On 21st of February, Change Healthcare – a large healthcare platform operated by Optum – a large healthcare technology provider, both owned by health insurance giant United Health Group were hit by a ransomware cyber-attack. The attack, which was initiated by a ransomware gang ‘BlackCat/ALPHV’, is believed to have nation-states in the background, caused Change Healthcare to take down their systems offline, including the portals which left many doctors, hospitals, pharmacies and patients facing delays in processing their healthcare claims.

Read more details about the incident

In the wake of this incident Falckon Health started noticing unusual processing delays and the web portal of Change Healthcare being unavailable. Jay Sundarajah – Senior Vice President Business Development of Falckon Health recalled the incident – stating, Falckon faced a critical challenge when Change Healthcare which was a vital component of Falckon’s submission infrastructure faced this cyber intrusion.

Jay’s detailed publication on tackling the situation

Since Change Healthcare decided to completely isolate their systems, the DNS propagation progressively started making the access unavailable to users:

  • This in turn disrupted claim submission, payment retrieval, non-payment remittances and prescription processing.
  • System unavailability obscured the claim status updates, due to absence of exclusion & acknowledgement report.
  • Started to notice cashflow drops at client end, due to inability experienced in filing the claims.

Falckon’s team is well versed in tackling these situations, due to their proactive thoughts on simulated risk management training. Understanding the effects of delayed revenue, Falckon Health started responding immediately by working on a short- & long-term plan to protect the clients from security and revenue hazards.

In his detailed publication Jay had also elaborated how they worked hand in hand with AdvanceMD to reinstate the claim processing. (https://www.linkedin.com/pulse/falckon-healths-swift-response-change-healthcare-jay-sundarajah-cu3cc)

With less time in hand Falckon team devised an interim plan to:

  • Redirect the claims through ‘Availity’ clearinghouse by collaborating with AdvanceMD. This in turn helped to limit the reliance on Change Healthcare for claim submission; therefore, submitting 90% of claims to payers, within 2 weeks from the incident.
  • Using the online portal of payers who did not support the redirection through Availity, by uploading the ANSI 837 files manually.
  • Using the online portals to retrieve remittance advices for payments and non-payments; therefore, resuming the payment posting and denial management processes within 3 weeks.

Since Availity was brought online as the new direct submitter, Falckon Health was able to significantly reduce the reliance on 3rd-party systems by March 21st. Ever since Falckon team is using their updates and support tools, for Claim EDI reports, for uploading ERA directly to PMS, update carrier settings in bulk and facilitating the re-billing of claims via Availity’s NPID.

As a responsible RCM company

Falckon Health ensures to maintain HIPAA safety and security protocols to safeguard it’s clients, and exercise best ‘3rd party risk management’ (TPRM) strategies to overcome such unforeseen intrusions.

Successfully bringing back the revenue of their clients on time, Jay stated:

“While several healthcare providers and practices are continuing to battle the crisis, Falckon Health with it’s swift response have restored normalcy in billing and cash flow for all of it’s clients.”