Change Healthcare Cyberattack: Latest Updates
The payment platform Change Healthcare, a subsidiary of UnitedHealth Group’s Optum Solutions division, was the victim of a cyberattack on February 21. Providers may experience disruptions to claims processing and prior authorization requests through any entities that include Change Healthcare as part of their processing chain. This includes the Community HealthChoices Managed Care Organizations (CHC MCOs) in Pennsylvania.
We will keep this news item updated with the latest updates for providers in Pennsylvania and will communicate additional information as it becomes available. Please reach out to GovAffairs@LeadingAgePA.org if you have any concerns, and review this article if you are facing severe cash flow issues resulting from the attack.
For updates that apply nationwide, reference LeadingAge National's website: View the latest updates here.
March 22, 2024: AmeriHealth Caritas / Keystone First
On March 22, AmeriHealth Caritas / Keystone First shared an update letting providers know that the claims issue with Availity has been resolved. Click here to view the AmeriHealth notice and here for the Keystone First notice.
March 20, 2024: Update from MCOs on Claims Submissions Workarounds
As of March 20, each of the CHC MCOs report the following regarding the status of claims submissions:
AmeriHealth Caritas:
- AmeriHealth issued a communication to providers on March 19 with additional details regarding claims submissions and Availity resources
- Earlier this week, there were reports of a coding issue preventing providers from submitting claims through Availity; however, as of March 20, AmeriHealth reports Availity is once again working for their Plans. Claims can now be submitted based upon AmeriHealth's standard processing guidelines.
- Please note: For anyone who needs to register with Availity, it can take up to 48 hours for registration. It can also take 24-48 hours (being a bit conservative here) for claims to transmit between Availity and our claims processing system. Providers are encouraged to review their submissions/registration as soon as possible.
- If there are any questions, providers can contact their Account Executive for additional assistance. We are working on a nursing facility-specific communication, but I am attaching our latest network communication that provides information relating to Availity.
- If AmeriHealth’s Availity pathway were to go down again, providers may use a workaround for remits through this portal guide. Navinet is working for some providers/participants but is hit or miss.
PA Health & Wellness:
On March 20, PA Health & Wellness reported, “I confirmed with our Provider Relations team that they have not heard any feedback; therefore, yes it appears that things are still running smoothly for us.”
UPMC:
UPMC has stated they have an increase of claims volume coming in, indicating providers’ workaround submission processes seem to be working. With the increase in paper claims, however, it will take longer for claims to be processed manually and paid. As a reminder, UPMC has 30 days to pay claims.
Nursing Facility Assessment Fee grace period will expire on April 15
The Office of Long-Term Living sent the following to providers via a listserv message on March 20:
The Department of Human Services (DHS), Office of Long-Term Living (OLTL) will end the flexibility it offered to nursing facilities affected by the Change Healthcare cybersecurity incident and require that nursing facilities pay the assessment fees due for assessment quarters ended September 30, 2023, and December 31, 2023, no later than April 15, 2024.
On February 21, 2024, a cybersecurity incident at Change Healthcare, the largest clearinghouse for medical claims in the United States (U.S.), resulted in system disruptions and an inability for the company to process claims. On March 1, 2024, OLTL learned of potential cash flow concerns for nursing facilities because of delays in claims processing and healthcare provider reimbursements. To help providers manage cash flow, OLTL allowed nursing facilities that demonstrated an urgent need to delay their February 29, 2024 assessment payments until alternate billing and reimbursement options became available. The Secretary of DHS waived interest on these delayed assessment payments.
DHS released guidance on how providers can bill fee-for-service claims if the provider used Change Healthcare for billing. Additionally, OLTL worked closely with the Community HealthChoices (CHC) managed care organizations (MCOs) to mitigate the delays in CHC claims processing.
As of March 15, 2024, alternate billing and reimbursement methods created by DHS and the CHC-MCOs have minimized the cash flow impact for nursing facilities. As a result, outstanding nursing facility assessment fees for assessment quarters ended September 30, 2023, and December 31, 2023, must be paid by April 15, 2024. Any assessment fees paid after this date will accrue interest for each additional day from April 15, 2024, until the date they are paid, as permitted by 62 P.S. §810-A.
March 13, 2024: Update from the Department of Health
Department of Health Recommends Providers Update Contingency Plans
The PA Department of Health (DOH) shared with LeadingAge PA on March 13 that they are concerned about regulatory compliance issues that may stem from payment interruptions (related to the Change Healthcare cyberattack). DOH has cautioned that providers should ensure they have updated plans in place regarding what they would do if cash flow issues become severe (resulting in failure to pay staff or necessary vendors). DOH reports they are watching for delayed preventative maintenance to emergency systems (fire alarms, sprinklers, generators, etc.), staff not showing up if not getting paid, as well as other elements of providing care that may be impacted, including pharmacy consults, staffing agency bills, transportation costs for resident appointments, etc. DOH wants to ensure providers have an up-to-date plan in place so that if they run into cash flow issues, they know if they will be applying for a short-term loan or accessing other backup funding sources versus having to start the process of relocating residents they are no longer able to care for. While DOH does not have any capacity to provide assistive funding to providers, they do encourage any provider struggling to cover necessary expenses that impact resident care and safety to proactively notify their field office for guidance.
March 13, 2024: Federal Officials Urge Payers to Support Providers
View this article for a review of a meeting held Tuesday between White House officials, the U.S. Department of Health and Human Services, industry groups, and UnitedHealth, urging parties to work together to support providers facing immense financial strain as a result of the Change Healthcare cyberattack.
March 11, 2024: Update from the Office of Long-Term Living
The Office of Long-Term Living shared the following with LeadingAge PA on March 11:
- DHS is pausing the assessment of penalties and late fees for the NF Assessment Fee until we determine that the claims processing is able to return to pre-Change Healthcare breach levels. Once that threshold is reached, DHS may return to imposing interest for non-payment of the NF Assessment Fee. NFs should be able to demonstrate a Change Healthcare impact as a reason for non-payment.
DHS issued the following information related to the Change Healthcare issue and claims submission for Fee for Services: https://www.media.pa.gov/Pages/DHS_details.aspx?newsid=995
UnitedHealth Group has included information for their Funding Assistance Program on their website: https://www.unitedhealthgroup.com/ns/changehealthcare.html
OLTL’s understanding is that CHC MCOs may consider funding advancements on a case-by-case basis, however, the UPMC and PHW have indicated that they are current with payments. AHC/KF notified on March 8 that they have an alternative pathway with Availity.
March 8, 2024: Updates from AmeriHealth Caritas
AmeriHealth Caritas sent a communication to all non-PAS providers, identifying Availity as an alternative channel for claims submissions that is now operational for nursing facilities (and other non-PAS providers). AmeriHealth Caritas also indicated they are continuing to work with Change Healthcare to get that pathway restored as soon as possible.
March 7, 2024: Updates from the Long-Term Services and Supports Subcommittee meeting:
During the March 7 meeting of the Long-Term Services and Supports (LTSS) Subcommittee Meeting, Juliet Marsala (Deputy Secretary of OLTL) and representatives from each of the CHC MCOs shared the following updates:
OLTL: For Fee-for-Service (FFS) claims, OLTL does not use Change Healthcare for billing processes or claims processes. FFS systems can continue to be billed to and through OLTL’s PROMISe system as they would primarily be unless providers themselves use a biller that interfaces with Change Healthcare. DHS has put out FAQs regarding how to bill DHS through the FFS system.
OLTL also recognized that a significant assessment fee deadline fell at the end of February and understands that some facilities may have had to make the decision to forego submitting payment for required assessment fees due to potential cash flow issues. DHS has determined they will waive penalties/fines for a short term to assist those facilities who had to make that decision to ensure that they have the cash flow needed to pay their staff and ensure the safety of residents. Assessment fees will still be due, but late fee penalties will be waived at this time.
OLTL is also evaluating internally day by day and remains in constant communications with the MCOs as this situation evolves to consider whether or not additional assistance or support can be provided to providers who are still being impacted (in addition to the announcements and support coming out at the federal level from CMS/HHA and Optum).
UPMC: Similar to FFS with OLTL, UPMC did not use Change Healthcare for claims, but there could be an impact if providers do. UPMC stated they have been working on communicating the matter to providers and HHA.
PA Health & Wellness (PHW): PHW does not use Change Healthcare as a clearinghouse. PHW’s biggest impact was with paper checks. PHW providers who receive paper checks were only impacted. ACH payments were unaffected. To address the paper checks issue, PHW contracted with an alternative vendor to run claims, and those checks were sent out this past Saturday. PHW does not anticipate any further disruption; PHW has been in the field helping providers.
AmeriHealth Caritas / Keystone First: AmeriHealth is impacted by the Change Healthcare situation for PAS providers, but that is not really impacting us greatly unless providers use Change Healthcare as an intermediary. As relates to other providers, AmeriHealth is impacted by Change Healthcare. There is a channel open for the submission of claims, and AmeriHealth is working on getting a more robust channel to be open within the next day or two.
March 5, 2024: Updates from CHC MCOs:
LeadingAge PA has been in contact with each of the three CHC MCOs and received the below updates as of March 5, 2024:
UPMC:
“Our systems are functioning as normal. Providers can submit claims via our Provider OnLine or paper. We are not receiving claims from Change Health. This is a Change issue, not a UPMCHP issue. Our systems are still processing the claims we receive. We are working on a provider communication.”
PA Health & Wellness:
“There was a small delay in making payments to providers who were signed up to receive funds via check or through the Virtual Credit Card but that was resolved yesterday. In regards to claims submissions, we are not currently experiencing any issues on our end. However, if providers are using Change Healthcare, they will just need to use alternative sources as noted below.”
“Providers can easily submit claims to PA Health & Wellness via many alternative methods including other claims clearinghouses, our secure provider portal, and mail. Our preferred clearinghouse for electronic claims submission is Availity. To enroll, please visit www.availity.com/Essentials-Portal-Registration and/or call Availity Client Services at 1-800-AVAILITY (1-800-282-4548). For step-by-step instructions for Availity, visit the Availity Lifeline page at https://availity.com/availity-lifeline-self-serve-resources. Additional information on claims submission can be found in our Provider Manual located on our website at https://www.pahealthwellness.com/providers/resources/forms-resources.html.”
AmeriHealth Caritas / Keystone:
- AmeriHealth was able to make payment for all claims currently in their system over the last three days (Saturday/Sunday/Monday). Claims outflow connectivity has been restored and no longer appears to be impacted. However, AmeriHealth reports they are still unable to intake new day claims from Change Healthcare and that functionality remains interrupted as of Tuesday. To address this issue, AmeriHealth has stated that they are:
- Working with Change Healthcare to revive standard functionality.
- Working on alternative workarounds to using Change that will allow providers to submit claims through different channels.
- One of the alternative input methods offered by AmeriHealth was shared in a communication with providers on March 4:
- Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address its network interruption related to a security incident. Below are updates for our systems and processes:
- Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, Providers who submitted claims during the outage may be able to resubmit them either through additional solutions once they are available or once Change Healthcare’s connectivity is restored through Change Healthcare. We appreciate the inconvenience this is causing Providers and are exploring other options for the submission of claims.
- Electronic remittance advice (ERA): ERAs are available at this time. However, some individual remittance advice may not be available due to Change Healthcare’s security incident.
- Prior authorization submission and processing: The prior authorization systems continue to operate normally.
- Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet Provider portal, please visit https://register.navinet.net/ [linkprotect.cudasvc.com] to sign up.
- Electronic claims submission: Our claims submission process relies on Change Healthcare transmitting the claim to Keystone First/Keystone First CHC/Keystone First VIP Choice. We are working on an alternate claims submission solution and will notify Providers when the alternate solution is available.
- Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address its network interruption related to a security incident. Below are updates for our systems and processes:
Please note that in the interim, our Provider Services Department will not be able to assist with the processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-800-521-6007.
Update from LeadingAge PA's February 29, 2024, GA News in the weekly member update:
Change Healthcare cyber attack impacting healthcare providers
Change Healthcare, a subsidiary of UnitedHealth Group since 2022 and its Optum Solutions division, is a payment exchange platform used broadly by healthcare providers and was the victim of a cyberattack on Feb. 21, 2024. Optum reports that once the attack was identified, it disconnected the Change Healthcare platform from its other systems, thereby containing the threat. As of 2:20 p.m. on Feb. 23, Optum said, “This action was taken so our customers and partners do not need to [disconnect]. We have a high level of confidence that Optum, United Healthcare, and UnitedHealth Group systems have not been affected by this issue.” Nonetheless, some healthcare providers have opted to actively disconnect themselves from the platform out of an abundance of caution. Given the platform’s role in processing claims, some providers have reported they are unable to submit claims for payment or services at this time. Optum indicates it is continuing to work to restore the “impacted environment” and expects the disruption to continue through at least Friday, Feb. 23. Optum updates on the Change Healthcare cyberattack can be followed here. Members who experience a disruption to their claims processing, prior authorization requests, or other issues related to this attack can report them to Nicole Fallon, and as appropriate, we will share them with CMS. Members are reminded that LeadingAge has curated a number of Cybersecurity Resources to assist them in protecting their own systems, including a listing of LeadingAge business partners who can assist members in addressing their cybersecurity needs. An article is here.