Billing and Coding Resources

 

Please check back frequently to view the most recently updated information for Billing, Coding and Payors:

 

HIGH ALERT! 3-06-2024

Ransomware attack on Change HealthCare Group and Optum-Claims Clearinghouse

What you Need to Know Now!

  • This attack occurred on 2/21/24 and may affect your ability to file claims and to receive payments
  • The attack affects many payors beyond United HealthCare
  • Change Healthcare group is a subsidiary of United Health Group and Optum

The ransomware attack can affect you on three main fronts:

  1. This may be your practice’s claims clearinghouse; or
  2. Change HealthCare may be the electronic claims payment clearinghouse that a payor or TPA utilizes to make their payments to you by connecting with your clearing house; and
  3. This disruption can interfere with your ability to gather information for enrollment verification and prior authorizations; and
    • While your clearinghouse may be Waystar, Avility or Payerpath (Veridigm), they may use Change Healthcare for certain functions, and
    • The above companies have already removed their connection to Change Healthcare.

The first question to ask: Is Change Healthcare your primary clearinghouse?

If Change Healthcare is your primary clearinghouse, you will need another option to file your claims:

  1. Choose another clearinghouse (the three listed are the most common)
  2. Availity offers options for providers who use Change Healthcare as their clearinghouse and are also registered within Availity Essentials™
  • Direct connections to the Availity network via Availity Essentials will be offered at no-cost for the time being.

                                        Register here: Availity Lifeline

  1. File the claims directly on the payor portal
  2. Determine if the payor will accept mailed-in claims

If Availity, Payerpath or Waystar is your primary clearinghouse, continue to monitor notices on their website for advice and the workarounds they have created.

  • Some electronic payments from many payors are processed via Change Healthcare

If Change Healthcare is not your clearinghouse,

  • Your clearinghouse portal may list the affected payor payments
  • Looks for patterns of non-payment by payor
  • If you can, contact the specific payor contact number (on the back of a patient’s cards), and ask if receiving paper checks is acceptable
  • Optum, a health services company that is also owned by UnitedHealth, said it has established a temporary assistance programto extend cash to organizations whose payment systems have been affected. This involves short-term loans that would need to be repaid once Change Healthcare is back up and running
  1. To determine eligibility and funding amount, you must register for the program. An Optum Pay account is required to complete registration, to receive funds, and to repay funds. Use your existing Optum Payaccount or sign-up for Optum Pay to log-in.
  2. Once you enroll, you can see the potential temporary funding assistance
  3. Temporary Funding Assistance (optum.com)

Additional Information:

The United Health Group provides regular website updates regarding the Change Healthcare status.

Additionally, according to an HHS press release from yesterday, CMS strongly encourages Medicaid and CHIP managed care plans to expedite the new iEDI enrollment and adopt strategies for 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.

In addition, the AAP is connecting with the CDC related to VFC implications, particularly borrowing across VFC and private vaccine stock.

Stay tuned for additional updates as we learn more about the ransomware attack and its impact on our practices.

 

Recent Payor Updates

You can view the updated TCCN Payor Telehealth Grid here.

 

Billing/ Coding/Payor  FAQs:  Updated December 12, 2023

  1. How can I add an Advanced Practice Provider (APP’s) to our Kids Health First payor contracts? 
  • Please go to the Credentialing page on the KHF intranet for instructions:
    • KHF can add APPs to applicable payor contracts after the credentialing process has been completed.
  • APPs should also enroll in the Georgia Medicaid program on the Georgia Department of Community Health website.
    • Please use this link to apply for a Medicaid number and opt-in for CMO participation.
  1. How does our practice contract with Anthem and CareSource?
  • The Anthem and CareSource contracts are through The Childrens Care Network (TCCN).  To begin  credentialing, please contact your named TCCN Provider Relations Representative.
  1. Does KHF help with contracts, credentialing, and claim issues with Amerigroup?
  • KHF does not hold a contract with Amerigroup. You will need to contact them on your own to participate with this payor. 
  • KHF can provide basic advice on how to solve problems with Amerigroup. For anything else, a practice must call Amerigroup’s provider relations customer service and ask to speak with its local representative. Beyond general advice, KHF practices are to resolve Amerigroup issues with their local representative and by calling the payor’s provider relations customer service number.
  1. Can a practice appeal an unfavorable claims outcome?
  • A practice has the right to dispute and appeal claims after getting an unfavorable outcome. The practice can submit as many reconsiderations or appeals, as needed to resolve a dispute or claim.
  • Practices are encouraged to follow payors’ dispute and appeal processes. It is particularly important that a practice follows the required appeal process as listed out by the payor.
  • KHF suggests that practices contact KHF’s provider relations team for help. We will work with the payor to help you with the issue.
  1. Does KHF participate in all plans within our contracted payors?
  • No.
  • There are several payors that administer plans as third-party administrators.
    • There are also several companies that have built their own network. These types of plans are often in relationships with healthcare systems, unions, and self-funded groups.
  • Staff should not rely on a payor logo found on the patient’s ID card to determine if a practice participates with a certain payor.
    • Please have your staff verify benefits and, if in doubt, call the payor.
  • Always obtain and save all reference numbers when speaking with a payor by phone or through the provider portal.
  1. How does a practice reach out to KHF?

 

For more information or questions related to billing and coding, please contact Patsy Chastain,  at pchastain@khfirst.com or  770-333-0033, ext. 207.