What’s happening: The cybersecurity incident affecting Change Healthcare which began on February 21 is having a broad impact on claims submissions and month-end billing for many post-acute providers.

• AHCA/NCAL is continuing its advocacy efforts to provide relief to members.
• VHCA-VCAL has gathered information from DMAS and the managed care organizations (MCOs) on workarounds during the system outage. Additionally, some members have successfully tested submitting small batches of claims from select MCOs.

Read this AHCA update for more information related to claims processing. The post covers what you can do:

• if you are not able to process claims through your billing software vendor related to the security situation; and
• how to request an accelerated payment.

This March 6 update from AHCA includes additional information on provider relief options and the associations request for audit relief.

Specific to Virginia, the MCOs have issued the following notices and updates:

• Sentara posted this provider alert (dated February 26, 2024), which notes the action it has taken and that Sentara Health Plans providers are unable to submit claims through Change Healthcare. The alert also states that providers are also unable to access the former Virginia Premier Provider Portal to view claims or submit claims reconsiderations status for dates of service in 2023.
• United Healthcare (UHC) has indicated providers can bill using paper claims or the UHC Provider Portal. There will not be a payment interruption if the facility uses one of those billing methods. If you have issues or questions, you can contact Provider Services at (866) 633-4449.
• A banner on the top of the Aetna Virginia Provider webpage directs users to additional information. Although not Medicaid specific, it may be useful to review.
• Molina Healthcare has posted a provider bulletin with a provider payments status update and claims submission reminders.
• Anthem does not appear to have posted an update (if you have received any information directly, please let Steve Ford know).

Of note: One Virginia provider has tested a limited number of claims with Aetna and UHC through normal submission (i.e., making no accommodation for anything related to the Change Healthcare incident.) These claims appear to have been accepted and are in process at the respective MCOs.

• As such, you may want consider submission of a limited batch of claims to test each MCO prior to modifying how you submit based on the Change Healthcare situation, to the extent the change in submission process is burdensome.
• We have heard from another provider that had the same experience with Aetna, but it appears the EFT (as opposed to the claim itself) may be impacted by the Change Healthcare incident.
• This information is evolving; if you have more information, please email Steve Ford.

For questions, please contact Steve Ford, or Grant Beebe and Dan Ciolek at AHCA/NCAL.