OIC Instructs Carriers Regarding Change Healthcare Disruptions

April 25, 2024

In response to concerns voiced by WSHA and member hospitals to state agency staff about the ongoing impacts of the Change Healthcare cyber-attack, the Office of the Insurance Commissioner (OIC) released guidance to insurance carriers regarding expected carrier flexibilities until the issue is resolved.  OIC is monitoring Change Healthcare as part of its health care benefit manager (HCBM) oversight. WSHA is pleased with OIC’s response in providing this guidance. The guidance document includes:

  • Prior Authorization: OIC affirmed that the Change Healthcare disruption qualifies as an extenuating circumstance and carriers should review and process claims that are subject to prior authorization under their extenuating circumstances policy until Change Healthcare is operational or the carrier establishes an operational alternative prior authorization process.
  • Timely claims billing: OIC urged carriers to waive timely filing requirements for impacted health care providers and hospitals. Some primary and secondary payors have requirements as short as sixty days, making it impossible for providers and hospitals to receive payment for impacted services.
  • Medical claims clearinghouse services: Some carriers have been reported to be unwilling or unable to waive requirements that limit providers to Change Healthcare as the exclusive clearinghouse, leaving providers with no opportunity for claims submission and payment. OIC affirmed it expects carriers to authorize an alternative clearinghouse in an expedited manner for impacted providers.

WSHA will continue it advocacy efforts and asks members to keep us informed of payment challenges related to disruptions to Change Healthcare. WSHA created and will continually update a resource page with links to updates from federal and state agencies and from individual health insurers.
(Caitlin Safford, caitlins@wsha.org)


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