Change Healthcare Assistance Program (CHAP)

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Impacted by the Change Healthcare disruption? We can help!

The Change Healthcare Assistance Program (CHAP) is sponsored by the Mass Collaborative (of which MHDC is a member). CHAP is designed to assist providers in getting connected and transacting with their trading partners during this disruptive period of time. 

Open Office Hours: Every Thursday, 12-1pm ET, via Zoom. Register HERE

Need Personal Assistance? Call 888-402-3550 or email CHAP@mahealthdata.org

What Happened?

What Happened? Change Healthcare, a leading healthcare clearinghouse, experienced a ransomware attack that compromised their systems. This incident has potentially affected the secure exchange of electronic data interchange (EDI) transactions, including billing, claims, and health information between healthcare providers and insurers. 

Role as a Clearinghouse: As a clearinghouse, Change Healthcare plays a critical role in the healthcare industry by facilitating the exchange of information between healthcare entities. They ensure that data sent from healthcare providers to insurance payers is accurate, secure, and in the correct format. 

Impact on Providers: The ransomware incident has disrupted the normal flow of EDI transactions, leading to delays in claims processing and payment and potential breaches of sensitive patient data. Many healthcare providers will experience financial delays and must act to restore connectivity while seeking financial relief from Change Healthcare and government and private payers. Healthcare providers should expect a period of several weeks after Change Healthcare restores their systems for your affected health plans to complete their transaction integrity and security testing before reconnecting your practice. Consider establishing an alternate EDI connection to reduce the risk to your practice that a longer-than-anticipated restoration will impose. 

What to Do?

Get Reconnected: Research and select an alternate clearinghouse that will enable you to reconnect to your health plans without using the Change Healthcare network. (List of EDI Vendors)

Stay Updated: Monitor communications from Change Healthcare for updates and guidance. 

Talk with my Health Plans about Support for my Practice:

Aetna

Change Healthcare Service Interruption FAQ

Blue Cross Blue Shield of Massachusetts

Provider Central

What options are available for providers to use to submit claims? Massachusetts health plans have worked to make sure there are multiple options available to accept claim submissions from providers: Clearinghouse connection, Direct EDI connection to BCBSMA, Direct Data Entry via Clearinghouse Portals, and Paper Claims.

What is a direct connection? Direct submission connection is when a provider or organization’s back-end system (such as a practice management system or EMR) connects electronically with the health plan to send EDI transactions. This connection typically processes much more quickly than paper transactions since it does not involve human intervention. A direct connection is not an online claim submission and does not replace a web-based data entry tool. Determining if a direct connection is the right fit will likely require some additional discussion with the EDI Support team (we can offer our number and email box info). When using a clearinghouse, file support is typically part of the arrangement between a provider and a clearinghouse. There is no cost to set up a direct connection with BCBSMA. Timelines will vary depending on technical capabilities.

Who should consider establishing a clearinghouse connection? Health plans often have relationships with many clearinghouses. For example, BCBSMA has agreements that allow it to accept claims from over 30 clearinghouses. These are typically for provider organizations that do not want to do the technical work needed to connect to BCBSMA outside of a clearinghouse, cannot produce “837 files,” or plan on using EDI transactions beyond claim submission. Provider organizations should visit the clearinghouse’s website or call the clearinghouse to learn more about the enrollment process. Enrollment/set-up timelines, costs, and requirements may vary from clearinghouse to clearinghouse. Provider organizations should contact the clearinghouse directly to learn more. Some clearinghouses also offer a website for online claim submission and eligibility checking. While health plans often have existing connections with most major clearinghouses, providers should confirm with any potential clearinghouse that they are currently sending electronic claims to BCBSMA.

Cigna Healthcare

Cigna for Health Care Professionals

CMS-Medicare

FAQ

How to apply for financial assistance

List of MAC Websites, Secure Internet Portals, & Electronic Mailing Lists 

CMS-Medicaid MassHealth

CMS Response and State Flexibilities Memo

MassHealth presentation: Office Hours - Change Healthcare Cyber Security Incident

Commonwealth Care Alliance

Provider Resources Fact Sheet

Dedicated email for providers: changehealthcare@commonwealthcare.org

*Not in response to Change, but includes all info re: claims and eligibility from their new platform effective April 1, 2023. They do not use Change anymore.

Fallon Health

FCHP - Providers (fallonhealth.org)

FCHP - Electronic data submission (fallonhealth.org)

Health New England

Change Healthcare Security Issue

*Updates are provided under "Alerts"

In addition, the following notice went to providers. 

Mass General Brigham Health Plan

Responding to the Change Healthcare Cybersecurity Incident

Point32Health

Our Response to Change Healthcare's Cybersecurity Incident

Senior Whole Health

Provider Bulletin

UnitedHealth Group

Information on the Change Healthcare Cyber Response - UnitedHealth Group

Press Release: UnitedHealth Group Update on Change Healthcare Cyberattack

Wellpoint (Unicare)

Unicare Providers

Change Healthcare Cybersecurity Event - Provider FAQ

WellSense Health Plan

Submit Claims

Provider Communications

 

How Do I Pick the Right EDI Vendor?

Evaluate Clearinghouse Options: Research and select a clearinghouse that meets your practice’s needs in terms of services, compatibility, and costs. (List of EDI Vendors)

  • For Medicare programs contact your MAC for rapid enrollment with a new clearinghouse vendor. For Massachusetts: National Government Services, Inc., 8115 Knue Rd, Indianapolis, IN 46250. (317) 841-4400, https://www.ngsservices.com/

  • Ensure the services offer batch upload, sFTP upload and DDE (Direct Data Entry) of claims for commercial and public plans

  • For commercial plans most do not require enrollment so claims can be submitted immediately upon initiation of the service

  • Become familiar with payers direct DDE functions (if available) on the payer websites

  • Ask your submitter / clearinghouse if they maintain more than one pathway to get to your payer(s) and if they can reroute transactions if a service is down

Configure your System: Work with your IT department, vendor, and clearinghouse to configure your systems for EDI transactions. 

  • Ensure your EHR / billing system can create a batch format for claims submission using the standard X12 837 claim file format

Do the Necessary Testing: Conduct thorough testing of the data exchange process with the clearinghouse and your health plans to ensure accuracy and reliability. 

  • Ensure your Remittance Advice (835) files are able to be retrieved from your existing service or re-route them to the new service, once subscribed

Training: Work with your alternate clearinghouse to train your staff on the new processes and how to handle any changes in workflow. 

Additional Resources & Support

Open Office Hours: Every Thursday, 12-1pm ET, via Zoom. Register HERE

Open Office slides - April 11, 2024

Need Personal Assistance? Call 888-402-3550 or email CHAP@mahealthdata.org

MA Health Information Sessions Provider Services: (800) 849-2900 or provider@masshealthquestions.com

Latest updates from the American Medical Association and the American Hospital Association

Health Insurance Claim Form CMS1500

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