exceptions, then send the first batch.
A tip from experience: sort the exported plan table by claim volume in the last twelve months and fix the top 40 first. In most practices those 40 plans carry more than 90 percent of claims. The long tail of plans with two claims a year can be fixed as they reject.
Dual running
For at least the first two weeks, run both routes. Send new claims through the new clearinghouse, but keep the old connection alive to receive acknowledgements, rejections and ERAs for claims already in flight. Reconcile daily: every claim sent has an acknowledgement from one route or the other, or it is resent. Only when the old route has gone quiet for two weeks do you close it. Practices that cut over on a Friday and cancel the old account on Monday spend the next month asking payers whether claims arrived.
The edit set will be different
Clearinghouses apply their own front-end edits before claims reach the payer. A claim that sailed through the old vendor for years may reject at the new one for a rendering provider taxonomy code, a nine-digit ZIP, or a diagnosis pointer format. Expect a rejection rate of several percent in the first week and assign one person to work the rejection report twice a day until it settles. This is not a sign the new vendor is worse; it is a different set of rules and it usually catches things the payer would have denied later.
When switching is the wrong call
Here is where we disagree with the mood in a lot of practice manager groups this month. Switching clearinghouses is a project, and doing it in anger has a cost. We think a practice should not switch, or should not switch back, in these situations:
- Your practice management system only supports one clearinghouse. Some do. If the vendor's integrated clearinghouse is the only option without a system change, the real decision is about the PM system, and that is not a March decision.
- You switched three weeks ago and it is working. The enrollment pain is behind you. Switching back to the restored vendor means repeating every step, including ERA redirection. Stay, and keep the old account as your secondary.
- Your contract has an exit fee or a long notice period. Read it before announcing anything. Some agreements require 90 days of notice; the outage may or may not count as a breach, and that is a question for counsel, not for the billing office.
- The main reason is anger. Any clearinghouse can be attacked. The right response to this month is a secondary route, tested quarterly, not a vendor change followed by the same single point of failure with a different logo.
The better outcome: two routes
The practices that will come out of this outage in the best shape are the ones that end up with two enrolled clearinghouses, one primary and one secondary, and a written switch procedure. The secondary costs a small monthly fee and a quarterly test batch of a few claims to Medicare and the top payers. It is the cheapest insurance in the revenue cycle. If you did the enrollment work in March, do not throw it away by cancelling one account in April.
Questions we hear
Will payers reprocess claims that were rejected for timely filing during the outage?
Many have said they will, on request and with documentation; some have said nothing. Keep your outage log and appeal each one with it. Do not batch-appeal without checking each payer's stated policy.
Should we reconnect to Change Healthcare at all?
That is a security question before it is a billing question. Ask your PM vendor what assurances they have received about the restored connection and whether they have completed their own review. Many practices will reconnect because their vendor gives them no alternative; if that is you, keep the secondary route you built and make sure the practice's own systems have current patches and multifactor authentication. The outage was at the vendor, but the phishing that follows it will be aimed at you.
Does switching clearinghouses affect our payer contracts or credentialing?
No. Enrollment for electronic transactions is separate from network participation. Your credentialing status is unchanged; only the EDI paperwork moves. The Revelrex billing team manages clearinghouse enrollment for the practices we serve, and the RCM audit includes a review of submission routes and ERA coverage by payer.
What to do this month
- Confirm with your PM vendor which connections are restored and which are still pending, in writing.
- Reconcile every claim sent since February 21 against a payer acknowledgement. Anything without one gets resent through a working route this week.
- If you enrolled with a second clearinghouse, finish ERA enrollment for the top ten payers and decide which route is primary.
- Export your plan table and verify payer IDs against the clearinghouse you are actually using, top 40 plans first.
- Write the switch procedure down while the details are fresh: who calls whom, which forms, which payers require what.
- Schedule the first quarterly test batch through the secondary route for June.
