Change Healthcare Notice
Change Healthcare, a prominent healthcare technology provider linking providers, payers, and patients, has reported a cybersecurity incident. As a customer, CareFirst BlueCross BlueShield (CareFirst) received notification of this incident on Wednesday, February 21 and immediately severed network connections with Change Healthcare to prevent any potential further risk to our members. Importantly, the cybersecurity incident did not occur within CareFirst's own systems.
CareFirst continues to stay in contact with Change Healthcare. At this time, Change Healthcare has not disclosed whether data was compromised. If Change Healthcare determines that our members’ data has been impacted, we expect Change Healthcare will communicate with them. The latest information from Change Healthcare can be accessed here: Optum Solutions Status - Update: Some applications are experiencing connectivity issues. (changehealthcare.com)
FOR PROVIDERS
We encourage providers to enroll in provider communications here: Providers & Physicians Home | CareFirst Provider. Most updates and guidance will be sent to those subscribers.
To confirm coverage:
- Commercial/FEP/CareFirst Individual and Group Medicare Advantage Plans: visit CareFirst Direct or call provider services at 800-842-5975
- Community Health Plan Maryland Medicaid (CHPMD)/CareFirst BlueCross BlueShield Advantage DualPrime (HMO SNP): visit MyHealthPortal or call 410-779-9359 or 800-730-8543
FOR MEMBERS: Our priority is to support your access to healthcare services. Please do not hesitate to seek the medical care you require. Ensuring your safety and well-being remains our utmost concern, and we will continue to be transparent as we navigate this situation. If you believe your service has been impacted, please call the number on the back of your ID card for support and assistance.
FOR BROKERS/CONSULTANTS: We are taking necessary actions to maintain our operations with providers and patients. If you have any questions, please contact your CareFirst Account Consultant.
Ensuring the safety and well-being of our members is our top priority, and we will continue to be transparent as we navigate this situation.
GENERAL FAQs
Do we know if this had/has any impact to members?
Change Healthcare has not disclosed whether the cybersecurity attack resulted in a breach impacting member data. If Change Healthcare determines that our members’ data has been impacted, we expect Change Healthcare will communicate with them. CareFirst continues to stay in contact with Change Healthcare. At this time, Change Healthcare has not disclosed whether data was compromised. The latest information from Change Healthcare can be accessed here: Optum Solutions Status - Update: Some applications are experiencing connectivity issues. (changehealthcare.com)
Who will acknowledge group specific compromised member information (CareFirst, Change Healthcare or the impacted pharmacies), and when will this be done?
If there was impact to our members, we expect Change Healthcare will communicate with them. Change Healthcare has not disclosed whether the cybersecurity attack resulted in a breach of member data. We understand that Change Healthcare is working with its cybersecurity forensics to understand the nature and scope of the attack and to analyze and determine what data that was impacted by the attack.
Is this going to prevent anyone from getting approval to proceed with a medical procedure?
There is no identified impact to our pre-authorization process as we do not utilize Change Healthcare for this function.
Are there any issues accessing prescription drugs?
While we acknowledge the media stories regarding the impact on Change Healthcare cybersecurity attack on pharmacies, there has not been any impact on CareFirst members. Pharmacies are able to verify eligibility and benefits for CareFirst members. CareFirst’s pharmacy benefit manager (‘PBM”) does not use Change Healthcare to communicate and conduct pharmacy transactions with network pharmacies. If you experience any issues, please call the number on the back of your member ID.
PROVIDER FAQS
What are your alternate options for claims submission? Do you allow direct submission to CareFirst? Or data entry into your provider portal?
Sending claims electronically is preferred and is your fastest path to payment.
Commercial
Providers can use Availity to submit claims electronically to CareFirst. Many practices have already switched over from Change Healthcare to Availity in the past two weeks. Providers who have not been able to make the switch can still use Availity’s provider portal to manually key in a claim for electronic submission to CareFirst (which may be helpful for aging or high dollar claims that need to be received quickly). New users can register here: Availity Essentials Portal Registration.
If you use another EDI vendor who uses Change Healthcare as an intermediary for medical claims submission, we recommend you work with your vendor to reroute medical claims through Availity.
We do not allow electronic claims to be submitted directly to CareFirst without the use of a trading partner or for the manual submission of claims into CareFirst Direct.
Claims received through Change Healthcare prior to the outage continue to be processed and paid. Claims submitted to Change Healthcare since Change Healthcare cybersecurity incident on 2/21 should be resubmitted through Availity.
Maryland Medicaid & Dual Prime
Effective March 6, we are now accepting electronic claims through Availity for our CareFirst Community Health Plan Maryland (CareFirst CHPMD) and CareFirst Advantage DSNP, Inc. (DSNP) products.
For continuity of electronic claims submission, CareFirst recommends providers that were directly contracted with Change Healthcare for medical claims submission transition to Availity. Please find resources to support registering with Availity here: Availity Essentials Portal Registration.
If you use another EDI vendor who uses Change Healthcare as an intermediary for medical claims submission, we recommend you work with your vendor to reroute medical claims through Availity. Any medical claims submitted to CareFirst using or passing through Change Healthcare since February 21 for the products mentioned above should be resubmitted to CareFirst once connection to Availity has been established.
CareFirst Administrators
Effective March 1, we are now accepting electronic claims through Availity for CareFirst Administrators products. More information can be viewed here.
How do we get electronic remittance advice (ERAs or “remits”) for processed claims?
Commercial
Users who are registered to receive ERAs through Availity prior to the outage will continue to receive ERAs on paid claims.
If you recently switched to Availity, you can register for ERAs online through Availity’s website. Please allow time for provider validation occur.
For others, copies of paper remittances are available to view and download on CareFirst Direct. This includes claims that came through Availity or Change Healthcare (before the outage began).
We understand providers are looking for more automated solutions to reconcile and post payments. We are evaluating enhancements to our provider portal.
Are you waiving or extending timely filing deadlines for providers who are unable to submit claims?
Many providers have already made the transition from Change Healthcare to Availity and resumed their billing. For those who have not, providers have 356 days following date of service to submit claims for most commercial products and 180 days for our Medicaid and Dual Prime products. Please refer to our Provider Manuals for specifics. If your practice has aging accounts receivable from 2023 that were never billed and are approaching timely filing deadlines, we recommend submitting those claims by paper if you cannot bill electronically yet.
Do you accept paper claims? Will I get paid electronically if I submit paper claims? How fast are paper claims processed?
All Lines of Business
We encourage providers to submit claims electronically whenever possible, as it will ensure faster and more accurate claims processing. We also accept paper claims. Generally speaking, most paper claims are processed within 30 days of receipt. Paper claims should be submitted as a last resort, and we encourage providers to switch to a different clearinghouse so claims can be submitted electronically. This reduces the administrative burden for the Provider, as well as ensures the quickest claims processing time.
Practices who have an active direct deposit set up through Availity EFT will be paid electronically via direct deposit for paper claims. If there is no active EFT account with Availity, practices will receive checks to the address on the claim with the paper EOP included.
Do you accept multiple paper claims in one envelope?
While we continue to encourage electronic processing whenever possible, if a provider must submit paper claims multiple can be submitted in one envelope. Follow-up correspondence should be sent separately with appropriate cover pages attached. Failure to do so may result in delayed or inaccurate processing.
Are we still able to submit authorizations and file appeals?
Yes, these processes are not impacted by the Change Healthcare outage. In network providers can continue to submit authorizations and appeals as you do normally for all lines of business.
We expect providers will continue to complete these functions without interruption.