The Feb. 21 cyberattack on Change Healthcare, the clearinghouse vendor that connects providers with insurance payers, including Medicare, has caused unprecedented challenges and had a critical financial impact on payments to providers nationwide. UnitedHealthcare Group (UHG), the parent company of Change, confirmed on March 8 that it is making significant progress to restore all systems. As part of the ongoing work it has provided the following timeline and workaround for providers as they restore all Change Healthcare systems. The ACR has been involved in discussions with the Department of Health and Human Services (HHS), as well as monitoring live updates from UHG regarding the incident and the steps being taken, and will continue to monitor and provide updates and resources for members.
Pharmacy Services
Electronic prescribing has been fully restored and is functional for all claim submission and payment transmission. UHG has taken action to make sure patients can access their medicines, including Optum Rx pharmacies sending members their medications based on the date needed.
Payment Platform
The electronic payment functionality will be available for connection beginning March 15. Optum has initiated temporary funding assistance to provide a funding solution to bridge the gap as a short-term cash flow solution for clinicians and practices. To determine eligibility and funding amount, register for the program here.
Medical Claims
Change Healthcare expects to begin testing and reestablish connectivity to the claims network and software on March 18, and plans to restore service moving forward. Providers should use Optum’s Intelligent Electronic Data Interchange (iEDI) claim submission system, as well as alternative clearing houses.
Medicare Advantage Plans
Prior authorizations for most outpatient services have been temporarily suspended, except for durable medical equipment and Part B step therapies.
Additionally, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are working with UHG because claims submission through Change Healthcare have also affected payments. In an effort to increase cash flow to providers affected by the disruption, the CMS is providing accelerated payments to Medicare Part A providers and advance payments to Medicare Part B suppliers experiencing the impact in Medicare claims processing as a result of the cyber attack. Lawmakers have stated that emergency funding would offer greatly needed financial relief to physician groups and other healthcare providers that have rapidly exhausted their cash reserves and are struggling to meet payroll.
For Part B claims, providers will have to contact their individual Medicare Administrator Contractor (MAC) for alternative options and workarounds regarding submission of claims for affected Change Healthcare customers.
