Updated April 11, 2024
The Academy has provided information to help you respond to the Feb. 21 cyberattack on UnitedHealth Group, Optum, and Change Healthcare that has disrupted claims submission and payment processes.
The recommendations provided by Change Healthcare, a United Health Group subsidiary, so far have not been ideal.
They include switching to another clearinghouse and identifying payer and/or vendor workarounds. United Health Group has published a webpage where you can follow progress on the Change Healthcare cyber response. As of March 1, you can apply for temporary funding at Optum Financial Services. An Optum Pay account is required. Note: Enrollment in Optum Pay Premium will impose additional fees, consider alternative Optum Pay options.
The Academy is working closely with the American Medical Association on next steps and will post updates as the situation progresses. Bookmark this page and check back frequently for any updates.
Questions regarding the Change Healthcare claims restoration process? Email your questions to client_assistance@optum.com to connect with a dedicated team.
Updates
April 10 The Academy and others joined an American Medical Association-led discussion with Optum and CMS leaders where they shared preliminary results from a recent provider survey showing how small practices are still overwhelmed by the Change Healthcare cyberattack and require more assistance.
While Change Healthcare continues to report connection progress many practices still experience hurdles with practice management software systems, individual payers and/or required labor to reestablish the ability to file claims. It is essential for practices to seek alternative filing methods. See filing instruction links for individual Medicare administrative contractors under Resources below.
March 28 CMS has reopened the Extreme and Uncontrollable Circumstances exception application for the 2023 MIPS Performance Year for practices affected by the Change Healthcare Cyberattack. Learn how to apply.
March 27 Change Healthcare is making progress getting payors reconnected for claims processing. A list of payers who have reconnected with the clearinghouse has been provided and will be updated multiple times a day. Individual practice claim submissions and reimbursement can ultimately be dependent on payers and trading partners re-establishing their connections first.
March 25 HHS issued a letter to the healthcare community with information, resources, and tools from national health plans and payers for providers in need of assistance.
March 22 United Health Group shared their medical claims preparation software, Assurance, went back online March 18 and claims have been staged for processing. They expect Relay Exchange to be brought online over the weekend for testing and reconnection. The priority order for restoration and estimated timeline for reconnection of additional products is available on their cyber response website. If you have questions regarding the Change Healthcare claims restoration process, you can contact their dedicated team by emailing your questions to client_assistance@optum.com. UHG encourages practices to utilize the temporary financial assistance inquiry form if help with cash flow is needed. They confirmed that the totality of the impact on cash flow, not just United Healthcare payment, is being used to calculate loan amounts.
March 18 UnitedHealth Group has begun testing its Assurance claims software and anticipates phased reconnection with thousands of providers this week and next. Testing and implementation with the Relay Exchange clearinghouse are expected to begin by the end of the week. There will be forthcoming guidelines for managing batch sizes. Eligibility services will not be addressed until all claims services are restored. Clients that have transitioned to Optum Inteligent EDI will not transition back to Change Healthcare until directed by UnitedHealth Group. Repayment of Optum temporary funding has been extended to 45 business days following resumed claims processing and payment services. Follow all updates on the cyber response website linked above.
March 15 Prompted by the Academy March 12 letter to UHC, Academy CEO Stephen McLeod, MD was invited to meet with UnitedHealth Group’s chief medical officer to reiterate the unsustainable situation Academy members face, while reinforcing our recommendations for increased financial assistance and a pause to step therapy requirements that were outlined in a previous letter to the payer.
March 12 The Academy sent a letter (PDF) to United Health Group president and chief operating officer demanding that they take immediate action to address the unresolved issues our members are currently facing.
March 11 Centers for Medicare & Medicaid Services (CMS) announced plans to make advanced payments available for Part B providers and suppliers. Find the application links below.
March 7 United Health Group updated its response to the cyberattack with an anticipated timeline for claims submission being reinstated and the expansion of emergency funding assistance through Optum Pay. Apply with the Temporary Funding Inquiry Form.
March 5 The U.S. Department of Health and Human Services (HHS) published a statement on the Change Healthcare cyberattack. It encourages all providers, technology vendors, and members of the health care system to strengthen their commitment to cybersecurity. In the statement, HHS announced flexibilities CMS has put into place. These flexibilities include but are not limited to:
- The expedition of new EDI enrollments for providers needing to switch their clearinghouse
- Guidance to Medicare Advantage (MA) organizations, Medicare Part D, and Medicaid encouraging them to remove or relax prior authorization, timely filing and other utilization management during the outage
- MAC acceptance of paper claim submissions
March 5 United Health Group hosted another call in which they shared their opinion that enrolling in Optum Intelligent EDI is the most expeditious way to restore the ability to submit claims for those who are still impacted by the outage.
March 4 the Academy sent a letter to HHS sharing the impact of the disruption on the ophthalmic community. The Academy urged HHS to use its authority to support physician practices and hold UnitedHealth Group accountable for swift resolution. Read the Academy's March 4 letter to HHS Secretary Xavier Becerra (PDF).
Part B Advance Payment Applications
Commercial Advance Payment Applications
Resources
AAOE®, the Academy's practice management arm, has provided practice management tips to prevent and mitigate a disruption in your revenue cycle.
Find additional prevention and managment resources on the Managing Financial Disruptions web page.
Here is information on clearinghouses and payers to help you stay up to date on alternative methods of eligibility verification, claims submission, and payment processes.
(Disclaimer: This list is not intended to be comprehensive. Contact your payer directly if it is not listed. )
Aetna
Anthem Blue Cross
Availity
Cigna
Humana
- Access Humana's electronic remittance advice (ERA) through secure provider tools available at Availity Essentials.
Medicaid
- Verify on each state's Medicaid website. Many have a secure provider log in that offers copies of remittances.
Medicare Administrative Contractors (MACs)
UnitedHealthcare (UHC)
- Use secure self-service options on the UnitedHealthcare Provider Portal or an existing API connection to connect with UHC.
- The portal is currently available to check eligibility, manage claim reconsiderations and appeals and submit prior authorization requests.