By now, everyone is aware of the UHC breach and its massive impact on most healthcare providers. The resolution of this problem has proceeded at a snail’s pace. Some, but not most, systems are back in operation, but specific clearinghouses, payers, and EMRs remain crippled. You can follow the update here: https://www.unitedhealthgroup.com/changehealthcare
Information and advice throughout the healthcare system, especially on social media, has been varied and often conflicting. Here are UHC statements as of April 5.
- Many systems are restored, but many are not. As of March 27, UHC states they have reconnection of most processing channels through a Relay Exchange system and claims are being processed. The new system requires payers and clearinghouses to go through a reconnection process, something entirely out of your control. PCS has many reports of claims that are starting to process, but some systems are still completely shut down. We have variable reports regarding Apex clearinghouse Eyefinity and Compulink EHRs, but it appears that none of those insurance processing and payment systems are operational.
– COMMENT: Despite these claims, a review of the published UHC action plan shows the vast majority of all UHC systems, including claims processing, are still not operational.
- Temporary financial relief is in place for severely impacted providers. You can determine your eligibility regarding UHC options here: https://www.optum.com/temporary-funding-assistance.html and information on advance payment alternatives from CMS here: https://www.cms.gov/change-healthcare/accelerated-payments
- One feature still causing significant problems, especially if you have remote billing, is the Remit Access feature which allows access to payment histories and EOBs. These are being fixed slowly. You can access the status of this feature here: https://changehealthcare.com/payer-lists
PCS Response to Frequently Asked Questions:
The following are our opinions in response to frequently asked questions about this issue. These should not be considered legal advice or concrete statements of fact regarding the Change Healthcare Breack or UHC actions.
- What is taking so long?
This was a massive information breach, possibly one of the largest ever. The magnitude and details are still unclear, but the impact on claims processing and payments is very clear. All we can go by is statements from UHC which continue to outline a recovery plan that could take a month or more to complete. - Do you recommend changing to a clearinghouse not supported by UHC?
First, very few clearinghouses are not impacted either directly or indirectly by this breach. Second, changing can be a slow process. Third, the resultant mix of places where claims reside may be a nightmare to untangle down the road. - Do you recommend filing paper claims?
PCS has received varied reports on paper claims being processed, but in general, it has not been effective. The normal adjudication period for paper claims is 29 days, but with providers filing massive amounts of paper claims, that period could be a fantasy number. - Are there alternative filing options?
In most cases, no. Several Medicare administrators have information on their websites about claims processing options. Review those on your MAC website. - Do you have any idea when things will be back to normal?
Honestly, we do not. The process has already been exceptionally slow and UHC is not going too far out on a limb with promises. - I saw on social media that I can make patients pay upfront for all services until this is resolved. Is that correct?
No. Your provider contracts do not allow patient billing for covered services, and no exception is stated in any contract we are aware of. - I heard some payers, especially Medicare, may start paying claims without going through the proper adjudication process. Is this true?
There are reports to this effect. The payments will likely be tied to the billed amount, not the payer fee schedule, so be careful accepting these likely inflated payments as eventually a reconciliation to the payer fee schedule will be forthcoming. - Is there any clarity on how this impacts HIPAA compliance?
No. Until UHC releases the details of the breach, determining the breach level and necessary actions is impossible.
While we wish there was more to report, this problem is clear to persist for some time to come. We will update you as we know more.
