Majority of US healthcare industry faced its worst turmoil during late February, by experiencing inability to file claims and delays in processing, attributed to the cyber attack targeted at healthcare giant United health group and it’s subsidiaries Optum and Change healthcare platform. Financial damages & Health Data compromise were widely reported across the industry in the aftermath.

Read More from this detailed incident showcase

While many healthcare companies struggled to get back on track, we followed these steps to mitigate the issues and return to normalcy in a shorter period of time.

1) Situation awareness & problem identification

Following Change Healthcare’s systems going offline, our team members started reporting issues in claim submission and update check. Being experienced and updated in the industry our management team figured out the nature of downtime, and started working on alternate plans.

2) Checked for alternate solutions and devised a strategy

We started to work in close collaboration with AdvanceMD devising a short term and long-term plan to meet the KPIs of claim processing queue. We

3) Redirected the Claims through Availity

We redirected all possible claim submission through Availity Clearinghouse. In 2 weeks time we were able to bypass the reliance on Change Healthcare by submitting 90% of claims.

4) Started to utilize online portals

We used the online portals of payers who couldn’t support redirection through Availity. At circumstances where claim redirection was not possible, efficient claim submission was achieved by manually uploading the ANSI 837 files, With the use of online portals we managed to retrieve remittance advices for payments and non-payments, and resumed payment posting & denial management processes within 3 weeks.

5) Using Availity as a direct submitter

Once AdvanceMD rolled out Availity as a direct submitter, we were able to certainly reduce the reliance on 3rd-party systems.

6) Using the updates and support tools for task completion

Using the tools such as Availity Claim EDI Report, AdvanceMD ERA import tool, Carrier update tool, and Mass re-bill claims by NPID tool  we were able to help our clients continue and maintain their processing activities by mid-April 2024.

Checkout Jay’s (VP Business Development – Falckon health) in-detail publication on how we worked hand in hand with AdvanceMD to reinstate the claim processing. (