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March 28, 2024

Change Healthcare Cyberattack Update

The WSMA continues to be on high alert for repercussions here in Washington from the Change Healthcare cyberattack, which has impacted health care operations across the country. The following is an up-to-date summary of resources for physicians and practices provided by health plans, and other actions your WSMA is taking to ensure our members and the practice community are provided with the support they need to weather any resulting disruptions.

Washington health plans offer resources and updates

The WSMA has been working with the Washington State Hospital Association and the Association of Washington Healthcare Plans to coordinate communications and distribution of resources to the physician and hospital communities. The AWHP this week provided a comprehensive roundup of health plan reactions and resources to the Change Healthcare cyberattack.

How the WSMA is responding to the cyberattack

The WSMA released an urgent update last week to help ensure our independent practice members could access resources in case of claims disruptions, and this week staff has met with representatives from the Health Care Authority and the hospital association to gauge further impacts.

If  your practice or group has been impacted by the cyberattack, please email our policy department at policy@wsma.org and let us know.

Hearing from our members can help us in our discussions with agencies and other health organizations as work to ensure our members and the practice community are provided with the support they need to weather any resulting disruptions.

HHS resources for physicians

In response to concerns from organized medicine that physicians were having difficulty securing information from health insurers, the U.S. Department of Health and Human Services distributed these resources to assist physicians, pharmacists, and hospitals with the aftermath of the Change Healthcare cybersecurity attacks. The resource document contains a national contact person for each plan, though HHS urges physicians, pharmacists, and hospitals, to reach out first to their health insurer’s regional contact. If these contacts do not respond to inquiries, please contact HHScyber@hhs.gov.

CMS, Optum announce assistance for physician groups

The Centers for Medicare and Medicaid Services has announced it will institute Change Healthcare/Optum payment disruption advance payments for physicians and health care professionals experiencing claims disruptions due to the Change Healthcare cyberattack. The advance Medicare payments may be granted in amounts representative of up to 30 days of claims payments for eligible physician practices.

The WSMA has been communicating with Noridian, the Medicare administrative contractor for jurisdiction F, which includes Washington state. Noridian indicated that its webpage has been updated and instructs WSMA members to click on the Change Healthcare alert and scroll to the bottom where information is provided for the advance payments. Note that CMS has provided a template to fill out and submit to Noridian.

Please see CMS' press release and fact sheet for more information.

In addition, Optum has released information on its Temporary Funding Assistance Program designed to help bridge the gap in short-term cash flow needs for physicians impacted by the disruption of Change Healthcare's services. To determine if you are eligible for this program, sign into your Optum Pay account or please submit a request through the temporary funding inquiry form.

Aetna

Aetna is advising its participating physicians and providers who directly use Change Healthcare for electronic data interchange transactions for Aetna to stay "digital first" and use one of its other business partners for their electronic transactions until the service interruption is resolved. Here is a list of Aetna's approved electronic transaction vendors.

Physicians and practices can also use Aetna's existing portal hosted by Availity for electronic claims submission.

If practices or groups work through a billing partner, practice management system, or other vendor partner, they likely can advise on an alternate connection method for electronic transactions with Aetna.

Finally, when digital submission isn't possible, they may also reach out to Aetna contact centers about submitting paper claims. A list of phone numbers is available to select from based on the specific transaction they are calling about.

Find the latest client updates on the cyberrattack response on the Aetna website.

Coordinated Care of Washington

Coordinated Care is working closely with its participating partners to ensure they are able to navigate through the claims submission disruption and receive reimbursement. Find the latest alert on its website, which will be updated as the situation evolves. Kate Mundell, mary.mundell@coordinatedcarehealth.com, can be reached for outreach and communication.

Kaiser Permanente

Kaiser Permanente uses Change Healthcare as well as other EDI trading partners for various revenue and payment management services and is encouraging practices and groups to submit claims through other clearinghouses at this time. For a list of other trading partners, visit the KP Community Provider Portal page (Northwest) or Contracted Providers page (Washington). Kaiser Permanente is encouraging practices to use OfficeAlly because they are offering services for free. Practices may reach out to Kaiser Permanente's provider relations team for direct support. See Kaiser Permanente's March 19 FAQ.

Molina Healthcare, Inc.

Molina Healthcare, Inc. is advising its participating partners of a critical outage of its third-party vendor, Optum-Change Healthcare, resulting in impacts to electronic claims submission, payment, and settlement services. For more, see Molina's March 18 bulletin.

Regence

Regence has reached out to its participating partners to make them aware of available solutions such as Availity's Lifeline and CHC's funding assistance program. Regence reports that nearly all of those submitting to Regence via Change Healthcare have now found another path to submit claims.

WellPoint Washington

Out of an abundance of caution and to protect its information, on Feb. 22, Wellpoint Washington enacted business continuity plans and disconnected from Change Healthcare. WellPoint reports that it is not currently experiencing problems adjudicating claims. WellPoint is encouraging participating partners to use Availity to submit transactions if Change Healthcare was their preferred platform to submit transactions. This and other updates are available in WellPoint Washington's March 5 update.

Wellpoint's pharmacy benefit manager, CarelonRx, does not rely on Change Healthcare to receive and process pharmacy claims. To date, WellPoint has not had reports of issues with retail pharmacies in its network processing its pharmacy claims.

UnitedHealth Group

UnitedHealth Group's focus has been on ensuring access to care and medications by addressing challenges to pharmacy, medical claims, and payment systems targeted by the attack. Based on its ongoing investigation, there is no indication that any other UnitedHealth Group systems have been affected by this attack. For the latest update, see this March 18 UnitedHealth Group Cyberattack Status Update.

UnitedHealth Group has announced the following immediate actions to support its participating partners:

Timeline to restore Change Healthcare Systems

UnitedHealth Group expects key system functionality to be restored and available on the following timelines:

  • Pharmacy services: Electronic prescribing is now fully functional with claim submission and payment transmission also available as of March 5. UnitedHealth Group has taken action to make sure patients can access their medicines in the meantime, including Optum Rx pharmacies sending members their medications based on the date needed.
  • Payments platform: Electronic payment functionality is available for connection as of March 15.
  • Medical claims: Reestablish connectivity to our claims network and software is expected by March 18, restoring service through that week.

UnitedHealth Group recommends its clients use the applicable workarounds, in particular, using its new iEDI claim submission system in the interest of system redundancy given the current environment.

Continued funding support for community-based providers

On March 1, Optum released information on its Temporary Funding Assistance Program designed to help bridge the gap in short-term cash flow needs for physicians impacted by the disruption of Change Healthcare's services. To determine if you are eligible for this program, sign into your Optum Pay account or please submit a request through the temporary funding inquiry form.

Additional consumer actions

For Medicare Advantage plans, including dual special needs plans, UnitedHealth Group is temporarily suspending prior authorizations for most outpatient services except for durable medical equipment, cosmetic procedures, and Part B step therapies. UnitedHealth Group is also temporarily suspending utilization review for Medicare Advantage inpatient admissions.

For Medicare Part D pharmacy benefits, UnitedHealth Group is temporarily suspending drug formulary exception review processes.

These actions will remain in place until March 31. UnitedHealth Group will work with state Medicaid agencies on any actions they wish to implement.

Prescription support

UnitedHealth Group reports that all major pharmacy claims and payment systems are back up and functioning, and that it has taken action to make sure patients can access their medicines in the meantime, including Optum Rx pharmacies sending members their medications based on the date needed.

Optum Rx PBM has notified network pharmacy partners and pharmacy associations that it will reimburse all appropriate pharmacy claims filled with the good faith understanding that a medication would be covered. More information is available on the UnitedHealth Group website.

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