Inside Highmark's Change attack response

Highmark Health has launched an advance funding program for providers struggling with cash flow in the wake of the Change Healthcare attack. 

Kate Musler, senior vice president of risk management and provider network at Highmark, told Becker's though providers of all sizes have had revenue disrupted by the outage, smaller providers with fewer days of cash on hand are facing the biggest challenges. 

"We're very worried about these smaller practices, particularly in rural areas, but certainly in urban areas as well, being able to continue to deliver care to our members," Ms. Musler said. 

Change Healthcare, which processes one in three medical claims in the U.S., has been down since Feb. 21. A ransomware group has claimed responsibility for the attack. 

A Highmark spokesperson told Becker's Highmark is the first Blue Cross Blue Shield plan to launch an advance payment program after the hack. The program will pay providers a substantial portion of the claims they typically bill Highmark based on historical audits, Ms. Musler said. 

Change Healthcare, a subsidiary of UnitedHealth Group, established a funding assistance program March 1. UnitedHealthcare is providing advance payments to providers in its network affected by the outage, according to a March 7 news release.

CMS has also implemented advance payments in Medicare Parts A and B and has urged private insurers to do the same. The American Medical Association has called for a list of payers providing advances to providers. 

CMS has also called on payers to waive prior authorization and utilization management during the outage, a move AHIP said could do more harm than good. 

Ms. Musler said Highmark is not waiving prior authorizations at this time. The system Highmark uses to process prior authorization is up and running, she said. 

"In respect of the due diligence that we have to perform on behalf of our plan sponsors, we need to keep performing these essential fiduciary functions," Ms. Musler said. 

UnitedHealth Group expects Change's payment platform to be available beginning March 15, and its medical claims platform to be back online beginning March 18, with service restored throughout the week. 

Though the platform could be restored in the near future, Ms. Musler said the outage will continue to take a toll on providers' cash flow. Change's systems have been unavailable for around three weeks — the typical length of time it takes for claims to be paid, Ms. Musler said. 

"It takes just about three weeks for a claim to get paid, on average. So what's happening is the impact to provider revenue is now starting to be felt. Even if they were able, right this minute, to start submitting claims again, the cash flow impact is still there," she said. 

Government officials are scrutinizing UnitedHealth Group and others payers' response to the attack as the fallout continues. HHS launched an investigation into the incident March 13. 

Ms. Musler said though a cyberattack of this size is unprecedented, Highmark's team was ready to effectively respond. 

"I am very proud of how we handled it and navigated it, how quickly we've gotten up and running and addressed the different solutions that we have," Ms. Musler said. "I think the learning here is the [reliance on a] single point of failure. That's not so much us, in terms of our own governance, but when you think of the industry as a whole, and how many points of the industry are depending on a single point of failure." 

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