Recent Updates: Change Healthcare Cyber Incident
On February 21, 2024, Change Healthcare experienced a cyberattack, forcing it to take systems offline. Because Change provides various clinical, administrative and financial services/processes to all types of health care entities (providers, payers and consumers), this cyberattack created significant impacts across the industry. [Change was acquired by Optum in 2022. Optum is a part of United HealthGroup.]
Per United HealthGroup’s cyber incident page, for pharmacy services, electronic prescribing is fully functional with claims submission and payment transmission available (as of March 8). In addition, Optum Rx pharmacies are sending members their medications based on the dates needed.
With respect to the payment platform, electronic payment functionality will be available for connection beginning March 15. For medical claims, Optum indicates they will begin testing and reestablishing connectivity to its claims network and software on March 18. They will work to then restore services through that week. In addition, Optum indicates they’ve taken several actions to assist patients. The following will remain in place through March 31:
- For Medicare Advantage plans, including Dual Special Needs Plans, temporarily suspending prior authorizations for most outpatient services except for Durable Medical Equipment, cosmetic procedures and Part B step therapies, temporarily suspending utilization review for MA inpatient admissions.
- For Medicare Part D pharmacy benefits, temporarily suspending drug formulary exception review processes.
- They will work with state Medicaid agencies on any actions they wish to implement.
Further, Optum indicates its separate clearinghouse, iEDI, was developed outside the Change Healthcare environment and was not impacted by the Change cybersecurity incident. That system has been in “continuous operation, processing claims and payments on behalf of providers, throughout the Change Healthcare service disruption.” They have been using that and transitioning providers to that system. Access more details.
Financial/Funding Options
- United’s Temporary Funding Assistance Program. The TFAP is a bridge funding program for those with short-term cash flow problems. Beyond this, Optum indicates it is expanding the funding program to “include providers who have exhausted all available connection options, and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down…[The] expansion is a funding mechanism of last resort, especially for small and regional providers, and will be evaluated on a case-by-case basis.”
- Medicare Accelerated & Advance Payments Program. The MAAP is an advance on Medicare-claims and available to Medicare Parts A & B. The maximum allowable amount is calculated by CMS and will represent 30 days of Medicare claims payments (the average 30-day payment is based on the total claims paid to the provider/supplier between August 1, 2023 and October 31, 2023 divided by three). A provider can also request a specific amount but not more than the maximum allowable amount. Repayment begins immediately via 100% recoupment of Medicare claims payments owed to the provider/supplier, as the provider/supplier submits claims and claims are processed, after the date on which the payment is granted. Recoupment will continue for a period of 90 days. A demand will be issued for any remaining balance on day 91 following the issuance of the accelerated and advance payment. Interest will start to accrue 30 days after a demand is issued. Full details on the MAAP. Contact your Medicare Administrative Contractor to request funds.
- State Medicaid Programs. Check with your state’s Medicaid program, as some are also advancing funding similar to the MAAP program.
- Other Payers. Talk with non-United payers and inquire if they have any programs or assistance available to you in the short-term.
- Accounts Payable. For bills/invoices due, talk with your vendors about delaying or spreading out those payments further to assist with cash flow.
As always, reach out to CLA with questions or if we can assist you during this situation.
Jennifer Boese is the Director of Health Care Policy at CLA. She is a highly successful public policy, legislative, advocacy and political affairs leader, including working in both the state and federal government as well as the private sector. She brings over 20 years of government relations and public policy knowledge with her to CLA. Well over half of her career has been spent dedicated to health care policy and the health care industry, affording her a deep understanding of the health care market and environment, health care organizations and health care stakeholders. Her role at CLA is to provide thought leadership, policy analysis and strategic insights to health care providers across the continuum related to the industry's ongoing transformation towards value. A key focus of that work is on market innovations and emerging payment models. Her goal is to help CLA clients navigate and thrive in an increasingly dynamic health care environment.
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