Earlier today, our crew here sent out a message to all of our clients about what we're seeing with the Change Healthcare debacle.  Because of our position as a clearinghouse ourselves, we're able to took further behind the curtain and are willing to share what we see.  I've removed some PCC-specific elements to not bore those of you who aren't PCCers, but the rest of you may find a helpful explanation in here.  Kudos to the team at PCC for being so on the ball with this!

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Optum/Change Healthcare (CHC) EDI services were disrupted by a cybersecurity issue beginning on February 21, 2024. By February 23, it was evident that the extent of the event’s reach was causing delays in real-time eligibility, electronic claim, and electronic remittance advice processing for a large number of payors.

How PCC Is Responding

We have no cause to believe that PCC systems are affected beyond CHC’s processing delays. We continue to work hard to identify and address all that we can to mitigate the effect of this interruption to CHC services used by PCC clients. Our highest priority is to mitigate the effects on our clients’ cash flow as efficiently as possible while providing resources and updates as they become available.

[PCC stuff here]

Along the way, we are uncovering more details about exclusive EDI processing contract arrangements on which our efforts are bound. Some of these arrangements require practices to submit a new claims provider enrollment agreement. Even in those cases, there are a few questions which only the payer(s) can answer:

• How long will it take for the payer to process the agreement? Note: Time estimates may have varying degrees of accuracy.
• Will CHC return to normal operation before the payer processes the new agreement?

Whether or not a practice should enter into such agreements while CHC metes out details about its service recovery plan is a judgment call practices must make. Contacting your payers to determine how long their agreement processing is taking right now is your best first step. PCC customizes claim routing to meet your unique combinations of clinician contracts and payer billing requirements.

What Your Practice Can Do

We suggest these additional actions to consider as part of your response to this interruption:

• Pay closer attention than ever to your claims oversight. PCC is not the only entity making changes in response to this interruption. Watch every claim closely for unusual responses and delays.

• Consider possible outcomes. For example, rebatching claims after rerouting may result in payments arriving before CHC’s recovery and may yield duplicate claim responses to any claims CHC receives and processes. Any preparation you can make to address those responses is a good idea.

• If you inquire with payers about rerouting ERAs:

  • Be aware that routing changes can take 8 weeks or more (even without the additional burden payers may be under right now).
  • Some payers have portals through which they make downloadable ERAs available.
  • Fees may apply to any or all of these additional services. Be sure that you know in advance what you’re agreeing to. It couldn’t hurt to ask if fees could be waived in light of current circumstances.
  • Consider temporarily agreeing to receive EOBs by mail.
  
  

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Claims Migration Details

Some of PCC’s migration work is a moving target as payer entities simultaneously enact their own dynamic responses. In addition, we are seeing an uptick in edits you’re making to your payer IDs. While understandable, this can potentially slow down PCC’s ongoing work. Please understand that configuration changes you are making right now are happening in the midst of a complex situation and could affect claim routing outcomes.

PCC carefully considers the best approach to claim migrations for payers who require provider claim enrollment. This type of enrollment with payers is a one-way road and replaces existing arrangements. It could take payers longer to process these enrollment applications than it does for CHC to restore services. HHS is encouraging payers to waive re-enrollment requirements. We have yet to hear of any payers doing so.

PCC has found alternate claim routing for 93% of claims that would otherwise remain in limbo due to this disruption. For context, 28% of the roughly 450K claims processed through PCC each month would all have been affected without action.

United Health Group (UHG) statement recently stated, “We [Change Healthcare] expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.” (That page has remained unchanged since 3/18). While awaiting any details related to this plan, PCC can’t form expectations around CHC’s next actions. Similar to the Optum IEDI option that is available and recommended by Optum, PCC continues to analyze and seek more direct and currently operational claim routes. At the same time, our inquiries to our CHC and IEDI representatives remain as yet unanswered.

Other resources we’re aware of include UHG’s own Cyber Response Webpage and a Temporary Funding Assistance tool. For the funding assistance, CHC is mobilizing Optum Financial Services to provide temporary funding assistance to help with short-term cash flow. The terms of this agreement have undergone several updates over the last few days. Optum has released this webinar recording, which features instructions and highlights.

Many thanks to all of you who are sharing the details you gather from your payers. Crowdsourcing solutions while this ongoing issue has yielded some impressive outcomes and lots of time and money savings. Keep it coming!

You may also be experiencing eligibility failures related to the CHC interruption. Migrations for eligibility checking are also underway at PCC. Stay tuned for more information about the specifics. In the meantime, another source of eligibility information is via the affected payer’s portal.

Future Plans

[PCC stuff]

Practices should continue to pay closer attention than usual to claim statuses and errors. Practice owners and admins may also want to review the recent post on PCC’s Chip Hart’s blog. It includes a great bulleted list of actions that may be taken right now in light of the cashflow challenges this issue may be causing.

UHG continues to hold periodic webinars, and PCC is in attendance. The information shared at the most recent event; however, it has not changed any of our previously shared expectations.

The status of other affected services looks like this:

• Eligibility: Roughly 33% of real-time eligibility requests remain affected.
• Electronic Remittance Advice (ERA): According to our estimate, 28% of affected remittances cannot be successfully received.
• Electronic Funds Transfer (EFT): PCC does not manage or have access to information about your Electronic Fund Transfers (EFT) . The affected payers are your best source for answers to your EFT questions and concerns.