Change Healthcare Incident Update
Description:
Change Healthcare is experiencing a network interruption related to a cyber security issue. As a resu
lt, Therasoft has suspended all transaction connectivity (to and from) with Change Healthcare until the issue is resolved. This includes the exchange of Claims, Claim Status, Remits, and any other electronic transactions. Multiple payers are impacted by this issue. Unfortunately, we do not have specific details about the nature and scope of the incident. They have been posting regular updates, but there is no indication of a timeline of when they expect things to be back online. You can use this link to check status and subscribe to updates from Change Healthcare:
Subscribe to Change Healthcare Status Updates
Services affected:
Change Healthcare e-prescribe systems have been rebuilt and are in testing. While Therasoft does not use Change Healthcare for e-prescribing, some providers may have experienced issues with pharmacies receiving prescriptions or difficulties with EPCS services related to the Change Healthcare outage. Those providers can expect a return to normal in the next few days.
Claims, status updates, ERAs, and eligibility checks continue to be non-functional. Change is prioritizing those who must use their tools, such as Therasoft customers, as part of their recovery. They recognize that it is not easy to find alternatives for claims, and some payers can only receive claims through Change Healthcare. They are working hard to restore those services as soon as possible, but did not provide a timeline for when that may be.
Optum is establishing a short-term bridge payment system for providers. Providers will be able to go to a website to enroll and verify eligibility for the program. You will be required to have an OptumPay account. Funding will be provided weekly to eligible providers based on claims history. Change has indicated that payments will be issued for the duration of the interruption, and that they expect payments will need to be repaid after claims resume normal operations.
Therasoft response and plan of action
Updates:
Therasoft will post any new information or change in status as soon as details are made available to us under the News and Updates link at the top of your Therasoft screen. You can use this link to register in our Help Center to have these updates sent directly to your email inbox: Subscribe to Therasoft News and Updates. We continue to look into all possible options and to provide as much information and transparency as possible.
➠For payers that do not require EDI enrollment:
On Monday 2/26 we started rerouting all claims for payers that do not require EDI enrollment to an alternate clearinghouse for processing. We believe the majority of these claims should go through without issue. You can check the status in Therasoft under Insurance/Claim Status. Please be aware that processing and response times could take longer than usual due to the increased volume and backlog.
➠For payers that do require EDI enrollment, such as Medicaid, Medicare and some BCBS the following options are available:
Option 1 - You are welcome to queue up claims and we will submit them when services are operational again, if you are able to wait. This is the least amount of work for you at this time, but obviously payments will be delayed. Claims will be held and queued for when the clearinghouse is functional again. We expect there to be a backlog when claim submission resumes, which may lead to a continued delay in submission and claim status updates. However, our team has already begun preparations for enhanced monitoring of our claim submissions to ensure all claims are successfully sent as soon as possible. We have plans in place to temporarily scale our services to clear the claims queue and return to real-time status as quickly as we can. However, we do not know when this process will begin or for how long claims may be delayed once it does.
Option 2 - You can easily create paper claims for any date of service by following the instructions listed here. This will allow you to generate CMS-1500 forms for any payer that accepts paper claims. Some payers no longer accept paper claims so you should check with them beforehand. Most of the time you can find this information in the provider section on the payer's website. We caution you that using paper claims are going to be very slow to be processed due to a huge surge. Payers such as Aetna are strongly encouraging providers to not send paper claims. The long delay to process paper claims versus the remaining delay for Change Healthcare to come back online should be considered. To avoid submitting duplicate claims, any claim submitted outside of Therasoft should be marked as externally submitted in the status drop down on the payments page under Individual/Payments.
Option 3 - Many payer portals will allow you to manually submit claims. This option is most likely going to be the quickest and easiest way to submit claims without having to complete paperwork and wait for approval. It's always best to verify with the payer beforehand in case they have specific requirements for billing. Most of the time you can find this information in the provider section on the payer's website. To avoid submitting duplicate claims, any claim submitted outside of Therasoft should be marked as externally submitted in the status drop down on the payments page under Individual/Payments.
Option 4 - See if your payers are supported by Office Ally. You can use this link to search by payer name or payer ID for enrollment requirements: Payer List Search. Please contact our support team for assistance with the enrollment process by submitting a Support Ticket.
Below are some frequently asked questions, and the information we have available to answer them. This post will continue to be updated as we gain additional information.
Q: What services are being affected?
A: Electronic claim submission (including EDI-to-paper claims), ERAs, and real-time eligibility (RTE) checks are all down during this outage. Appointment reminders, credit card processing, telehealth, secure messaging, and e-prescribing* are all fully functional and not affected by the outage.
Q: You said that e-prescribing was not affected by the issue, but I have been having trouble. What happened?
A: E-prescribing in Therasoft does not involve Change Healthcare. However, Change does play a prominent role in communication for prescribing. Many pharmacies use Change Healthcare to receive prescription information and PBMs use Change Healthcare to provide benefit and formulary information. In those cases, prescriptions may be successful in Therasoft but fail to reach the pharmacy. You should receive an error message letting you know the transmission failed. In those cases, other methods of prescribing should be used. Change Healthcare has reported that all patient care services are receiving priority in their recovery, and specifically reported concentrating efforts on their e-prescribing services. They reported having rebuilt their network and are currently testing it. Change expects services to be functional again soon.
Q: Will I still be paid on claims that I submitted prior to the incident, or claims that I submit directly to the payers in the meantime?
A: Yes. Neither Therasoft nor Change Healthcare are directly involved with EFT (electronic funds transfer, aka direct deposit). Any claims that are successfully submitted to any payer will continue to be processed and paid as normal. As of this time, UnitedHealth Group has stated that any claims submitted to a UHC/Optum payer will continue to be processed and paid as normal.
Q: Will I receive ERAs for those payments?
A: Yes, once systems are fully functional ERAs will be sent to Therasoft. While the clearinghouse is down, no ERA from any payer will be sent to Therasoft. If you wish, you can download ERA files from any capable payer portal and upload them to Therasoft. This will allow you to continue to easily post insurance payments as normal. Once ERAs begin flowing again, this may cause some duplicate payments to be registered in Therasoft. You can mark those duplicate ERAs as processed without posting an additional payment to ensure your bookkeeping remains accurate.
Q: Can I submit claims through Therasoft while the clearinghouse is down?
A: Yes, all claims submitted through Therasoft will be held and queued for when the clearinghouse is functional again. We expect there to be a backlog when claim submission resumes, which may lead to a continued delay in submission and claim status updates. However, our team has already begun preparations for enhanced monitoring of our claim submissions to ensure all claims are successfully sent as soon as possible. We have plans in place to temporarily scale our services to clear the claims queue and return to real-time status as quickly as we can. However, we do not know when this process will begin or for how long claims may be delayed once it does.
Q: What other options do I have to submit claims?
A: You can easily create paper claims by updating the submission method for any date of service. This will allow you to generate CMS-1500 forms for any payer that accepts paper claims. Many payer portals will also allow you to manually submit claims. For any claim submitted outside of Therasoft, you should mark the claim as externally submitted to avoid submitting duplicate claims.
You can also sign up for a third-party clearinghouse account with a different vendor, such as Availity. Change Healthcare has been working with Availity to help support them in ensuring seamless claim submission where possible. Learn more about registering with Availity and next steps. Other third-party clearinghouse options include NaviNet and Office Ally.
Q: How can I find out more information about claim statuses or check eligibility?
A: The best solution would be to go directly to payer portals. Most payers have an electronic portal where you can check eligibility, submit and monitor claims, and see remittance information. If the payer does not support downloading 835 ERA files, but you can view a PDF or insurance payment directly in the portal, you can manually enter the insurance payment in your Therasoft account.
Q: Do you have more information about what happened, or a potential timeline for operations to return to normal?
A: As is usual in any cybersecurity incident, Change Healthcare is not providing much detail about the specifics of the attack. In a regulatory filing, UnitedHealth Group reported believing a "nation-state associated threat actor" gained access to their information technology systems. It is now believed that this attack is related to the ALPHV/Blackcat Ransomware-as-a-Service. It is not known if any data was exfiltrated from affected technology systems, though forensic experts and law enforcement agencies have been engaged to determine the scope of the issue. Change Healthcare is using multiple approaches to restore services in a safe and secure manner. They have reported that they are focusing on systems directly impacting patient care first, such as those related to e-prescribing and imaging. They are acutely aware of the impact of delays on the revenue cycle and will bring those systems online as soon as possible.
Q: Does this have any effect on the security of my Therasoft account?
A: No. Your Therasoft account is entirely separate from Change Healthcare. Upon becoming aware of the incident, we immediately engaged our internal cybersecurity playbooks to begin assessing the potential impact to Therasoft. Our connection to the clearinghouse had minimal risk from the beginning. User accounts are entirely separated, so there is no need to change your Therasoft password related to this issue. Our risk team has been working closely with our technology teams to identify ways to enhance monitoring of our systems and restart our connections safely when Change Healthcare is ready to do so. In addition, Change Healthcare has given repeated assurances that they will not bring any service online until they are absolutely certain it is safe to do so and will immediately disconnect any service they suspect may have an issue.