March 8, 2024

Resource Sheet and Frequently Asked Questions

Change Healthcare Service Outage

March 8, 2024

• DFS Insurance Circular Letter No. 2 (2024): Suspension of Certain Utilization Review Requirements, Appeal Timeframes, Claim Submission Timeframes, and Eligibility Verifications

If you are an OMH or OASAS Managed Care provider, please read the instructions on the Suspension or Tolling Certification Related to the February 2024 Change Healthcare Cyber Incident. When you submit the form that has been signed by both issuers and providers to the Department of Health at URAgent@health.ny.gov and to the Department of Financial Services at externalappealquestions@dfs.ny.gov, please cc OMH-Managed-Care@omh.ny.gov for OMH providers and PICM@oasas.ny.gov for OASAS providers.

• Federal Relief for Medicare Providers from Change Healthcare Outage

Highlights the following actions that the Centers for Medicare and Medicaid Services (CMS) will take to ensure providers can continue to serve patients:

• CMS strongly encourages Medicaid and Children’s Health Insurance Program (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. 
• Medicare providers can contact their Medicare Administrative Contractor (MAC) to get set up with a new clearinghouse.
• Medicare providers have been directed to reach out to their MAC if issues with submitting claims and CMS has contacted all of the MACs to ensure they are prepared to accept paper claims.
• CMS is offering to provide hospitals with significant cash flow problems, accelerated payments if needed.

• CMS Statement on Change Healthcare Cyberattack

• Information on the Change Healthcare Cyber Response https://www.unitedhealthgroup.com/changehealthcarecyberresponse

• Optum Change Healthcare Cybersecurity Status https://status.changehealthcare.com/incidents/hqpjz25fn3n7

• Funding Assistance Offered by Optum

• OMH Provider Survey – Change Healthcare Cyber Threat

Change Healthcare Cyber Threat Survey

• OMH Plan Survey – Change Healthcare Cyber Threat

Change Healthcare Cyber Threat Health Plan Survey

0. OASAS Provider Survey – Change Healthcare Cyber Threat

Medicaid Managed Care Plan (MMCP)-Specific Resources or Responses:

Frequently Asked Questions

1. If we have already communicated potential cash flow issues through the OMH Change Healthcare Cyber Threat Survey distributed by the State, should additional contact be made?

A: Yes, providers are encouraged to provide more information which will help the State understand the magnitude and status of the fiscal impact. OMH providers can submit the additional information to OMH-Managed-Care@omh.ny.gov.

2. Is this issue expected to last a significant amount of time? It has been out for two weeks.

A: The State does not currently have a timeline. A joint workgroup is discussing the issue with payers, providers, etc. If a timeline becomes available, it will be distributed. If providers use Change Healthcare, the State encourages providers to seek alternative clearinghouses as an interim solution. Several health plans have successfully connected with alternative clearinghouses and providers are recommended to work with health plans to implement the switch.

3. Will the plans be required to waive or extend timely filing for any claims impacted by the cyber incident? Regarding Change Healthcare, will a modifier be created for those claims that have or will be exceeding the timely filing?

A: Per the HHS Statement, CMS encourages Medicare Advantage (MA) organizations, Part D sponsors, Medicaid, and CHIP managed care plans to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages.

The State just released the communication to Health plans (including but not limited to Medicaid Managed Care Organization), and health plans should toll the statutory and contractual timeframes for providers to submit claims upon receipt of a provider’s signed certification that such tolling is needed.

The State will consider any potential necessary billing logistics as recommendations, options, and/or solutions are being worked through.