and eviCore-CAC-Avmed Claims
Hello Doctors, Therapists and Staff,
The following is my update of the Change Healthcare ransomware cyberattack based on the latest information I’ve been able to glean from several official health news outlets. I’ve tried to present this information as best as understandable. Please note that some of this might not seem like it pertains to you, but understand several things: First, this cyberattack has had ripple effects that created damage and havoc in the most unlikely way; second, although you might use a clearinghouse other than Change, many clearinghouses have to forward certain claims through Change to get to the proper insurer – as Change is owned by UHC certain UHC-owned insurers mandated claims process via Change [it’s good to be king]; third, different specialties were affected in different ways; and fourth, where one might think temporary financial aid is available to them you must read the “rules” closely.
At the end of my update I’ll also address the current status of CAC, AvMed and eviCore as it relates to Chiropractic claims at the least. For our current clients we have also attached a document from eviCore speaking on the Change Healthcare matter and its effect on CAC and AvMed claims and where claims should be addressed at this time. Of course, this could change once this madness is behind us. Here is my synopsis:
As the aftermath of the cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group, continues to impact healthcare operations nationwide, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are actively working to mitigate disruptions and support affected providers and suppliers.
CMS Actions and Support: CMS recognizes the significant challenges faced by healthcare providers and suppliers due to disruptions in claims processing and payments resulting from the cyberattack. In response, CMS has taken several proactive steps to offer assistance and ensure continuity of operations:
1. Communication and Coordination: CMS is in regular communication with UnitedHealth Group and Change Healthcare/Optum, urging them to promptly communicate with the healthcare sector and provide viable options for interim payments to affected providers and suppliers.
2. Financial Assistance Programs: On March 9, 2024, CMS introduced the Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments for Part A providers and advance payments for Part B suppliers [my italics] experiencing claims disruptions. These payments, equivalent to up to thirty days of claims payments, aim to alleviate cash flow problems caused by the Incident. Repayment will occur through automatic recoupment from Medicare claims over a 90-day period.
3. Encouragement to Payers: CMS is actively engaging with private health care plans, encouraging them to support efforts to minimize further disruptions to the healthcare sector. Additionally, CMS has urged Medicare Advantage (MA) organizations to offer advance funding to providers most affected by the cyberattack. Unfortunately, my research hasn’t found any of our specialty groups being given any special consideration.
Eligibility and Certification Requirements: Providers and suppliers seeking CHOPD accelerated or advance payments must meet specific eligibility criteria and make the following certifications:
- Eligible providers/suppliers are those experiencing disruption in claims payment or submission directly related to Change Healthcare’s platform.
- Certifications include the inability to submit claims to Medicare, lack of alternative funding sources to cover the disruption, and assurance of ongoing business operations.
- Providers/suppliers must acknowledge terms of the payment, including repayment obligations and recoupment procedures.
Next Steps for Providers: To navigate the current challenges effectively, providers and suppliers are advised to:
1. Stay Informed: Continuously monitor updates from CMS and other payers regarding payment options and support programs.
2. Collaborate with Payers: Maintain open communication with all payers to access timely payments and explore additional short-term funding opportunities.
3. Assess Insurance Coverage: Consult liability insurers to determine coverage for disruptions caused by the cyberattack.
Conclusion: During this challenging time it is important for all healthcare providers to keep in contact with their clearinghouses, and specifically ask if they have been affected by the Change Healthcare situation. If so, what steps are they taking to work around the inability to transmit through Change Healthcare’s system. Our team at iCollect is also attempting to gather information from the many clearinghouses we work with, including alternate means to transmit claims, if possible. In addition, it’s important that you forward to us any communications you receive from your clearinghouse regarding this, or any other situation. You will most likely get such notifications before we will so be sure to forward any such news to us right away! By working together and staying informed, we can navigate through these challenges and emerge stronger than before.
Now, for those of you lucky enough to be CAC AvMed providers I have attached an announcement that was sent out by eviCore this month following the Change Healthcare cyberattack. In the announcement they not only provide what address AvMed claims should be sent to, but they give a payerID# for electronic billing as well. When you’re staff creates a “new” insurance in your software you might want to name it eviCore-AvMed, so they choose the right insurance for those cases. Keep in mind, when this Change Healthcare issue is behind us [not close yet], eviCore could change things again!
We found when calling eviCore, they have yet to begin processing February claims because of the Change Healthcare matter. On top of that, because of the volume of calls they’re getting they are making providers ask for status, and in some cases appeals, by email only. Our collection crew has been creating spreadsheets to keep track of all that is outstanding.
So, generally this seems to be part of the Change Healthcare debacle. We’re keeping our fingers crossed that this will resolve soon although none of my health news feeds have reported any advancement so far on that front.
Think you might require billing and collection services? Call us for a no obligation chat to discuss your needs, or any difficulties you may be experiencing with your insurance revenue management. We work and bill directly from your software, and our knowledge and experience in different software programs now exceeds more than a dozen programs! We also post your payments for you directly in your software! Mention you read this e-newsletter and we’ll waive your start-up fee!
***We are pleased to announce the EHR software we work with has expanded and now includes the following: ChiroTouch, ACOM, PayDC, EZNotes, Eclipse, ChiroHD, Office Ally, ChiroFusion, zHealth, CollaborateMD, MediSoft, Jane App, and more! Don’t see yours on the list? We continue to expand every month! Call to find out more!
Yours in health and wealth,
Dr Art
Dr. Arthur I. LeVine
CEO & Founder, iCollect Medical Billing Services, LLC
Past President, Florida Chiropractic Assn.,
Board of Directors, Florida Chiropractic Assn.,
Chairman, Insurance Relations Committee, Florida Chiropractic Assn.,
Co-Chairman, Government Relations Committee, Florida Chiropractic Assn.,
Florida Representative, Congress of Chiropractic State Assns.,
7027 W. Broward Blvd., #229
Plantation, FL 33317
954-530-6232 Office
206-309-4925 Fax to Email
