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Department of Human Services Shares Resources for Alternate Claims Submission and Eligibility Verifications for Providers Affected by Change Healthcare Outage


Harrisburg, PA - The Pennsylvania Department of Human Services (DHS) today advised health care providers participating in Pennsylvania’s Medicaid program (also known as Medical Assistance in Pennsylvania) on how they may continue to bill DHS directly for fee-for-service claims while Change Healthcare, a national billing and claims management system used by both payers and health care providers, remains unavailable due to a cyber-attack.

“While DHS does not directly use Change Healthcare for Medicaid billing operations, a number of our providers and partners have been affected by the outage. Continuity of care and operations is our primary focus, and we continue to monitory the situation closely and remain available to assist providers as this disruption to Change Healthcare is addressed and rectified,” said DHS Secretary Val Arkoosh.

DHS does not use Change Healthcare to manage claims processing for payments issued directly by the department for fee-for-service claims, which represents a portion of our Medicaid program. However, managed care organizations that operate the majority of our physical health, behavioral health, and long-term services and supports managed care programs may use Change Healthcare in varying capacities, and healthcare providers, hospitals, and health systems may use Change Healthcare for claims management on their side of the billing structure.

For providers participating in Physical HealthChoices, Behavioral HealthChoices, and Community HealthChoices – Pennsylvania’s three Medicaid managed care programs – the managed care organizations (MCOs) that they participate with are communicating with providers about how to submit claims for payment. MCOs that use Change Healthcare for their operations are also issuing new processes for billing and information about delayed claims payments due to the ongoing outages. Providers billing an MCO should follow or seek guidance from the MCO to ensure they receive payment for services rendered.

Providers who bill DHS directly for Medicaid enrollees covered through fee-for-service coverage can submit individual claims via the PROMISe™ Provider portal. The portal has a form available where providers may log individual claims. Questions about billing and claims can also contact DHS’ Provider Service Center at 1-800-248-2152. Paper claims forms may also be submitted, and more information about where to mail forms is available on PROMISe™. Providers may also use PROMISe™ to assist with recipient eligibility verifications.

DHS has also directed pharmacy providers who may be unable to use an alternate vendor to fulfill claims to issue temporary, short-term supplies of necessary medications. Once billing issues are resolved, pharmacists will be able to retroactively bill for the short-term dispensations.

More information about the cyber-attack and UnitedHealth Group’s response is available here. Optum is also offering financial assistance to affected providers.

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