What Happened? 
On February 20th, 2024, Optum, Inc. reported a cybersecurity breach causing significant network disruptions to its Change Healthcare clearinghouse services. This issue led to an immediate shutdown of systems to prevent further damage, affecting both Change Healthcare’s operations and those of its connected third-party services, including many used by healthcare providers and pharmacies. This outage has made it challenging to access patient benefit information, submit claims, and other critical services.
Staying Updated on the Outage
LATEST UPDATE 3/26/24 & OPTUM FORM INSTRUCTIONS FOR IEDI
For the latest updates on the outage, providers can check communications through ConnectCenter or the clearinghouse portal, or the Change Healthcare status page.
Outage Duration: How Long Will It Last?
It remains unknown how much longer the systems will be down. Change Healthcare is working with law enforcement and cybersecurity experts to understand the scope of the attack, and is proceeding cautiously in trying to restore services. Updates will be provided as more information becomes available.
Impact on CGM Users
The disruption affects providers using:
- Practice management systems connected directly to Change Healthcare for EDI transactions.
- CGM’s eMEDIX clearinghouse services for claims, remittances, attachments, and eligibility checks, as Change Healthcare has some exclusive connections with payers, meaning all clearinghouses may need to connect with them for certain transactions.
- Services connected to the CommonWell Health Alliance and prescribing services linked to pharmacies using Change Healthcare as their clearinghouse.
What About Claims Processing Prior to the Outage?
For claims that were sent to payers before the Change Healthcare outage, the process remains largely unaffected. These claims should have been received by the payers and are being processed according to their standard policies. As a result, any payments due from these claims are expected to be made through Electronic Funds Transfer (EFT) or other customary methods your practice has established with the payers.
What About Receiving ERAs?
During the outage, Electronic Remittance Advice (ERA) files that normally route through Change Healthcare to your system will be temporarily unavailable. However, there’s a workaround. You can access these ERAs directly from the payers’ portals. Once downloaded, these files can then be uploaded into your practice management system to keep your billing and payments updated. It’s important to note that when ERAs begin to automatically flow again, you should ensure that these are not duplicated within your system. If you’re unsure about how to import ERAs or need to know how to avoid posting them automatically, please reach out to our support team for guidance.
Managing Claims and Patient Information
- Electronic Claims: CGM’s systems are set to continue accepting and queuing electronic claims for processing. They are also rerouting claims to alternative paths to ensure continuity.
- Paper Claims: Providers can still submit paper claims where applicable, with systems tracking submissions to avoid duplicates.
- Patient Eligibility: CGM has begun rerouting eligibility checks through alternative pathways to ensure providers can still access this vital information.
- Patient Communications and Statements: Due to the outage, there might be delays in processing patient statements through Change Healthcare. Printing statements directly is a recommended alternative to keep patients informed.
Microwize is committed to supporting healthcare providers affected by the Change Healthcare outage, providing resources, updates, and alternative solutions to maintain operations during this challenging time. We understand the importance of continuity in patient care and are here to assist our clients in navigating through this disruption, including switching to the eMEDIX clearinghouse as a secure and reliable alternative. Optum has also implemented a Temporary Funding Assistance Program to “help bridge the gap in short-term cash flow needs for providers impacted by the disruption of Change Healthcare’s services.” You can learn more here.
