Upon learning of the cyberattack on Change Healthcare, AHIP’s members took immediate steps to implement business continuity plans, creating tailored solutions to serve their provider partners and to ensure patients continue to have access to the medical care and prescriptions they need.
The scale and scope of impact across health insurance providers, physicians and hospitals varies significantly. While not all health insurance providers use Change Healthcare’s products, those that do have experienced varied service availability and are working diligently to pivot to alternative approaches. Broadly, the business processes that have been impacted and where alternatives have been implemented include:
- Enrollment,
- Eligibility,
- Prior authorization,
- Claim processing,
- Generation of Explanation of Benefits,
- Chart abstraction, and
- Quality measurement submission.
These areas of impact also apply to physicians, hospitals, pharmacies and other providers depending on the Change Healthcare products and services they each use. For many providers, their ability to quickly adopt new operational and payment processes has been a challenge.
Recognizing the interconnectedness of health care and that the needs across the system vary significantly, a one-size-fits-all solution is not feasible or even the best way to maintain real-time operations to support patient care.
As a result, health insurance providers have prioritized workarounds and alternatives that are highly customized to their situations and that of the individual provider partners such as:
- Increasing call center staff and providing up-to-date guidance on how to assist consumers and providers,
- Hastening the processing of electronic claims that were received prior to the outage to enhance provider cash flow,
- Clearing existing paper claim loads to both enhance provider cash flow and to be ready to accept an influx of new paper claims,
- Connecting to new clearinghouses and claim payment services while assisting providers in doing the same,
- Providing targeted advanced payments to providers for whom cash flow is problematic,
- Re-routing patient eligibility checks via phone,
- Avoiding impacts to prior authorization through reliance on phone, fax and portal request access.
Hospitals, doctors and other providers that are experiencing critical cash flow problems or other significant disruptions should contact their health insurance provider partners to discuss solutions.