Change Healthcare outage - FAQ

On February 20, 2024, Change Healthcare (“Change”) notified the industry that it was experiencing a network interruption related to a cyber security issue. Change communicated that it immediately disconnected systems to prevent further impact. The disruption has continued since then and has impacted numerous Change and third-party systems connected to Change that our customers use either directly or through back end connectivity. Numerous other healthcare industry entities are impacted. 

(updated 03/04/24)

In addition to messages that CGM is providing through our standard CGM Portal and newsletter customer communication channels, you can also subscribe to updates at Optum Solutions Status (changehealthcare.com). United Health Group has also published this additional page: Information on the Change Healthcare Cyber Response - UnitedHealth Group.

(updated 03/15/24)

Unfortunately, there is no way to know. It is normal for companies that experience a cyber-attack to be careful about the information they provide as they work to determine what happened. As this time, it is not known if information was exfiltrated (uploaded) by the “threat actor,” but we do know, through a regulatory filing, that Change is working with law enforcement and forensic experts to determine the extent of the incident.

The Information on the Change Healthcare Cyber Response - UnitedHealth Group page includes ways users can stay abreast of Change's timelines for various services as well as updates on their forensic work.

CGM’s teams are working with Change and participating in information update calls. We will provide additional updates to our customers as we learn more.

(updated 03/15/24)

• Customers using practice management systems which connect directly to Change for EDI
• Customers using CGM's eMEDIX clearinghouse for claims, remits, attachments, eligibility, etc. Change has many exclusive connections with payers so all clearinghouses connect with Change to pass EDI back and forth
• Customers that send statements to eMEDIX.
• Those using CommonWell Health Alliance for clinical interoperability. Connectivity was restored on March 14
• Prescription networks including EPCS were initially impacted but as of March 2, Surescripts indicated that EPCS services are operational and recommended that practices resume normal e-prescribing and EPCS workflows

Claims that had already been forwarded to payers should now be in their adjudication systems and those without issues processed and paid per the payer’s policies. Those payments should still be received via EFT or other methods normally used between your practice and the payer. 

(updated 03/04/24)

ERAs that are routed through Change to our systems will not be available while their system is down. You will be able to go to payer portals that provide these and download from those sites and then upload into your practice management systems. Keep in mind that once ERAs start coming through automatically, you will need to ensure these ERAs are not posted. Please contact Support for assistance if you do not know how to import or revoke automatically posted remits. 

Temporary Funding Assistance Program

Providers who receive payments from payers who were processed by Change Healthcare were notified of their eligibility for a Temporary Funding Assistance (optum.com) program. This page includes FAQs about the program, whether you are eligible, and more.

We understand the impact that an inability to submit claims for services provided has upon our customers and their cash flow in the coming weeks. After all, we also run the market-leading ARIA revenue cycle management service and are thus as invested in solutions as our practice customers. We are doing everything possible to mitigate these issues, including providing continuing messaging, new functions, and a Guidance Document to help our customers understand and mitigate the outage’s impact. 

If you are not sure how to use certain optional functions outlined in this document, please open a support ticket and we’ll be glad to assist. 

• eMEDIX continues to accept claims so that connected practice management systems can keep functioning without system errors. If these are not automatically routed through non-Change pathways, claims are automatically queued for processing as soon as systems are live again. Users can easily see the status of forwarded or queued claims in the eMEDIX system. Refer to the Guidance Document.
• As described in the Guidance Document, for the few payers eMEDIX is not connected with, there is an option to export claims in several formats should payers support a direct upload to their sites.
• For those payer connections that do not require re-enrollment, eMEDIX has started re-routing new claims to minimize cash flow disruption for customers. The team is continually monitoring the integrity of these claim pathways. The vast majority of claims submitted since the outage are now going through alternative routes and reaching payers.
• Any claims that were batched will also be reviewed for re-routing should the Change outage continue.
• eMEDIX is also taking appropriate care of how it handles different responses from payers and whether claims should be re-submitted to other payers. We want to minimize disruption that customers may experience if there is a sudden deluge of conflicting claim status messages for duplicate and inaccurate claim responses/status that ends up creating even more work for our valued customers.

(updated 03/15/24)

Any of our customers that are already connected to eMEDIX should continue to use electronic processes. Approaching 100% of claims submitted since the outage have been routed to payers. Our team continues to route the remainder and automatically sends queued claims when that route is established.  If you are not connected to eMEDIX, then you should switch as quickly as possible.

Otherwise, our practice management systems can submit paper claims in CMS-1500 and CMS-1450 formats, if a payer accepts paper claims by mail (print) or via their online portals (print to file). You will need to review the options available by payer. Each practice management system will still mark claims as submitted and typically sets the method used so you can avoid duplicate submission. 

(updated 03/15/24)

• CGM knows that understanding patient benefits is always critical at the time of service, particularly` since we are still in “deductible season” with higher patient out-of-pocket expense.
• eMEDIX immediately started re-routing many eligibility transactions to other non-Change paths. This happened “invisibly” for our customers.
• We continue to monitor volumes across all of our customers to ensure optimal connectivity.
• With eMEDIX, almost all eligibility is flowing electronically as it did before the outage. If you are not an eMEDIX customer and are using a CGM practice management system, you can switch to eMEDIX, and we can usually get you connected within a couple of business days. Alternatively, you can also do manual eligibility in our online portal.
• You can also check eligibility directly using payer portals. If needed, you can download reports and import them into the patient document management storage parts of our systems.
• These actions are helping customers understand potential amounts they should be collecting upfront from patients, particularly because effective policies communicated to patients are critical during the outage.

(updated 03/25/24)

• Change is the back end for any statements being routed through eMEDIX. Due to the length of time since the beginning of this incident, the statements we have been holding are no longer accurate and will not be released. Once we have a working solution for statements, we will send a notice and you can regenerate statements. You will not be charged for any statements sent that have not been printed.
• An alternative option for customers is to print statements. This is a good solution for customers that are concerned that Change’s outage may continue for an extended period.

(updated 03/15/24)

If you use CGM APRIMA, CGM eMDs, CGM MEDISOFT, or CGM LYTEC, contact us and let us know your situation. We can typically get you switched to eMEDIX within a business day and as a benefit, you'll get to take advantage of the significantly enhanced functionality in your PM that only works with eMEDIX. If you use CGM PRACTICE PARTNER, please open a support ticket and we'll provide you with additional options.

If you are not a CGM customer already, we have systems and connectivity that can help practices that are only able to submit and receive data from Change. See additional details for different transaction types below. While some payers require practices to re-enroll when they switch clearinghouses, we can help in several ways: 

• eMEDIX Reimbursement Solutions: You can use the eMEDIX online system to upload HIPAA-compliant X.12 claim files so you’ll be able to get cash flowing for all the payers to which we have connectivity. We also have a simple system that will show the claims that are held, and as soon as Change is up and running again, we’ll take care of automatically sending the held claims on for you. You can view the eMEDIX payer list at https://online.emedixus.com/payer-list.
• CGM webPRACTICE: Our SaaS practice management system is easy to deploy and learn, and a perfect replacement for practices that may have been looking for a new solution anyway. We can get you going on this quickly and submit as many claims as possible using both the eMEDIX online tools and webPRACTICE while you get trained. At the same time, we’ll expedite your re-enrollments process for payers that require it so you can make the transition as quickly as possible.
• CGM APRIMA EHR and Practice Management: If your existing EHR vendor’s inability to help you is the final straw, then we can help you with a speedy transition to a new, market-leading integrated system. As you go through this transition, we’ll get you set up with eMEDIX Online so you can keep your cash flowing.
• ARIA RCM Services: If you have been considering outsourcing your billing, or changing your existing billing service, now is the time to move to CGM’s services. It is easy and quick to start services with ARIA which will act as a navigator for you through the Change outage and beyond. ARIA was just awarded the Best-in-KLAS Ambulatory RCM Services (EHR-Associated) award for 2024 and is specifically renowned for the quality of the service, the relationship our account executives have with customers, and the continuous and timely follow up and engagement with practices. Many practices consider the CGM team to be part of their own team.