Change Healthcare Cyber Attack Response

Practice Update Friday March 15, 2024

CMS recently published a broad list of frequently asked questions to address the CHOPD Accelerated and Advance payments. Among many key points of clarification, one was that practices, who are submitting paper claims to help alleviate the disruption in electronic claims submissions, are still eligible for a CHOPD accelerated or advance payment. Visit their website for the full list of FAQs

Practice Update Thursday March 14, 2024

We recently held a practice webinar to share additional information about the CMS CHOPD Accelerated advance and payments and Aledade's One Time Accelerated Payment program. If you were unable to attend, you can access the webinar recording here. Please note you will need to register using the form on the right to access the recording.

Practice Update Tuesday March 12, 2024

Payer Specific Resources

The websites provided below are key resources for the most recent Payer-specific news, updates, and information, including impacts arising from the Change Healthcare incident.

Aetna	Amerihealth	BCBSKS	BCBSLA	BCNC	Carefirst
Centene	Cigna	Elevance	FL Blue	Healthy Blue	Highmark
Horizon	Humana	Regence	United	Viva

Practice Update Monday March 11th, 2024

Dive into the impacts of the Change Healthcare cyber attack with analysis in our latest episode of the ACO Show featuring Farzad Mostashri, CEO of Aledade, and a firsthand account by Dr. Christine Meyer. From the initial system shocks to the unforeseen challenges faced by healthcare practitioners, discover the resilience amidst adversity and innovative solutions bringing relief to medical practices.

Claims Processing

When will Change Healthcare services be fully restored?

UnitedHealth Group, (UHG), parent company of Change Healthcare, has stated that Electronic payment functionality is expected to be available for connection beginning March 15. Connectivity to claims network and software is anticipated to begin testing and reestablishment on March 18, with service restoration through that week. It is also important to note that there hasn’t been any firm dates defined for when any restored systems will be certified. Until the systems are certified some 3rd parties may not want to reconnect their systems.

Does Aledade have recommendations for a new clearinghouse?

We recommend speaking with your PM/EHR vendor to identify which additional clearinghouses are supported by them as that integration is the most important factor in your decision. If your vendor offers multiple clearinghouse options, evaluating their pricing and payer connections are secondary considerations to weigh.

What are the workarounds for submitting electronic claims?

Payer portals are a workaround for submitting electronic claims. This may be any combination of payer-specific portals as well as the state’s MAC for Medicare and solutions such as Availity and Office Ally which allow for electronic submission to a wide range of payers.

Is there a different way to submit claims to Medicare during the downtime?

Medicare has agreed to paper claim submission.
Aledade Accelerate Financial Assistance:

How will Aledade determine eligibility for the Aledade Accelerate program?

Aledade Accelerate is a portfolio of programs with varying eligibility. For the Change Healthccare Cyber Incident response, all Aledade partner practices are eligible to apply for financial assistance, with funding allocations to be decided on a case by case basis.

Can the practice receive a monthly loan in addition to a lump sum due?

Practices who are approved for the Aledade Accelerate Monthly program can receive their monthly payments in addition to a lump sum payment to assist with Change Healthcare hardships.

What is the expected response time from Aledade for applications and what is the timeframe for Aledade Accelerate funding payments to be received in practice accounts?

Once a practice submits an application, Aledade will confirm receipt within 24-48 business hours. A decision will be rendered in as soon as one but no later than seven days from that submission. Practices who agree to the offer will be required to sign an amendment to their Participation Agreement that details terms associated with the advance on shared savings. Upon contract execution, funds will be deposited in the practice account in an estimated 3 to 5 business days.

What are the terms associated with accepting Accelerate funds?

The funds are an advance of your shared savings and are to be used to help cover your operating expenses during this challenging time. If possible, repayment should happen as soon as your practice begins receiving any suspended payments due to the cybersecurity incident. If this causes undue hardship to your practice, we will recoup the funds from shared savings earned by your practice, by withholding up to 100% of any such payments we are scheduled to make to you. See your amended Participation Agreement for additional details.

How will these payments affect our taxes?

Please consult your tax advisor for any taxation related questions.

Will interest be charged on Aledade Accelerate dollars?

The lump sum is an interest-free advance provided as an advance on shared savings.

Who should be the contract signer for these financial assistance programs?

An individual with the right to sign documents on behalf of your practice should sign the contract; that is, an individual with signatory authority.
Payer Implications:

Where can we find a comprehensive resource on payers connected to Change Healthcare?

Some payers have added Change Healthcare impact FAQs on their website. Please reach out to your local market leaders for more specific payer inputs. We have shared the payer responses to the market leaders for their awareness.

Is Medicare making advance payments to Part B physicians, and how can we approach them for this?

CMS announced extended financial relief to medical practices impacted by the Change Healthcare cyber attack, now offering accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions. Contact your MAC as soon as possible to request assistance.

Will payers extend the timely filing limit due to this disaster for the healthcare industry?

Market leaders have insight into payer's responses regarding extensions, we recommend you engage their market leader to discuss payer by payer.
Practice Support and Resources:

How does an organization know if it has been affected by the Change Healthcare issue?

If your practice is using Change Healthcare as your clearinghouse for any or all payers, you are definitely impacted as no claims or remittances can be exchanged with those payers. Even if your practice does not utilize Change as your clearinghouse, you may find that some subset of claims may have failed to transmit to payers that utilize Change exclusively for their own data exchange. To identify these claims and the extent of impact, monitor the claims queue in your practice management system; many of these transactions are now being flagged with error reasons indicating they failed due to the Change Healthcare cyber attack. As those payers become connected through alternate clearinghouses (or Change is restored) you can resubmit those claims. You may also elect to submit those failed claims directly through the payer’s portal or, if necessary, on paper.

Will this impact our practice’s Core4 Metric performance? Will any such metrics impact our relative portion of shared savings earned in 2024?

Any delays in billing claims, not just this incident, can show up in Core4 metrics as a temporary underreporting of performance. If you had to submit paper claims, that lag could be even longer, as we'll have to wait for CMS or other payers to send us back paid claims. Fortunately, months of claims run out are allowed after the end of the year before final Core4 metric calculations for distributions take place.
Patient Data Security:
CMS CHOPD Accelerated Payments

What are CHOPD accelerated and advance payments?

On March 9, 2024, CMS introduced the Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments for Part A providers and advance payments for Part B suppliers facing claims disruptions due to the cyberattack. These payments are intended to cover up to thirty days of claims payments.

Who is eligible for payments?

Providers and suppliers are eligible for CHOPD accelerated or advance payments. CHOPD accelerated and advance payments must be requested for individual providers/suppliers, i.e. unique National Provider Identifier (NPI) and Medicare ID (PTAN) combinations. Providers on Periodic Interim Payments are not eligible.

What are the required certifications?

Providers/suppliers must certify their inability to submit claims, disruption in claims payment or submission due to the cyberattack, lack of sufficient funding from other sources, and their intention to continue operations among other certifications.

How is the CHOPD payment amount determined?

The amount is based on the average of total claims paid to the provider or supplier between August 1, 2023, and October 31, 2023, divided by three, representing up to 30 days of Medicare claims payments.

Can providers/suppliers choose the amount of CHOPD payment they receive?

Yes, providers/suppliers can request either the maximum allowable amount, calculated based on their claims from August to October 2023, or a specific amount not exceeding the maximum.

What are the repayment terms?

Payments will be recouped from Medicare claims over a period of 90 days after issuance. Any remaining balance will demand repayment on day 91, with interest accruing 30 days after a demand is issued. Repayment terms do not offer administrative or judicial appeal rights or rebuttal rights.

What terms must be acknowledged for CHOPD payments?

Providers/suppliers must agree that the payments are advances on future claims, not loans, and acknowledge CMS’s repayment terms, including the inability to appeal the repayment demand.

Upcoming Webinar:

Join our upcoming webinar on Wednesday March 13th at 3pm EST for an update on the Change Healthcare Cyber Incident, including the latest on CMS Change Healthcare/Optum Payment Disruption (CHOPD) accelerated and advance payments and Aledade’s One-Time Accelerated Payment program. We'll also cover the impact on clearinghouses and payers stemming from this incident, ensuring you're informed and prepared. Don't miss this session designed to address questions related to these developments. Register to attend here

Health and Human Services Letter to Health Care Leaders on Cyberattack on Change Healthcare
On Sunday March 10, 2024 Health and Human Services published a letter to health care leaders on Cyberattack on Change Healthcare.

Key highlights of the letter include:

Urging UnitedHealth Group to expedite payments and improve communication with healthcare providers.
Calling on insurance companies to make interim payments and ease administrative burdens.
Encouraging clearinghouses and other healthcare entities to support providers in overcoming the challenges posed by the cyberattack.
Outlining actions by CMS to facilitate continuity of care, such as streamlining processes for changing clearinghouses and relaxing prior authorization requirements.
Highlighting the importance of adopting cybersecurity best practices to prevent future attacks.

Practice Update Saturday March 9th, 2024

CMS announced extended financial relief to medical practices impacted by the Change Healthcare cyber attack, now offering accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions. Payments must be requested for individual providers using unique National Provider Identifier (NPI) and Medicare ID (PTAN)combinations. Contact your MAC as soon as possible to request assistance. Here is a CMS list of MACs if needed.

Practice Update Friday March 8th, 2024

UnitedHealth Group published an update addressing the impacts of a significant cyberattack on the U.S. health system, particularly targeting the Change Healthcare claims and payment infrastructure. The company's efforts are focused on restoring services and providing relief to affected consumers and care providers.

Key Actions and Developments:

Restoration Timelines: Electronic payment functionality is expected to be available for connection beginning March 15. Connectivity to claims network and software is anticipated to begin testing and reestablishment on March 18, with service restoration through that week.
Funding Support for Providers: UHG will continue to offer the Temporary Funding Assistance Program through Optum to advance funds to medical, dental, and vision providers to cover the gap between historical payment levels, with no immediate repayment required until claims processing fully resumes.
Patient Support Measures: UHG has taken steps to ensure patient access to medications and care, including suspending prior authorizations for most outpatient services for Medicare Advantage plans and drug formulary exception review processes for Medicare Part D, effective until March 31.
Prescription Support: UHG has restored pharmacy claims and payment systems, ensuring patients' access to medications. Optum Rx pharmacies have been proactive in sending medications to members based on their needs, and the company has pledged to reimburse pharmacies for all appropriate claims filled with the understanding that the medications would be covered.
Financial Considerations: UHG plans to exclude the principal impacts of the cyberattack from its adjusted earnings calculations.

Practice Update Thursday March 7, 2024

Aledade Cyber Response Webinar Recording
We recently held a practice webinar to share additional information about the Aledade Accelerate program and address practice questions or concerns about the Change Healthcare incident. If you were unable to attend, you can access the webinar recording.

Webinar: Change Healthcare Incident

Practice Update Wednesday March 6, 2024

Policy Measures to Support Healthcare Providers:

Aledade is working closely with the AAFP, AMGA, and APG to secure help for independent practices.
We have met with senior officials at CMS and HHS and will soon meet with WH staff.
Our coalition is also securing letters of support from key members of Congress
CMS has implemented Accelerated Payments, but for part A providers only
CMS has instructed MACs to shorten the timeline for changing MACs to no more than 4 days
CMS has urged MA plans to work with affected practices

Health and Human Services Response to Change Healthcare Cyberattack

The U.S. Department of Health and Human Services (HHS) is actively addressing the cybersecurity incident that affected Change Healthcare. Recognizing the attack's significant impact on healthcare operations nationwide, HHS is prioritizing minimizing disruptions and maintaining continuity of care.

HHS is coordinating with UnitedHealth Group, state partners, and federal agencies, including the FBI and CISA, to mitigate the impact and ensure continuous healthcare service. Regular updates and guidance are being provided in collaboration with various stakeholders to understand and address the situation effectively.

Change Healthcare Temporary Funding Assistance Program Review

We've heard the collective concerns from our practices about the terms associated with the Change Healthcare / Optum Temporary Funding Assistance Program. Our legal team has had the opportunity to review the terms and we want to provide all of our practices with the benefit of their observations. Click here to read our review.

Practice Update Tuesday March 5, 2024

Aledade Accelerate Financial Assistance Program

Aledade is taking action to support its network of primary care practices nationwide in the wake of this ongoing ransomware attack, which has rendered unavailable the payment and infrastructure systems that independent doctors use to pay for vital expenses. Click here to learn more about the Aledade Accelerate program.

Aledade is:

Advocating the Centers for Medicare & Medicaid Services to re-launch the Medicare Accelerated Payment program, through which the agency can pre-pay three months of claims based on the historical spending of these practices. Just as important, CMS can continue to pay in full any claims a practice submits until the Change Healthcare attack is resolved.
Providing resources for primary care providers to quickly locate alternative clearinghouse options compatible with their electronic health record systems.
Exploring ways to augment Optum support through an additional limited financial support program for Aledade partner practices

Aledade will continue to keep your practice informed about available support options. We ask you to communicate any practice concerns or needs as we navigate these challenges together.

EHR Guidance for Practices

Please refer to this EHR Guidance document for latest information on impact from the Change Healthcare incident. We've compiled this resource for informational purposes based on insights from our practices, conversations with EHR vendors, and other publicly available information. We can’t guarantee its accuracy given this ever-changing situation, so please confirm with your vendor before taking any action.

Upcoming Change Healthcare Cyber Response Webinar

We will be holding a webinar on Thursday, March 7 at 3 pm ET to share additional information about the Aledade Accelerate program and address practice questions or concerns about the Change Healthcare incident. Register to attend here.

Practice Update Monday March 4, 2024

The ongoing disruption from the Change Healthcare cyber incident continues to impact patient care and practice operations significantly, affecting prior authorizations, pharmacy operations, and the overall flow of claims and payments.

Recognizing the urgency of the situation, Optum has a Temporary Funding Assistance Program
which provides some cash flow. We are not sure to what extent these funds will meet practice shortfalls. We encourage affected practices to submit the application on that site to receive an estimate of weekly payments from Optum. Please read the terms of this program carefully to make sure they are acceptable to you.

Funding Assistance Program Summary:

Limited to covering payments specifically from UnitedHealth/Optum, not all claims and payments that would typically be processed through Change Healthcare's infrastructure.
Terms require loan repayment within five days, allow for immediate fund recoupment without notice, and impose broad waivers of liability along with stringent damage limitations.
Variability in assistance levels among providers, influenced by their billing and claim patterns with UnitedHealth/Optum.

On March 4, AHA
sent a letter to Congress, urging for actions to support hospitals in their patient care efforts as they deal with the ramifications of an ongoing cyberattack affecting the entire health care system. They sent a letter to UnitedHealth Group on the same day, expressing concerns regarding the Temporary Funding Assistance Program that the company announced on March 1.

Practice Update March 1, 2024

On February 21, a cybersecurity incident occurred at Change Healthcare, a subsidiary of Optum, involving a cyberattack that led to the unavailability of its Medical Network and Medical Network API systems. Change Healthcare has not yet provided an expected resolution time or date. We wanted to provide you with an update on the situation as we understand it, and how we understand it impacts the healthcare industry and potentially your practice.

Practice Impact

Revenue Cycle Disruptions

The inability for practices to submit claims for any extended period of time will create cash flow challenges. Practices who utilize Change Healthcare as their primary method of submitting claims to payers are most impacted as no claims can be submitted to the payer, nor can any remittances be received.

Payers using Change Healthcare for data exchange are also affected, leading to delays in claims processing, including UHC, among approximately 400 others. Payers are in the process of transitioning to different exchange partners; however, the timeline for resolution remains uncertain. Meanwhile, it's probable that claims submitted during the incident will encounter errors or stay pending in the submission queue.

Workflow Disruptions

The inability to perform any combination of eligibility checks, process remittances, ePrescribing, or send/receive lab results may necessitate time consuming workarounds that are likely to slow day to day clinic operations.

Data Disruptions

We are not aware of any impact to Aledade and Aledade data, but are continuing to monitor the situation. Practices will not have the most recent claims data available in the Aledade App to refresh worklists or update diagnosis suggestions. For practices unable to submit claims, Aledade will also not be able to receive that claims data to refresh data in the Aledade App. This will result in some worklists and diagnosis suggestions not resolving automatically (For example, a patient with an AWV completed during this outage may remain on the Wellness Worklist or a diagnosis suggestion documented in a visit during this outage would continue showing as a suggestion).

Potential Paths Forward

EHR/PM vendors, including Athena, eClinicalWorks, and Veradigm, have activated and continue to enable alternative pathways for submitting claims to payers, potentially allowing for a seamless continuation of exchanges with many Payers.

Additionally, practices have the option to switch clearinghouses, with some EHR vendors offering expedited paths for implementation.

Another available choice for practices is to manually submit claims and download remittances through Payer Portals. Alternatively, practices may choose to wait for the restoration of Change Healthcare services.

We understand Optum is offering financial for impacted practices. For more information on this program visit the Optum Resource page here.

Contact Us

Contact changeincidentresponse@aledade.com for any questions.

Helpful Links:

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