Healthcare Payments/Transactions Suspended

On Feb. 21, Change Healthcare reported that it had experienced a cyber security attack that led to the company halting the processing of healthcare transactions. Change Healthcare, the largest medical billing and insurance claims processing company in the country, is responsible for more than 15 billion healthcare transactions per year including electronic prescribing authorizations, establishing patient insurance eligibility, and prior authorization determinations.

The disruption in reimbursement and other electronic healthcare-related transactions has placed individual health professionals, medical practices, hospitals, pharmacies, and other health organizations under severe financial and operational stress. Click here for updates from Change Healthcare about the cybersecurity breach.

Here is what PAs need to know:

  • Electronic claims payments are expected to be reestablished the week of March 18.
  • Change Healthcare has restored its pharmacy claims and payment operations. Certain specialty pharmacy coupon programs and infusion claim services remain interrupted.
  • Providers can use other claim submission options such as paper claim submission or the use of billing clearinghouses that have not been affected by the cyberattack.
  • Change Healthcare, through its partner Optum Financial Services, set up a temporary funding assistance program to help offset the lack of claims payments. Initial feedback on the funding assistance program indicates the amounts may be insufficient to offset cash-flow difficulties. The Department of Health and Human Services and the Centers for Medicare & Medicaid Services are responding to the payment disruption by 1) suggesting that providers temporarily shift to a different claims payment clearinghouse and, 2) offering advanced and accelerated payments to Part A and B providers. On March 13, CMS issued an FAQ related to the Change Healthcare payment disruption providing additional information about which services qualify for accelerated and advance payments, application criteria, terms of repayment, and financial concerns.

AAPA will continue to follow this issue and make the most current information available to PAs. If you have additional questions contact AAPA’s Reimbursement & Professional Advocacy department at [email protected].