Resource Center

Electronic Claims

Supported Clearing Houses

Charm is integrated with two clearing houses, viz., "Optum 360" and "Change Healthcare (Emdeon)". Both these clearing houses support about 2500 payers each. This covers most of the payers that practices work with. Before choosing your favorite clearing house, check out their supported payer list and their pricing.

Supported Payer List

OPTUM

Real time Eligibility https://iedi.optum.com/iedi/enspublic/Download/Payerlists/OptumInsight%20RT%20Eligibility%20Payer%20List.pdf
Electronic Claim Submission (Professional) https://iedi.optum.com/iedi/enspublic/Download/Payerlists/Medicalpayerlist.pdf
Electronic Remittance Advice (ERA) https://iedi.optum.com/iedi/enspublic/Download/Payerlists/ERAPayerlist.pdf

Alternatively, you can access the payers' list in excel format from the below URL. Scroll to the bottom of the page where you will find all the supported payers list in Excel format https://www.optum.com/business/solutions/provider/claims-management-strategy/edi/intelligent-edi.html

Change Healthcare (Emdeon)

Real time Eligibility http://s3-us-west-2.amazonaws.com/media.capario.com/documents/Capario_Real_Time_Payer_List.pdf
Electronic Claim Submission (Professional) and Electronic Remittance Advice (ERA) http://s3-us-west-2.amazonaws.com/media.capario.com/documents/Capario_Claims_and_ERA_Payer_List.pdf

You can access the Payer List home page from the URL given below https://support.changehealthcare.com/customer-resources/payer-lists/revenue-performance-advisor-payer-list

Enrollments

Practice needs to do ERA enrollment with the payers to get the ERAs to the clearinghouse account automatically. A few payers require enrollment to use Eligibility and for Electronic claim Submission as well.

How to check which payer requires enrollment?

OPTUM

To get the complete list of payers that needs enrollment, one should check the 'Enrollment' column in the appropriate payer list. When Enrollment is 'TRUE', it denotes that the payer requires enrollment. Refer to the screenshot from the Optum payer list.

(i) Eligibility Enquiry:
A few payers that need enrollment to do eligibility checks are:

  • Medicare and Medicaid plans
  • Some commercial payers such as a) Kaiser Permanente Northern CA, b) Michigan Blue Cross Blue Shield

Eligibiilty Enquiry for Optum

(ii) Electronic Claim Submission (LOB - Professional)
A few payers that need enrollment for electronic claim submission are:

  • All Medicare and Medicaid plans
  • Majority of Blue Cross/Shield plans
  • Avalon Healthcare Solutions North Carolina
  • Beacon Health Option
  • Health West / CHP

Electronic Claim Submission (LOB - Professional)

 

Change Healthcare (Emdeon)

(i) Eligibility Enquiry:
Eligibiilty Enquiry for Change Healthcare

(ii) Electronic Claim Submission (LOB - Professional)
Electronic Claim Submission (LOB - Professional)

Clearing House Charges

OPTUM

Transaction Based:

  • 1-150 transactions: $40 per month minimum fee
  • 151-4500 transactions: $0.25 additional per transaction
  • 4501 transactions: $0.2 additional per transaction

Provider Based: $99/provider/month

Practices will have a direct contract with Optum. Optum will bill the practice.

Change Healthcare (Emdeon)

  • Provider Based: $79/month/provider

Practices will be charged $79/month/provider. Charm will bill the customer once the account is set up.