Optum/Change Healthcare EDI services were disrupted by a cybersecurity issue beginning on February 21, 2024. By February 23, it was evident that the extent of the event’s reach was causing delays in real-time eligibility, electronic claim, and electronic remittance advice processing for a large number of payors.
PCC is working hard to respond to this disruption. This post is an edited version of a message by PCC's Jan Blanchard released to clients and friends of PCC in March 2024.
How PCC Is Responding
Below is an explanation of what PCC has been up to following this disruption. Our highest priority is to mitigate the effects on our clients’ cash flow as efficiently as possible while providing resources and updates as they become available.
Our main focus is restoring or preserving cash flow for PCC clients by migrating claims submissions from Change Healthcare to other vendors. Our Get Paid team is working hard to work in real time with other players in this disruption, such as other vendor clearinghouses, Change Healthcare, and the AAP.
Along the way, we are uncovering more and more details about exclusive EDI processing contract arrangements on which our efforts are bound. Some of these arrangements require practices to submit a new claims provider enrollment agreement. Even in those cases, there are a few questions which only the payer(s) can answer:
- How long will it take for the payer to process the agreement? Note: Time estimates may have varying degrees of accuracy.
- Will Change Healthcare return to normal operation before the payer processes the new agreement?
Whether or not a practice should enter into such agreements while Change Healthcare metes out details about its service recovery plan is a judgment call practices must make. Contacting your payers to determine how long their agreement processing is taking right now is your best first step. PCC customizes claim routing to meet our clients' unique combinations of clinician contracts and payer billing requirements.
What Your Practice Can Do
We suggest these additional actions to consider as part of your response to this interruption:
- Pay closer attention than ever to your claims oversight. PCC is not the only entity making changes in response to this interruption. Watch every claim closely for unusual responses and delays.
- Know what’s in your hands. PCC does not have access to the information you need to determine which claims must be resubmitted, and we cannot rebatch claims for you.
- Consider possible outcomes. For example, rebatching claims after rerouting may result in payments arriving before Change Health’s recovery and may yield duplicate claim responses to any claims Change Healthcare receives and processes. Any preparation you can make to address those responses is a good idea.
- If you inquire with payers about rerouting ERAs:
- Be aware that routing changes can take 8 weeks or more (even without the additional burden payers may be under right now).
- Some payers have portals through which they make downloadable ERAs available.
- Fees may apply to any or all of these additional services. Be sure that you know in advance what you’re agreeing to. It couldn’t hurt to ask if fees could be waived in light of current circumstances.
- Consider temporarily agreeing to receive EOBs by mail.
Claims Migration Details
Some of PCC's migration work is a moving target as payer entities simultaneously enact their own dynamic responses.
United Health Group (UHG) statement recently stated, “We [Change Healthcare] expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.” (That page has remained unchanged since 3/18). While awaiting any details related to this plan, PCC can't form expectations around Change Healthcare’s next actions. Similar to the Optum IEDI option that is available and recommended by Optum, PCC continues to analyze and seek more direct and currently operational claim routes. At the same time, our inquiries to our Change Healthcare and IEDI representatives remain as yet unanswered.
Other resources we’re aware of include UHG’s own Cyber Response Webpage and a Temporary Funding Assistance tool. For the funding assistance, Change Healthcare is mobilizing Optum Financial Services to provide temporary funding assistance to help with short-term cash flow. The terms of this agreement have undergone several updates over the last few days. Optum has released this webinar recording, which features instructions and highlights.
Many thanks to all of you who are sharing the details you gather from your payers. Crowdsourcing solutions while this ongoing issue has yielded some impressive outcomes and lots of time and money savings. Keep it coming!
You may also be experiencing eligibility failures related to the Change Healthcare interruption. Migrations for eligibility checking are also underway at PCC. Stay tuned for more information about the specifics. In the meantime, another source of eligibility information is via the affected payer's portal.
Future Plans
PCC’s future plans include turning our attention to addressing Electronic Remittance Advice (ERAs).
Practices should continue to pay closer attention than usual to claim statuses and errors. Practice owners and admins may also want to review the recent post on PCC’s Chip Hart’s blog, Confessions of a Pediatric Practice Management Consultant. It includes a great bulleted list of actions that may be taken right now in light of the cash flow challenges this issue may be causing.
United Health Group continues to hold periodic webinars, and PCC is in attendance. The information shared at the most recent event; however, it has not changed any of our previously shared expectations.
The status of other affected services looks like this:
- Eligibility: Roughly 33% of real-time eligibility requests remain affected.
- Electronic Remittance Advice (ERA): According to our estimate, 28% of affected remittances cannot be successfully received. By our estimate, 28% of affected remittances cannot be successfully received according to what we see right now.
- Electronic Funds Transfer (EFT): PCC does not manage or have access to information about your Electronic Fund Transfers (EFT). The affected payers are your best source for answers to your EFT questions and concerns.
Thanks to everyone who brought questions about this interruption to us at our March 2024 Billing Drop-In on Thursday, 3/14/24. If you couldn’t join us, you may find the video for it all past Billing drop-ins here and we hope to see you at future PCC Monthly Pediatric Billing Drop-Ins.
We will continue to share what we can as we can, and we deeply appreciate everyone’s understanding and patience. Please continue to share your experiences and feedback with us by contacting us at contact@pcc.com.
