Change Healthcare Cybersecurity Incident
Updated: June 21, 2024
Johns Hopkins Health Plans (JHHP) has resumed provider payments for USFHP and Advantage MD following operational disruptions caused by the Change Healthcare (CHC) cyberattack. Starting the week of June 17, 2024, for USFHP and Advantage MD, JHHP issued the first round of payments via PNC/ECHO.
Subsequent payments will continue to address claims processed from Feb. 21, 2024, onward. JHHP expects full reconciliation of pended payments within the next several weeks. Once reconciliation is complete, providers can expect regular weekly payments. Remittances will be similar to the current PNC/ECHO remittances for Priority Partners and EHP. There will be ongoing enhancements to the USFHP and Advantage MD payment process, resulting in minor updates to remittance formats and payment details as the payments are released.
- For impacts to Johns Hopkins Health Plans’ ability to receive claims submissions and process remits and payments, see the appropriate sections below.
- Apart from services connected to Change Healthcare, no other systems or processes within Johns Hopkins Health Plans are affected at this time. Providers can still make benefit and eligibility inquiries and submit prior authorization requests. Access to our provider portal is not impacted; providers are strongly encouraged to access the Availity and HealthLINK portals for member eligibility and benefit verifications.
- Authorization submissions are not currently impacted by this incident. InterQual is available, and we are operating business as usual for authorizations and medical necessity determinations. Providers should not delay authorization requests and should submit them following standard procedures. However, if a provider failed to request authorization related to the Optum/Change Healthcare cybersecurity incident, Johns Hopkins Health Plans will provide the opportunity to request a retrospective authorization following normal protocols and without penalty. In addition, providers will continue to be afforded opportunities to appeal medical necessity determinations.
Claims Submission
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Johns Hopkins Health Plans cannot currently receive any claims that are submitted through Change Healthcare.
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Johns Hopkins Health Plans can receive claims from all other clearing houses except Change Healthcare at this time. Providers can use any alternative clearing house as usual. Claims for Priority Partners, Employer Health Programs and Advantage MD can be submitted through our Availity portal; Claims for US Family Health Plan can be submitted through our HealthLINK portal.
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Yes, Johns Hopkins Health Plans will accept paper claims. However, paper claims must be manually entered, which may cause delays in claims adjudication/payments versus electronic claims submission.
Please mail paper claims directly to:
EHP
P.O. Box 4227
Scranton, PA 18505Priority Partners
P.O. Box 4228
Scranton, PA 18505Johns Hopkins Advantage MD
P.O. Box 3537
Scranton, PA 18505Johns Hopkins Health Plans
PO Box 830479
Birmingham, AL 35283
Attn: USFHP Claims Submission -
No. Claims submitted through Feb. 20, 2024 have been sent to Johns Hopkins Health Plans.
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There is no impact to the adjudication of claims that were already in process before the Change Healthcare cybersecurity incident of Feb. 21, 2024.
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Johns Hopkins Health Plans will extend limits for timely filing and claims adjustments for 60 days from when connections are restored for Change Healthcare.
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Johns Hopkins Health Plans will extend the timeframe within which a claims payment dispute will be accepted for USFHP and Advantage MD, based on when the payment and remittance was released. Claims disputes should be submitted through the normal channels. Medical necessity appeal and Advantage MD clinical dispute timelines are based on date of denial for medical necessity, and therefore have not been affected.
Claims Payment
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Electronic claims payments and remittances for Priority Partners and Employer Health Programs (EHP) can be processed, as long as a provider uses a clearing house other than Change Healthcare for claims submission and remit services.
Johns Hopkins Health Plans has engaged PNC Healthcare and ECHO Health, Inc., to provide new electronic methods for claims payment and remittances via their Claim Payments & Remittances (CPR) service for Advantage MD and USFHP. Claims processed since Feb. 21, 2024, are sorted into 16 payment files. Johns Hopkins Health Plans started issuing payments from the first file the week of June 17 for USFHP and Advantage MD. Subsequent payments will be made over the next several weeks, with full reconciliation expected by the end of July 2024. Once reconciliation is complete, providers can expect regular weekly payments.
Providers that are already enrolled with PNC/ECHO for Employer Health Programs (EHP) and Priority Partners do not need to take further action. Providers not enrolled with PNC/ECHO for EHP and Priority Partners, please follow the important instructions below to ensure you receive payment for Advantage MD and USFHP. We also recommend that providers call Advantage MD Customer Service at 877-293-5325 or USFHP Customer Service at 800-808-7347, as applicable, to confirm the remittance address as the first payment after the transition will be sent via mail.
To learn about payment options and any next steps needed to receive your preferred method of payment, view our Provider Update.
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If you are interested in receiving an advance payment to stabilize your health care delivery services, please reach out to your Provider Relations contact.
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Claims processed since Feb. 21, 2024, are sorted into 16 payment files. JHHP will start issuing payments from the first file the week of June 17 for USFHP and Advantage MD. Subsequent payments will be made over the next several weeks, with full reconciliation expected by the end of July 2024. Once reconciliation is complete, providers can expect regular weekly payments.
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- Providers currently enrolled with PNC/ECHO: Payments will be received via their preferred payment method.
- USFHP providers enrolled with PNC/ECHO after Feb. 21, 2024: The first payment will be via a virtual card, with details needed for converting to EFT or paper check provided. Subsequent payments will be via EFT or paper check, as preferred.
- Advantage MD providers enrolled after Feb. 21, 2024: The first payment will be via paper check and paper remittance. This information can be used to enroll in EFT, if preferred.
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Providers enrolled with PNC/ECHO and receive an EFT payment can view remits within the PNC/ECHO portal for both USFHP and Advantage MD. Paper remits will be issued with paper checks. Claims payment detail will also be available on Availity (Advantage MD) and HealthLink (USFHP).
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Providers who have not received a check within 15 days after the paid date can call Advantage MD Customer Service 877-293-4998 (Option 1) or USFHP Customer Service at 800-808-7347 (Option 2). JHHP can check the status, verify your address and reissue a payment, if needed. If a virtual card was not received, please contact PNC/ECHO at 888-697-6755.
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JHHP will issue paper checks for any payments that must be made from MC400 for Priority Partners or EHP claims with DOS prior to Sept. 1, 2022, or Dec. 1, 2022, respectively. We anticipate sending these checks toward the end of June.
Additional Information and Assistance
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Providers who received an advance payment will receive a repayment request once the full implementation with PNC/ECHO is complete for USFHP and Advantage MD. Please reference the repayment terms in the advance payment agreement for more details.
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Optum Financial Services is offering temporary funding assistance to provider organizations affected by the payer system outage. Eligible providers can register at http://www.optum.com/temporaryfunding.
This information has been provided by the United HealthGroup.
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Availity has prepared their own Frequently Asked Questions on their response to the Change Healthcare Cybersecurity event to assist providers on processing transactions.
This information has been provided by Availity.