We are actively monitoring a cybersecurity incident involving Change Healthcare which offers claims and prescription processing services, as well as member eligibility verifications, for many hospitals and physician offices around the country. This has impacted some of our providers who used Change Healthcare as their clearinghouse as well as those who share data with Optum as Change Healthcare is part of Optum and owned by UnitedHealth Group.
When we learned of the cybersecurity incident on February 21, we disconnected from Change Healthcare as a precaution. As a result, we are not receiving any electronic transactions, including claim submissions, from providers who use Change Healthcare. Currently, there is no impact to EmblemHealth or ConnectiCare’s systems, but we are monitoring this ongoing nationwide situation.
How long will it take to resume processing transactions?
We do not know how long Change Healthcare will be unavailable. We will begin processing all claims as they come in when Change Healthcare’s services are restored. The time it will take to process the backlog of claims will depend on the length of time Change Healthcare is offline. In the meantime, we are working through our current inventory of claims so we can free up resources and more quickly tackle the expected backlog of claims once Change Healthcare services are restored. We will share more information as it becomes available, especially if this is to be an extended disruption.
Were EmblemHealth’s/ConnectiCare’s systems compromised?
We are not aware of any unauthorized access or disclosure of EmblemHealth member information through our systems or those of our business associates that perform services on our behalf. If this changes, we will make sure to take the necessary steps to notify our members, employer groups, and regulators as required.
Are there other clearinghouses that EmblemHealth/ConnectiCare use to accept electronic transactions?
EmblemHealth and ConnectiCare accept medical, dental, and facility electronic transactions from several companies.
| Trading Partner | Medical | Facility | Dental |
|---|---|---|---|
| Ability/MDonline | X | ||
| Allscripts | X | X | |
| Availity LLC | X | X | |
| Claim MD | X | X | |
| ClaimLogic | X | ||
| Cortex EDI Inc | X | ||
| Office Ally LLC | X | X | |
| Practice Insight LLC | X | X | |
| SSI (2946)/SSI (2970) | X | X | |
| TriZetto Provider Solutions | X | X | |
| EDI Health Group / DentalXchange | X | ||
| Tesia/Vyne Dental/National Electronic Attachment | X | ||
| Secure EDI/Inmediata | X | ||
| EmblemHealth / ConnectiCare Provider Portal | X |
You may also visit our websites for helpful information, including how to connect to TriZetto Provider Solutions (TPS). Furthermore, our provider portals are a convenient way to check member eligibility and claim status, submit referrals, obtain prior approvals, and more.
- EmblemHealth: https://www.emblemhealth.com/providers/claims-corner/submissions/emblemhealth-guide-for-electronic-claims-submissions
- ConnectiCare: https://www.connecticare.com/providers/billing-claims
Can providers submit paper claims during the period when Change Healthcare is unavailable?
We cannot accept paper claims as a substitute for the claims handled by Change Healthcare. As an alternative, providers can reach out to TriZetto to engage their electronic transaction processing services. However, providers may also want to wait several days to see if Change Healthcare’s services can be quickly restored. If providers are using other companies for their electronic transactions, they should continue doing so as only Change Healthcare was impacted.
How can I perform other electronic transactions, such as checking on the status of a claim or member eligibility?
Providers can check member eligibility and claim status using our provider portals. Please visit emblemhealth.com or connecticare.com to log in or sign up.
Has this impacted preauthorizations or other utilization management functions?
We have not seen any impact to preauthorizations or utilization management functions, but we do encourage providers to submit preauthorization requests or updates, including attaching needed clinical data, through our provider portals. (emblemhealth.com/providerportal and connecticare.com/providerportal).
We are committed to keeping you informed as the situation with Change
Healthcare continues to evolve.
JP 64961 02/2024