The U.S. healthcare industry is regulated under mandates established by the U.S. Department of Health & Human Services (HSS) and Office of Civil Rights (OCR) resulting principally from the Health Insurance Portability and Accountability Act (HIPAA) and administrative simplification provisions of the Affordable Care Act (ACA) and other regulating entities and mandates.
To demonstrate our continued commitment to assure that applicable Change Healthcare products and services meet industry and regulatory requirements and expectations, we maintain the following industry recognized and trusted accreditations and certifications:
CAQH certifies and awards CORE Certification Seals to entities that create, transmit or use the administrative transactions addressed by applicable Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product is operating in conformance with a specific phase(s) of the Operating Rules.
Change Healthcare is CAQH CORE Phase I, II, and III certified demonstrating that our associated IT systems and products are operating in conformance with effective standards and operating rules.
The CAQH link to our certification status can be found at http://www.caqh.org/core/core-certified-organizations-pending-and-current within the Clearinghouses and Vendors tabs.
Additional information regarding the Operating Rules for HIPAA transactions can be found on the Change Healthcare HIPAASimplified.com website.
ONC Certification Information: Certification details for Change Healthcare's 2015 Edition Certified products.
These Health IT Modules are 2015 Edition compliant and have been certified by an ONC‐ACB in accordance with the applicable certification criteria adopted by the Secretary of the U.S. Department of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services.
|Developer||Change Healthcare, LLC (formerly Emdeon)|
|Date Certified||April 15, 2018|
|Product Name and Version||Clinical Exchange, Version 9.1|
|Unique Certification Number||15.04.04.3017.Clin.09.00.0.180415|
|Certification criteria to which the product has been certified||170.315(a)(1-4, 7, 8,10,11); 170.315(b)(3); 170.315(d)(1-8, 11); 170.315(g)(1, 3-5)|
|CQM's to which the product has been certified||None|
|Additional Software Used||None|
|Mandatory Disclosure||Mandatory Disclosure Statement|
|Date Certified||November 22, 2019|
|Product Name and Version||Clinical Exchange Communicator Version 19|
|Unique Certification Number||15.04.04.3017.Comm.19.00.1.191122|
|Certification criteria to which the product has been certified||170.315(a)(13); 170.315(d)(1,2,3,5,6,7, 9); 170.315(e)(1,2,3); 170.315(g)(1, 4-6)|
|CQM's to which the product has been certified||None|
|Additional Software Used||Refer to ONC CHPL listing|
|Mandatory Disclosure||Mandatory Disclosure Statement|
|ONC Certified Health IT Product Listing||https://chpl.healthit.gov/#/listing/10185|
Change Healthcare is EHNAC HNAP-EHN accredited.
The Electronic Healthcare Network Accreditation Commission (EHNAC) is a federally-recognized, standards development organization and tax-exempt, 501(c)(6) non-profit accrediting body designed to improve transactional quality, operational efficiency and data security in healthcare.
EHNAC indicates the following compliance benefits associated with accreditation:
EHNAC’s Healthcare Network Accreditation Program (HNAP) Electronic Health Network (EHN) assessment and review covers five main categories of criteria:
EHNAC requires that organizations complete the program every two years to maintain accreditation which includes a detailed criteria based assessment and EHNAC audit and site reviews. Change Healthcare has maintained our EHNAC Electronic Health Network accreditation since 2001.
Change Healthcare Certificate of Accreditation
Change Healthcare has earned HITRUST CSF® Certification status for the solutions listed below, and is currently working to achieve HITRUST Certified status for additional solutions in our portfolio.
Why is HITRUST Certification Important?
Change Healthcare Solutions that have achieved HITRUST CSF Certification include:
|Change Healthcare Solution Name||Formerly Known As|
|Clinical Abstraction||Altegra Health Analytics Chart Complete - Abstractions & Chart Reviews|
|Medical Record Retrieval||Altegra Health Chart Complete - Abstractions & Chart Reviews|
|Clinical Care Visits||Altegra Health Home Assessments|
|EMR Risk Advisor||Altegra Health Enterprise Risk|
|Quality Performance Advisor™||Altegra Health HEDISmart|
|RADV & Validation Audits||Altegra Health Initial Validation Auditor (IVA)|
|RADV & Validation Audits||Altegra Health Medicare RADV & Validation Audits|
|Dual Enrollment Advocate™||Altegra Health Dual Eligible Enrollment Assistance, Medicare Savings Complete|
|Part D Complete||Altegra Health Part D Assists|
|Quality Performance Advisor™||Altegra Health Quality Performance Reporting|
|Recert Complete®||Altegra Health Medicaid Recertification|
|Risk View™||Altegra Health Risk Analytics|
|My Advocate™||Altegra MyAdvocate Automated Communication Programs|
|Risk Adjustment Coding||Altegra MyAdvocate Chart Retrieval & Risk Adjustment Coding|
|Community Advocate™||Altegra MyAdvocate Community Link|
|Smart Appointment Scheduling||Altegra MyAdvocate Provider Appointment Scheduling Assistance|
|Patient Access Advisor||Assistant Patient Access Advisor|
|Advanced Claiming||Assistant Referrals and Authorizations Network|
|Office||Change Healthcare Office Emdeon Office Portal|
|Claims and Denials Advisor||Claims & Denials Advisor|
|Claiming and Remittance||Claims & Remittance Network|
|Accupost||Claims & Remittance Network|
|Clinical Exchange ePrescribe||Clinician|
|Clinical Exchange EPCS||EPCS|
|Encounters & Claims Submissions - EDGE Complete™||CMS Services EDGE Complete|
|Encounters & Claims Submissions - Encounter Complete®||CMS Services Encounters & Claim Submissions|
|Eligibility and Enrollment Advocate - Financial Counseling||Coverage Discovery Solutions Financial Counseling|
|Eligibility and Enrollment Advocate - Self Pay Coverage||Coverage Discovery Solutions Self Pay Coverage Advocate|
|SSI Enrollment Advocate||Coverage Discovery Solutions SSI Advocate|
|Eligibility and Enrollment Advocate - Third Party Coverage||Coverage Discovery Solutions Third Party Coverage Advocate|
|Coding Advisor||Customer Portal Products Coding Advisor|
|Eligibility & Patient Access||Customer Portal Products Eligibility & Benefits Verification Network|
|Dental EDI Network||Dental Connect, Dental Network|
|Dental Network||Dental Connect|
|Process and System Modernization||HTMS Consulting Services Business Transformation and Optimization|
|Analytics and Insights||HTMS Consulting Services Analytics & Insights|
|Government Programs||HTMS Consulting Services Government Programs|
|Population Health||HTMS Consulting Services Population Health Advisor|
|Healthcare Consumerism||HTMS Consulting Services Retail Transformation|
|Member Correspondence Advocate||Member Correspondence Advocate Multi-Channel Distribution System|
|Integrated Repricing Network||Payment Accuracy Insight Integrated Repricing Network|
|Audit & Recovery||Payment Accuracy Audit & Recovery|
|Pre-Payment Insight & Review||Payment Accuracy Insight|
|Authorization Advocate||Pharmacy Benefits Mgmt Systems Authorization Advocate|
|Pharmacy Claim Advisor||Pharmacy Benefits Mgmt Systems Pharmacy Claim Advisor|
|Rebate Insight™||Pharmacy Benefits Mgmt Systems Rebate Insight|
|Rx Care Advisor||Pharmacy Benefits Mgmt Systems Rx Care Advisor|
|MedRx™||Pharmacy Network & Services MedRx Network|
|Smart Commercial Pharmacy Services™||Pharmacy Network & Services Smart PBA|
|SmartPay™||Receivables Advisor - Member Payment Advocate|
|Payment Network Advocate||Receivables Advisor - Payment Network Advocate|
|Patient Billing & Statements||Member Payment Advocate - Patient Billing & Statements|
|A/R Recovery||RCM / Revenue Optimization - A/R Recovery|
|Charge Insight||RCM / Revenue Optimization Charge Insight|
|Class Action Settlement Recovery||RCM / Revenue Optimization - Class Action Settlement Recovery|
|Coverage Insight||RCM / Revenue Optimization - Coverage Insight|
|Denials and Appeals Management||RCM / Revenue Optimization - Denials & Appeals Management|
|Patient Financial Insight||RCM / Revenue Optimization - Patient Financial Insight|
|Payment Automation||RCM / Revenue Optimization - Remittance Advisor|
|Retro MVA Recovery||RCM / Revenue Optimization - Retro MVA Recovery|
|Settlement Advocate||RCM / Revenue Optimization - Settlement Advocate|
|RCM / Revenue Optimization - Third Party Advocate||RCM / Revenue Optimization - Third Party Advocate|
|RCM / Revenue Optimization - Underpayment Audit & Recovery||RCM / Revenue Optimization - Underpayment Audit & Recovery|
|Revenue Network/Revenue Performance - Revenue Network||Revenue Network/Revenue Performance - Revenue Network|
|Revenue Performance Advisor||Revenue Network/Revenue Performance - Revenue Performance Advisor|
|True View™||TrueView - Engagement Solutions True View Healthcare Shopping|
As a trusted industry leader and in support of our commitment to compliance, Change Healthcare volunteered and was selected to participate in the U.S. Department of Health & Human Services (HHS) Administrative Simplification Optimization Program pilot. The program comprises a formal assessment by the Division of National Standards (DNS) within the Centers for Medicare & Medicaid Services (CMS) to review compliance with federally mandated transaction standards, code sets, unique identifiers, and operating rules.
Change Healthcare is one of the first organizations certified by the DNS demonstrating that our Medical, Hospital, and Dental Exchange batch and real-time services and solutions have been reviewed for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations and Affordable Care Act (ACA) Operating Rule provisions.
Change Healthcare is a Maryland Healthcare Commission (MHCC) certified Electronic Health Network (EHN).
The Maryland Health Care Commission is an independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access in a rapidly changing health care environment by providing timely and accurate information on availability, cost, and quality of services to policy makers, purchasers, providers and the public.
The Maryland Health Care Commission certifies Electronic Healthcare Networks that meet national standards for security, business processes, technical performance, privacy and confidentiality when transmitting patient health information. As part of the evaluation process, MHCC reviews an EHN’s national accreditation site audit and recommends areas where enhancements would help reduce risks of exposure to data breaches.
Maryland Regulation 10.25.07, Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses, requires third party payors that accept electronic health care transactions originating in Maryland to accept electronic health care transactions only from MHCC certified EHNs. MHCC-EHN certification demonstrates that Change Healthcare meets a number of national and local standards intended to ensure high quality business operations and the existence of sound privacy and security policies. MHCC certification represents to other networks, payers, and providers that Change Healthcare meets a reasonable level of quality and technical performance.
MHCC requires that EHN’s complete the evaluation process every two years to maintain certification.
The National Committee for Quality Assurance (NCQA) is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality by assessing and reporting on the quality of health-related programs. NCQA certification is a reliable indicator that an organization is well-managed and demonstrates the organization's commitment to meeting and maintaining industry developed quality standards.
NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) Measure Certification is precise, automated testing that verifies compliance with HEDIS Specifications and satisfies the source code review portion of the HEDIS Compliance Audit™. Since its introduction in 1993, HEDIS has evolved to become the gold standard in managed care performance measurement. Change Healthcare has been providing certified HEDIS reporting solutions since 1997.
Change Healthcare's Quality Performance Advisor™ and Compliance Reporter™ solutions power a suite of web-based HEDIS offerings, including certified rate reporting and analytics, hybrid medical record reviews, and customizable reporting across measures, enabling health plans to effectively manage and optimize HEDIS processes, reporting, submission, and results.
NCQA's Physician and Hospital Directories certification validates quality measures for online solutions which help eligible individuals choose physicians and hospitals. Change Healthcare's Provider Directory solution has been NCQA Health Information Product Physician and Hospital Directories (HIP4) Certified in all measures. Change Healthcare's Provider Directory solution helps members easily search and compare doctors, specialists, hospitals, imaging centers and more in a user-friendly interface. Combined with our cost transparency solution, Provider Directory empowers members to take a more active role in their health, guiding them to make smarter decisions for healthier outcomes.
The following Change Healthcare solutions are Payment Card Industry Data Security Standard (PCI DSS) certified:
SmartPay™ Consumer Pay Online
SmartPay™ Consumer Lockbox
SmartPay™ Phone Pay
This annual certification verifies that these Change Healthcare solutions have passed the rigorous standards promulgated by the PCI DSS.
The PCI DSS is a set of security requirements created by an association of credit card brands, including VISA, MasterCard and American Express intended to protect cardholder data (credit card data). The steady increase in electronic payment options available makes it extremely important to protect customers’ personal information. You can learn more about the PCI DSS and the standards it requires at www.pcisecuritystandards.org/security_standards.
Change Healthcare abides by all applicable PCI DSS requirements under which we secure any and all cardholder data that we store, process or transmit for our customers. This notification is part of the certification process.
Keeping our customers’ information secure is a top priority for Change Healthcare. We dedicate extensive resources to make sure personal medical and financial information is secure and we strive to build a company culture that reinforces trust at every opportunity.
We appreciate your continued partnership. If you have any questions about the Change Healthcare PCI Compliance efforts or the measures we’re taking to keep your data safe, please contact your account representative or the Security Compliance Team.