Change Healthcare Outage Update

Last updated April 22, 2024 at 8:21am CST

4/22/2024 Update:

Our system is now connected to Claim.MD's eligibility service and eligibility reports can be run again. There are some differences between Change Healthcare's service and Claim MD's depending upon the payer. Our switch to Claim.MD is now complete. Some payers that depend upon Change Healthcare's system for enrollments (even those initiated from Claim.MD or other clearinghouses) are still unable to process those enrollments while Change Healthcare's system is still inoperative. Change Healthcare is still not providing any timelines for when that part of their system will be restored.

3/30/2024 Update:

When you receive notification from payers that your enrollments through Claim.MD are completed, you can mark these as approved.

3/27/2024 Update:

Change Healthcare announced today they still do not have a timeline of when their clearinghouse will be functioning again. We still encourage our customers who have been delaying enrollments through the new clearinghouse, Claim.MD to initiate those as soon as possible.

3/19 Update:

We are continuing to help our customers complete the switch to Claim.MD. Common concerns that are coming up regarding the switch to Claim.MD:

We don't have enrollment timelines for Claim.MD.
We aren't receiving every submission confirmation back from Claim.MD. So if the enrollment icon in Sessions Health still says Instructions instead of the clock symbol, it doesn't mean it hasn't been submitted. Feel free to check with support@sessionshealth.com if you need confirmation.
Some payers don't let Claim.MD know that an enrollment has been approved, so let us know if you receive confirmation from a payer that your enrollment has been approved but aren't seeing it updated in Sessions Health. For those payers, we are applying a 7-day auto-approval of the enrollment because we'll never get notified of the approval. You'll want to make sure you don't submit claims until you receive the approval from the payer.

Change Healthcare had communicated this week there is still no confirmation or estimate when services will be restored.

Previous Claim.MD updates:

On 3/13/24, we successfully submitted all claims to Claim.MD that have been queued since the outage! There are a few exceptions and considerations to keep in mind:

Claims have not been sent for payers that first require an approved claims enrollment. These would likely be rejected so we did not submit them. Once we receive the enrollment confirmation from Claim.MD, the clock icon next to Claims in your Billing Settings > Insurance > Payers page will move to a green check-mark, at which time providers may submit claims.
Some payers do not let the clearinghouse know when the enrollment is approved. In this case, payers will send the provider a notification of approval. Because Claim.MD and Sessions Health are not notified, we will mark them as approved after 7 days. Providers will still want to wait until an approval notification is received before submitting claims or claims will likely be rejected. If providers receive notification that the enrollment has been approved prior to the 7-day period, contact support@sessionshealth.com and we will approve the enrollment in our system. In the future, we may add a “self-approval” solution so providers can approve the enrollment in their account once approval from the payer has been received.
Several payers still require Change Healthcare to process their claims regardless of the clearinghouse used to submit them. Those claims have been submitted but the status will state, “The claim was successfully sent to the clearinghouse for submission,” until the connection is restored and Claim.MD can further submit those claims to the payers. We’ve listed the payers with claims submitted that fall into this category below, but you may also search payers from the Claims.MD Payer List page. Impacted payers will have a “Change Healthcare Issue” message.
- Claims to these payers are on hold due to the Change Healthcare issue. Optum expects to restore connectivity to a large portion of the remaining affected payers between 03/18 - 03/22.
  - Agency Services Inc [64158]
  - CareFirst Administrators (Charlotte) [75191]
  - CHAMPVA HAC [84146]
  - Cofinity - Group Resources [42049]
  - Community Care Managed Health Care Plans of Oklahoma [73143]
  - Direct Care Administrators [DCA62]
  - Gilsbar Inc [07205]
  - Gravie Inc. [GRV01]
  - Group Administrators Ltd [36338]
  - Health New England [04286]
  - Health Payment Systems Inc [20270]
  - Kaiser PPO [94320]
  - Loma Linda University Adventist [37267]
  - Maine Community Health Options [45341]
  - ProviDRs Care Network [48100]
  - Sanford Health Plan [91184]
  - Trusteed Plans Service Corporation [91078]
  - VA Fee Basis Programs [12115]
  - Viva Health Plan [63114]
Although not required, we encourage you to also enroll in Remittance/ERAs at this time from your Billing Settings > Insurance > Payers page. Claim.MD will serve as the primary clearinghouse and will be fully supported going forward. As an added bonus, early feedback is that the enrollment process is much easier with Claim.MD compared to Change Healthcare.

Change Healthcare is stating that the week of March 18th, they plan to start restoring connectivity to their services. Even if connectivity restoration begins that date, Change Healthcare has provided no timeline for how long restoring connectivity will take to complete.

For any questions or concerns, please contact our support team at support@sessionshealth.com.

Summary of Issue, Impact, and Response

What happened to Change Healthcare

A cyber security issue was discovered at Change Healthcare, a subsidiary of Optum, on February 21, prompting the company to immediately disconnect all systems to prevent further impact. It was later learned that it was a sophisticated ransomware attack by a group know as ALPHV BlackCat. The impact of the Change Healthcare outage is felt nationwide as many hospitals, clinics, EHRs, and other clearinghouses depend on Change Healthcare for services. The company is working with security experts, law enforcement, and government agencies to resolve the issue. The company hasn't stated how long it will take to restore services, but do provide updates on their Cyber Response page.

Impact to Sessions Health

Your account with Sessions Health is safe. Change Healthcare's system is separate from your account and there's no need to take any precautionary measures. Out of an abundance of safety, we have temporarily disconnected the connection to Change Healthcare until services are returned. Here are the services impacted through Sessions Health:

Claims Submissions: We are unable to submit claims to Change Healthcare. You may still submit claims during this outage and we will keep them in queue to be submitted once services are restored and our connection is re-established.
Claims Status: We are not receiving claims status updates from Change Healthcare. We will process any claims status updates once services are restored and the connection is re-established.
Remittances / ERAs: We are not able to receive remittances during this outage. Any remittances sent to us after the service is restored will be processed by Sessions Health and applied to your claims and your bills.
Real-time Eligibility: This service is not available until Change Healthcare's systems are restored.
Payer Enrollments: We are not able to generate enrollment forms, but if you attempt to enroll, we will send you the necessary forms after the systems are restored.

Sessions Health Response

Since the Change Healthcare outage, we have evaluated several technical solutions, including a new clearinghouse integration. Given we still don't have a timeline when services will be restored, Sessions Health has made the decision to integrate our platform with a second clearinghouse, Claim.MD. We feel this decision allows for the quickest path to restore services while creating redundancy in the event of future clearinghouse outages. Our development team has successfully built the connections to this clearinghouse and we've submitted all claims that have been in queue since the outage, with the exception of those still needing enrollments through Claim.MD.

We continue to closely monitor the Change Healthcare situation, are communicating with the company, and attending bi-weekly status update meetings.

We understand the challenges many of our practices and providers are facing, and are working through this situation as quickly as possible.

Provider options and alternatives to submitting claims through Sessions Health

Your claims queued to be sent to Change Healthcare have been sent to Claim.MD for processing. Some claims that require enrollment have not yet been submitted. Some claims submitted to Claim.MD still have a dependency on Change Healthcare, so will be submitted to the payer once the connection is restored. Here are some other options to consider:

You may be able to submit claims directly through payer portals. You'll want to check with each payer whether this is an option. You may also check with other clearinghouses such as Availity or Office Ally to submit claims. However, you may need to sign-up for those services if you haven't already done so. NOTE: If you submit a claim outside of Sessions Health, you may Mark as Submitted Externally. We will ignore those claims and not send submit those to Claim.MD or Change Healthcare once services are restored to avoid submitting a duplicate claim.
You may create CMS-1500 forms through Sessions Health by following the steps to create a claim and clicking the Download button within the claim. These can then be printed and mailed to the payer if they accept mail-in claims. You may still experience delays with this approach as mail-in claims will take longer to process and payers may have a backlog of these claims.

Some payer portals may also support looking up claims status, remittances/ERAs, and eligibility checks. If you receive insurance payment records outside of Sessions Health, you may manually record your insurance payments in your account.

Top

Q&As

When can I expect the new clearinghouse to be ready?

The integration with Claim.MD is complete for submitting claims, receiving claims status, enrolling in claims and remittance/ERAs, and receiving enrollment status. We are currently working on posting remittance/ERAs to the claims in Sessions Health and enabling the eligibility report functions. You may need to enroll with some payers through Claim.MD before you're able to submit claims. You can do this in your Billing Settings > Insurance > Payers page immediately. At this time, we encourage you to also enroll in remittance/ERAs.

Will I need to re-enroll with payers using the new clearinghouse?

Most payers do not require enrollment to be able to submit claims. If you had to enroll with Change Healthcare, you'll most likely also need to enroll with Claim.MD. For those that do require enrollment to submit claims, you will see an Enroll button in your Billing Settings > Insurance > Payers page for each payer you need to enroll. Although not required, we encourage you to also enroll in Remittance/ERAs at this time as Claim.MD will serve as the primary clearinghouse and will be fully supported going forward.

How do I mark claims in Sessions Health that I submitted externally?

To support claims you submit externally, we've added a Mark as Submitted Externally option to change the status to Submitted Externally.

What solutions are Change Healthcare / Optum offering to resolve the issue?

For continuous updates, Change Healthcare has established a thorough landing page. Please visit uhg.com/changehealthcarecyberresponse to stay informed on the latest developments. You may also visit Change Healthcare's status page for a list of services and their status.
Temporary Funding Program Launched

Understanding the financial strain this situation may have imposed, a Temporary Funding Program has been officially launched to aid providers during this challenging period. We encourage you to explore the program details available at www.optum.com/temporaryfunding.
Key Points to Note:
- OptumPay Account Requirement: To participate in the Temporary Funding Program, providers will need to have an OptumPay account.
- No Fees or Interest: The program is designed to offer financial support without the burden of fees or interest.
- Repayment: Funds received under this program will need to be repaid from claims payments once services are fully restored.
- Eligibility: Specific eligibility criteria apply, though the details have not been disclosed. It remains uncertain whether all our providers qualify for this program.
- For those providers enrolled in Optum Pay who are not seeing the Temporary Funding tab in their Optum Pay accounts, that indicates that the Optum Pay system isn't recognizing your account as eligible. However, you can likely still get assistance by following these steps:
  - Please contact 1-877-702-3253 and explain that you are interested in the temporary funding program but you aren't seeing the tab in your Optum Pay account.
  - Fill out the Temporary Funding Application.
  - Someone from Optum will reach out regarding your application.
  - In response to the cyber attack, efforts are underway to establish Change-only payers connection through an Optum EDI solution, referred to as "IEDI." This initiative is part of a broader strategy to offer an alternative to Change Healthcare's services, ensuring continued support for companies like Sessions Health. While no specific timeline has been provided, progress is being made towards the setup of IEDI, and Change Healthcare may be "getting close" to its implementation. We understand the importance of this development for your operations and will keep you updated as more information becomes available.

What can I do to encourage our representatives to act?

We have drafted a letter to representatives to urge them to open up an emergency funding channel similar to what was done for businesses during the COVID-19 emergency through the SBA. Feel free to use this letter with your representatives and share it with others.