Impact of Change Healthcare Cyberattack Continues
As disruptions caused by the cyberattack on the country’s largest processor of health care claims continue, providers who rely on impacted claims clearinghouses are facing an increased danger of cash flow interruptions. In regular updates to their web page dedicated to the cyber response, UnitedHealth Group indicates that due to workarounds and systems coming back online, pharmacy claims are flowing at near-normal levels, with the full pharmacy network anticipated to be back online as soon as Thurs., March 7th.
UnitedHealth expects the medical networks to take longer to fully restore than pharmacy networks and acknowledges that there are still a number of providers who are not able to submit claims or receive payment. The company recommends that providers and revenue cycle vendors connect to the Optum electronic data interchange (EDI) claims connection option, writing on their site that this approach:
…will work for the vast majority of providers who cannot submit today. There are some cases where other approaches need to be designed due to connection incompatibility. We regard EDI to be the most expeditious way to help solve this problem. We fully acknowledge that not all functionality will be in place and will create some rework burden, but we are recommending this approach to get claims flowing. To support these efforts, as of March 5, 2024, we began hosting an ongoing series of webinars. Our teams are ready to engage and help those payers and providers get claims connections built quickly through this secure and verified platform.
In addition, Optum has initiated a temporary Funding Assistance Program for provider organizations impacted by the payer system outage to support the most impacted providers with short-term cash flow. Note that the program is specifically for those whose payment distribution has been impacted, NOT for providers who have had claims submission disruptions. This is, in effect, an interest-free loan, meaning that once standard payment operations resume, the funds will need to be repaid. Once standard payment operations resume, the funds will simply need to be repaid. To determine eligibility, providers need to have or establish an Optum Pay account and follow the procedures described here. Early reviews of the program suggested that funding amounts were fairly meager.
National Government Services, the Medicare Administrative Contractor (MAC) for NYS, posted some information regarding claim submission workarounds which include manual claims entry (which is not a feasible option for many providers) as well as their guide for various EDI options. Providers also have the option to request advance or accelerated Medicare payments through the MAC, a process that was widely employed during the early stages of the COVID pandemic. The application form is here, but providers may want to contact NGS for additional guidance prior to submitting the application.
On March 5th, the U.S. Department of Health and Human Services (HHS) issued a statement on the incident, outlining the following flexibilities that are in place for impacted providers:
- Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their MAC to request a new EDI enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. The Centers for Medicare and Medicaid Services (CMS) has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
- CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
- CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State.
- If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
- CMS has contacted all of the MACs to make sure that they are prepared to accept paper claims from providers who need to file them. While CMS recognizes that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.
LeadingAge National is providing many helpful resources as well. Their member-only serial post provides regular updates along with a “Five Things You Can Do” guide for those impacted and an in-depth article detailing actions providers who are unable to process claims should take to avoid significant operational disruptions. LeadingAge National also offers a wealth of cybersecurity information and resources.
We encourage impacted members to monitor the UnitedHealth Group site for updates, to be responsive to any further Department of Health (DOH) requests for information, and to keep us informed of any ongoing disruptions or anticipated financial hardships.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841