Are your payments at risk? Challenged with Eligibility?
As some of you are aware, Change Healthcare – part of the Optum division of UnitedHealth Group – experienced a cybersecurity breach on 2/21/24. Change Healthcare is utilized by different organizations for a variety of transactions, including electronic data interchange (EDI) – the secure method of transferring data between health care providers/institutions, insurers/payers, and patients. As such, it involves patient information, claims, and prescriptions. Although the largest impact of this breach appears to involve larger organizations and hospitals, it has also impacted individual provider offices. There have been challenges reported while attempting to verify eligibility, process claims and payments, and delays in processing prescriptions.
In response to several member concerns, the NYSCA reached out to Optum to determine what impact this may have on our members and the patients we serve. To date, doctors utilizing Change Healthcare’s portal and AdvancedMD experience continued issues. UnitedHealth Group, Optum, and Change Healthcare have also posted information on their websites.
UnitedHealth Group has noted they “have a high level of confidence that Optum, UnitedHealthcare and UnitedHealth Group systems have not been affected by this issue. We see no evidence of compromise beyond the scope of the Change Healthcare applications”. According to UnitedHealth Group (last updated on March 4, 2024):
Change Healthcare has experienced a cybersecurity issue, and we have multiple workarounds to ensure provider claims are addressed and people have access to the medications and care they need. The following page is a resource for UnitedHealth Group, UnitedHealthcare, Optum and Change Healthcare stakeholders. In addition to being a main source for the latest business and information updates, this page also contains links to other resources to support stakeholders in managing any related impacts.(See https://www.unitedhealthgroup.com/ns/changehealthcare.html)
If your office has been impacted by the Change Healthcare breach, you can still verify eligibility directly with the insurer/payer, file claims, and ascertain what workaround they have implemented (each impacted insurer will have their own recommendation).
If you are subject to a significant financial impact, Optum has posted a link for temporary funding based upon your historical transactions through Change Healthcare. For more information, please utilize the following link:
https://www.optum.com/en/business/providers/health-systems/payments-lending-solutions/optum-pay/temporary-funding-assistance.html
We have also received communication from several clearinghouses. On 2/22/24 OfficeAlly posted notice that they temporarily suspended all transactions to and from Change Healthcare, including eligibility, claims, remits and other electronic transactions which impacted multiple payers. On 2/25/24 Office Ally ‘received assurance that our connection to Optum was unaffected by the Change Healthcare cyber security issue. We reestablished our connection and all claims have been sent.’
Inovalon has posted similar information, noting 'The only claims and insurance verification transactions that will be impacted by this event are those where Change Healthcare and the Payer have an exclusive connection. We realize this has the potential to create serious financial impact to your business, and unfortunately for these Payers there is no way to resume transaction processing until connections are reestablished or new connections are built. Inovalon has direct connections to all Medicare, Medicaid, and BCBS plans nationwide, as well as most large commercial Payers. We are in talks with Payers that have surfaced as having the largest impact to our customers to determine if alternative routes can be established and are seeing success.'
We suggest members contact their clearinghouse to determine what, if any, impact this may have had and follow their recommendations.
We will continue to keep you updated on this and other issues which impact our profession. As always, please contact the NYSCA to share your challenges and solutions as we help move our profession forward.
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