Following the recent cyberattack on Change Healthcare, Availity, a national revenue cycle management and electronic data interchange clearinghouse vendor, has “terminated” its connections with Change Healthcare.
Catherine Montgomery
The attack on Change, which processes a reported 50% of U.S. health care claims, crippled billing, prescriptions and other services across vast swaths of the nation’s health care system.
In a message to trading partners, Availity also stated that after March 16, 2024, it will return Change bill submissions “for which Availity has no current alternative pathway for electronic submission.”
In other words, Availity is washing its hands of bills that would usually be sent to Change, described as “the largest electronic ‘clearinghouse’ in the business.” Below, we summarize how this termination impacts providers’ revenue.
DaisyBill e-bills remain unaffected by the attack, as our software connects directly to claims administrators or their specific workers’ comp clearinghouses, none of which include Change.
Return to sender
In a March 14 email, Availity announced that it would cut ties with Change as a result of the cyberattack — a momentous decision considering Change’s near-omnipresence in U.S. health care (the federal Department of Health and Human Services estimates that Change is “involved in one in every three patient records”).
This Availity announcement contains three points that potentially affect providers' revenue:
The fact that e-bills passed through two clearinghouses — both Availity and Change’s systems — exemplifies how unnecessarily convoluted medical e-billing has become, even before the cyberattack.
Navigating the clearinghouse maze
Clearinghouses accept e-bills from providers and forward them to payers for processing. However, navigating the clearinghouse system requires expertise.
A reliable e-bill delivery system should send each bill to the (single) correct clearinghouse, not a redundant, daisy-chained series of clearinghouses cobbled together with duct tape and bubblegum.
Too many billing vendors and clearinghouses assert that e-bills are easily “rerouted” to multiple clearinghouses in their journey to the designated payer. But in reality, that’s precisely how e-bills and documents get lost.
The Change cyberattack is a wake-up call for billing vendors to establish the most direct, efficient electronic pathways for sending bills from the provider to the payer and to have contingencies in place for the unexpected.
That approach is how 92% of daisyBill e-bills reach the payer intact, with mainly automated processes to submit the rest via fax or email (or mail in less than 1% of cases) when necessary.
Catherine Montgomery is the co-founder and CEO of daisyBill, a provider of workers' comp end-to-end revenue cycle management software. This post appears with permission.
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