The US Department of Health and Human Services (HHS) issued the following statement March 7 about immediate steps that the Centers for Medicare & Medicaid Services (CMS) is taking to assist providers impacted by the cybersecurity attack on Change Healthcare (a unit of UnitedHealth Group). Providers should continue to work with all their payers for the latest updates on how to receive timely payments, CMS said.
Affected parties should be aware of the following flexibilities in place:
- Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
- CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
- CMS strongly encourage Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State.
- If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
- CMS has contacted all the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While electronic billing is preferable, the MACs must accept paper submissions if a provider needs to file claims in that method.
CMS has also heard from providers about the availability of accelerated payments, like those issued during the COVID-19 pandemic. Many payers are making funds available while billing systems are offline, and providers should take advantage of those opportunities. However, CMS recognizes that hospitals may face significant cash flow problems from the unusual circumstances impacting hospitals’ operations, and—during outages arising from this event—facilities may submit accelerated payment requests to their respective servicing MACs for individual consideration. The agency is working to provide additional information to the MACs about the specific items and information a provider’s request should contain. Specific information will be available from the MACs later this week.
HHS will continue to communicate with the healthcare sector and encourage continued dialogue among affected parties. It will continue to communicate with UnitedHealth Group, closely monitor their ongoing response to this cyberattack, and promote transparent, robust response while working with the industry to close any gaps that remain.
CGS, the DMAC for Jurisdictions B and C, also offered the specific guidance below that align with the flexibilities HHS outlined.• Common Electronic Data Interchange (CEDI) offers a list of approved software vendors, billing services and clearinghouses alternatives to send claims to and/or receive ERAs from CEDI. CEDI also offers the web-based CEDI Claims Portal for manual entry of claims and to retrieve the ERA.
Suppliers will need to complete CEDI enrollment forms to use another method of exchanging transactions with CEDI. CEDI enrollment forms are submitted online through the CEDI website under Enrollment and are processed within 5 business days.
Please contact the CEDI Help Desk at ngs.cedihelpdesk@anthem.com or 866.311.9184 if you have any questions.
- Any provider affected by the incident may request an Administrative Simplification Compliance Act (ASCA) waiver to submit paper claims. To request a waiver, send an email to cgs.dme.mac.email.inquiries@cgsadmin.com that includes the following information:
- Subject line of the email: Attention: ASCA Request
- Contents of the email: We are requesting an ASCA waiver due to billing through Change Healthcare to allow us to submit paper claims for [Insert your Supplier Name] and [insert Provider Transaction Access Number (PTAN)] until this issue is resolved.
Note: The payment floor for paper claims is 29 days (versus 14 days for electronic claims).
- If you experience significant cash flow problems from the unusual circumstances impacting operations during outages arising from this event, you may request an Accelerated and Advance Payment.
