April 26, 2024

WSMA Advocacy Leads to New Flexibilities in Response to Change Healthcare Cyberattack

The WSMA continues to monitor the impact of February's Change Healthcare cybersecurity event that has impacted health care operations in Washington state and across the country. Last week, responding to requests from the WSMA and others in the health care community, the OIC notified affected health carriers in Washington with guidance regarding prior authorization, timely claims and billing standards, and use of medical claim clearinghouse services.

Here's a rundown of the main takeaways from the OIC's guidance.

Prior authorization

Effective on and after Feb. 21, 2024, health carriers must process any claim that is subject to prior authorization under their extenuating circumstances policy. Health carriers must follow this process until either Change Healthcare is fully operational or the health carrier establishes an alternative prior authorization process that is fully operational.

Timely claims and billing standards

Online problems persist for outpatient facilities and hospitals attempting to submit claims for covered services electronically consistent with timelines set forth in their contracts with carriers. Many facilities are unfairly being held to the terms of their contract with carriers that may result in the denial of valid claims unless the carriers take action to waive contract provisions that present unreasonable barriers. The OIC requests that each affected health carrier waives these contractual provisions immediately, and shares this information on their websites and appropriate communication platforms, such as but not limited to bulletin boards, news briefs, etc. Providing this temporary waiver will reassure impacted health care partners that claims will be paid.

Medical claim clearinghouse services

Finally, the OIC is aware of ongoing practices by health carriers that are either unwilling or unable to waive exclusivity requirements for health care facilities to use Change Healthcare or its affiliates for the submission of medical claims. At a minimum, it is the OIC's expectation that health carriers will permit outpatient facilities and hospitals to change medical claim clearinghouses if they are prepared to make a switch and provide authorization for the switch in an expedited manner.

WSMA members are advised to review the OIC guidance in full for impacts on their practice operations, and to keep apprised of updates from UnitedHealth Group on its ongoing investigation of the security event.

In meeting with the OIC and impacted health care organizations, the WSMA had advocated for these flexibilities on behalf of the outpatient community and asked that they be retroactive to Feb. 21, the date of the cybersecurity event. The WSMA thanks the OIC for taking these steps on behalf of the outpatient and hospital communities. To help our ongoing advocacy on your behalf, if your practice or medical group has been impacted by the Change Healthcare cybersecurity event, let us know by emailing the WSMA policy department at policy@wsma.org.

For more WSMA guidance on state health carrier prior authorization, visit the WSMA Prior Authorization Navigator. For additional billing guidance, check the WSMA latest news pages.