In a March 11, 2024, letter to the U.S. Department of Health and Human Services (HHS) (PDF, 134KB)opens in new window, APA Services urged the agency to take stronger action to compel Change Healthcare, along with its parent corporations Optum and UnitedHealth Group, to shoulder the responsibility for addressing the fallout from the recent ransomware attack on the electronic health data processing companyopens in new window. The February 21, 2024, attack disrupted Change Healthcare’s processing of billions of claims submissions, provider payments, eligibility confirmations, prior authorization requests, and coverage determinations, and is considered the most significant attack on the U.S. health care system in history. The attack occurred within days of reports that UnitedHealth Group is under investigation by the Department of Justice over antitrust concerns.
In the letter, APA Services notes that the failure of Change Healthcare’s security systems and the shutdown of its processing operations are occurring in the midst of a mental health crisis. The association also notes that many psychologists provide mental health care services in small practices, and often lack the cash reserves and administrative support to navigate communication changes and workarounds. “For small practices, every single day that they continue to go without being able to verify benefits, submit claims, and receive payment compromises their ability to pay for operational costs and ultimately hinders their ability to deliver vital mental health care to the public at a time when the need is overwhelming,” the letter states.
The Centers for Medicare and Medicaid Services (CMS) has announced that Medicare Administrative Contractors will consider applications for advance payments for services provided by Part B providers, and that it is urging Medicaid managed care plans to make prospective payments to impacted providers, as well. The association urges CMS to take stronger steps, including by requiring Medicare Advantage, Medicaid, and Children’s Health Insurance Program plans to make advance payments available to providers, and to remove or relax prior authorization, utilization management, and other filing requirements for providers affected by the cyberattack.
Based on information released by Optum, payers and providers are advised to adopt certain recommended workarounds such as switching to another health claims clearinghouse. As part of its most recent guidance posted on March 7, 2024opens in new window, Optum has advised the following:
- Payments platform: Electronic payment functionality will be available for connection beginning March 15, 2024.
- Medical claims: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, 2024, restoring service through that week.
In light of the above, psychologists should consider whether to switch to another clearinghouse or to wait for the claims processing and payment platforms to be operational. If you use an electronic health records system, or practice management or billing platform, the vendor may have additional information for workarounds. You may also want to apply for some of the advance claims payment funds provided by CMS or Optum.
Note: Not all health insurance companies have been affected. Providers are encouraged to regularly check the Optum webpageopens in new window and HHSopens in new window webpage for continued updates.
For more information, contact Scott Barstow.