Providers and health insurance companies see a long road ahead that stretches past whenever UnitedHealth Group declares Change Healthcare is fixed.
Full restoration of claims, billing and other processes won't mark the end of the mess that began with a cyberattack last month, which forced UnitedHealth Group to take Change Healthcare systems offline and plunged the healthcare sector into disarray. Healthcare organizations anticipate operational and financial effects even when Change Healthcare is up and running again.
Related: 5 weeks of uncertainty: How the Change breach has unfolded
UnitedHealth Group, which operates Change Healthcare through its Optum subsidiary, has scrambled to repair the damage allegedly caused by the ransomware group BlackCat (also known as ALPHV or Noberus) Feb. 21. The company has turned back on some, but not all, of the vital systems providers and insurance companies depend upon. UnitedHealth Group has not offered a prediction about when its work will be complete.
Change Healthcare’s electronic payments tool was restored on March 15, according to UnitedHealth Group, enabling health insurers to reimburse providers. A few days later, the company said its medical claims software was available for providers to test and reconnect. Providers logged into the system should be able to direct claims to payers through Change Healthcare, according to UnitedHealth Group.
In the meantime, healthcare entities have been forced to employ workarounds to navigate disruptions the network outage caused. They expect that to continue for an indeterminate amount of time.
“There's this narrative that the systems are back and it's over, and that is very much not the case for our hospitals," said Emily Leish, senior vice president of health finance and managed care at the Greater New York Hospital Association. "This is going to be a long process, both in terms of restoring, deciding whether to restore, and then dealing with the claims processing.”
Health insurance companies, government programs such as Medicare Advantage and Medicaid, and providers including hospitals, physicians, pharmacies, nursing homes and infusion centers rely on Change Healthcare’s tools for managing claims, billing, prior authorizations and prescriptions. Other capabilities include identifying value-based care opportunities and sharing laboratory results among providers, tools UnitedHealth Group expects to restore in April.
As systems are switched back on, customers are going through rigorous testing and seeking independent verification before reconnecting. It’s not an immediate fix.
Insurers and providers such as CVS Health and Renton, Washington-based Providence Health and Services said this week they are still using workarounds.
The level of disruption varies based on how reliant customers are on Change Healthcare. Christi Siedlecki, CEO of Grants Pass Clinic in Oregon, said the multispecialty medical practice has resumed normal operations after issues related to the outage, including problems checking patient eligibility and electronically sending prescriptions to pharmacies, were resolved. Similarly, Louisville, Kentucky-based Baptist Health has resumed normal operations since permanently switching from Change Healthcare to another vendor, a spokesperson said.
Change Healthcare brought nearly all pharmacy network services back online March 7 but is still working through some kinks. Most pharmacies should be able to send claims to insurers and government health programs, review claims and process copayment coupons, according to UnitedHealth Group.
Some members of the National Community Pharmacists Association are still experiencing difficulties processing claims for vaccines and nebulizers and receiving reimbursements from drugmakers offering copay coupons, said Lisa Schwartz, senior director of professional affairs. It could take weeks, at least, for drugstores catch up on claims, she said.
A letter the Alliance of Community Health Plans sent to Health and Human Services Secretary Xavier Becerra Wednesday underscores how far the healthcare system is from business as usual, despite UnitedHealth Group's progress.
Members of the insurance trade group are still awaiting verification from third parties that Change Healthcare’s systems are secure before reconnecting, according to President and CEO Ceci Connolly. “We eagerly await news on restoration of UnitedHealth Group's systems and independent third-party attestation to ensure safe, secure transactions moving forward,” she wrote.
The American Hospital Association anticipates that once systems are online and customers are reconnected, cash flow challenges will persist.
“The financial impact of this outage is not something that closes once they get claims and payment systems or even once they get all systems online. There's just going to be a significant amount of financial impact that's going to lag,” said Terrence Cunningham, director of administrative simplification policy at the AHA.
Providers and federal officials have been outspoken about the need for insurers, Medicare and Medicaid to support hospitals, doctors and others via advance reimbursements. Some, including UnitedHealth Group subsidiary UnitedHealthcare and Highmark have made public offers of assistance.
Highmark, a Blue Cross and Blue Shield licensee, is offering advance reimbursements to providers serving its Medicare, Medicaid, exchange and small group members for the foreseeable future. Even when Change Healthcare is fully functional, that won't mean providers have reconnected, said Kate Musler, senior vice president of health plan risk management and provider networks at Pittsburgh-based Highmark, which comprises insurance and provider assets including hospitals.
“We haven't put a specific end date on it to say, 'We're not going to do this past this date.' Because, for one, if a given provider is still not up and running in two months, we've just kicked the can down the road,” Musler said.
Hospital financial performance could be challenged in the coming months by the fallout from the network outage, Erik Swanson, senior vice president of data and analytics at Kaufman Hall, said in a news release Wednesday. In a report, the management consulting company recommended hospitals focus on preserving liquidity, monitoring claims processing and denials, and diversifying clearinghouses to mitigate long-term financial and operational effects.
St. Louis-based Ascension acknowledged Change Healthcare's progress in a regulatory filing March 18, but said it cannot determine how long disruptions will last. Providence Health and Services said in a statement Tuesday it continues to assess options to mitigate payment delays even as services come back online.
Once Change Healthcare customers reconnect, providers and insurers will need to wade through a backlog of claims and continue using workarounds, said Greater New York Hospital Association President and CEO Kenneth Raske. “This could easily last through the entire spring of this year.”
Hayley DeSilva contributed to this story.
Clarification: After this story published, Baptist Health said it switched to an alternate claims processing company and no longer employs temporary workarounds because of the Change Healthcare outage.
