Accreditations & Certifications

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 CORE

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.

Drummond Certified

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 08, 2020
Product Name and Version Clinical Exchange, Version 9.2
Unique Certification Number 15.04.04.3017.Clin.09.02.0.200408
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



Developer Change Healthcare
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

EHNAC HNAP-EHN

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:

  • Confirms HIPAA, ARRA/HITECH, Affordable Healthcare Act, Omnibus Rule and other regulatory compliance requirements
  • Fulfills Maryland and New Jersey state regulatory requirements
  • Identifies privacy, security, confidentiality and business risk exposures and mitigation strategies

EHNAC’s Healthcare Network Accreditation Program (HNAP) Electronic Health Network (EHN) assessment and review covers five main categories of criteria:

  • Privacy and confidentiality criteria include policies for securing PHI, system access controls, role-based user authentication and other related measures.
  • Technical performance criteria include transaction monitoring and processing capacity, response timeliness and accuracy, system availability, use of industry standard data formats and other infrastructure practices.
  • Business practices criteria include policies, procedures and contract standards to assure truth in advertising, ongoing customer satisfaction measurement, customer service and training, and other related measures.
  • Physical, human and administrative resources criteria include the organizational ability to sustain levels of service, maintain escalation procedures, and invest in professional development and other capabilities.
  • Security criteria include facility access, disaster recovery, business continuity, organizational safeguards, audit trails and other practices.

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

HITRUST

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?

  • HITRUST is a privately held company which, in collaboration with healthcare, technology, and information security leaders, has established a Common Security Framework (CSF) that can be used by all organizations that create, access, store, or exchange sensitive and/or regulated data. The CSF includes a prescriptive set of controls that seek to harmonize the requirements of multiple regulations and standards.
  • The HITRUST CSF is an industry-agnostic information protection framework for the healthcare industry, and the CSF Assurance Program is bringing a new level of effectiveness and efficiency to third-party assurance.
  • By including federal and state regulations, standards and frameworks, and incorporating a risk-based approach, the HITRUST CSF helps us develop and maintain a comprehensive and flexible framework of prescriptive and scalable security controls.

Change Healthcare Solutions that have achieved HITRUST CSF Certification include:

Change Healthcare Solution Name Formerly Known As
ClaimsXten™  
NFM Analytics  
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
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

HHS Administrative Simplification Optimization Program

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.

HHS Optimization Program Certificate

MHCC

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.

NCQA

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.

  • For each consecutive year since 2005, Change Healthcare's Quality Performance Advisor™ solution has been NCQA HEDIS Measures Certified in all measures. Quality Performance Advisor™ also received NCQA certification for the California Value Based Pay for Performance (VBPP) program. This statewide initiative is one of the largest alternative payment models in the United States.
  • Change Healthcare’s Compliance Reporter™ solution has been NCQA HEDIS Measures Certified every year since 2012. Compliance Reporter™ also supports Quality Assurance Reporting Requirements (QARR) measures as required in the state of New York.

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.

PCI Compliance

The following Change Healthcare solutions are Payment Card Industry Data Security Standard (PCI DSS) certified:

SmartPay™ eCashiering
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.