Senior Whole Health LLC
April 5, 2024
Optum-Change Healthcare outage
Senior Whole Health, LLC (SWH) is advising our providers of a critical outage of our third-party vendor, Optum-Change Healthcare (CHC), resulting in impacts to Electronic Claims Submission, Payment and Settlement Services.
Status Update
Provider payments
As of April 4, 2024, SWH transitioned its direct connection with ECHO (an Optum-CHC partner). SWH has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received.
835 Electronic Remittance Advice files and Explanation of Payment
835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will continue to be available on providerpayments.com. These files have returned to pre-outage layouts and formats.
Electronic claims submission
As of the 4/4/24 updates, electronic claims submissions continue to follow our alternate process, as SWH has not reconnected to CHC for any EDI clearinghouse services nor established connectivity to any of CHC's affiliate clearinghouses (iEDI/Relay) at this time.
Contact Us
SWH has established a dedicated contact center to assist providers impacted by the CHC outage. Agents can assist with claim(s) submission, emergency financial assistance requests, or other concerns related to the CHC outage. The contact center is available Monday-Friday from 5:00AM PST to 6:30PM PST.
The contact center number is (844) 548-7684.
Reminders
Claims submission
As previously communicated, providers utilizing CHC to submit claims to SWH prior to this outage may do so via our alternate established connection with SSI Claimsnet, LLC (“SSI Group”)* clearinghouse or another clearinghouse of their choice. Providers not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission. Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key in claims for submission.
https://www.availity.com/availity-lifeline-self-serve-resources
https://www.availity.com/documents/learning/QSG_Atypical_Registration.pdf
During this transition, we encourage all our providers submitting paper claims to explore our electronic submission options.
For those providers who have submitted electronic claims to SWH via a clearinghouse on or after 2/21/2024 and have not received acknowledgment from SWH of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to any providers submitting directly to SSI Group, UHIN, TMHP, COBA, Ohio Medicaid Enterprise System (OMES) or via our Availity portal solution.
Eligibility Verification
SWH has reestablished member eligibility verification (270/271) services using SSI Group, our alternate clearinghouse. In addition to online verification with SSI Group, eligibility verification continues to be available via the Availity Essentials portal, the SWH Contact Center and IVR. SWH’s member eligibility continues to be updated timely.
Questions?
We understand that the CHC outage can disrupt you and your practice. SWH is in regular contact with CHC, ECHO, SSI Group and Availity Essentials to help mitigate this outage, and we will continue to update our provider community regarding this situation. We appreciate your patience and understanding during this unprecedented time of disruption. Thank you for your continued partnership.
See list of additional FAQs here
All questions should be directed to SWH’s provider contact center or your local Provider Services representative. Click here to visit the contact page.