Back to Insights and Updates for ProvidersMay 2024

Change Healthcare update: Claims submission connectivity available for all products

All products

We’re pleased to report that all Point32Health lines of business now have the ability to accept claims electronically (837 claims submissions).

When Change Healthcare, a subsidiary of Optum, experienced a cybersecurity event on Feb. 21, Point32Health suspended system access and data transmissions between our organization and Change Healthcare. This affected providers who utilized Change Healthcare and some of its affiliates.

We have been establishing connections with other clearinghouses to restore electronic claims submission capabilities for all lines of business and providers who utilized Change Healthcare as a clearinghouse — including with Optum’s iEDI and RelayHealth, as Optum has been directing clearinghouse traffic to these options and has not made Change Healthcare’s Emdeon available again.

While for many lines of business other clearinghouse options were available, for Harvard Pilgrim Health Care StrideSM (HMO)/(HMO-POS) Medicare Advantage, Emdeon had been the sole clearinghouse option. At the end of April, however, we established a connection with RelayHealth for Stride (please look to future issues of the newsletter for potential updates).

With this milestone, all Harvard Pilgrim and Tufts Health Plan lines of business once again have electronic claims submission capabilities.

Point32Health has connections with a variety of clearinghouses beyond Optum’s RelayHealth and iEDI, with clearinghouse availability varying by product.

The following functionality is still unavailable through Change Healthcare: 276/277 claims status inquiry, 270/271 eligibility and benefits inquiry response, and 278 referral and authorization.  The impact of this varies by line of business as these transactions may not have been available via Change Healthcare electronically for some products.

However, Point32Health offers alternatives for you to utilize to conduct these transactions. For more information, please refer to the Our Response to Change Healthcare’s Cybersecurity Incident page, which includes a chart that notes ways in which you can conduct affected transactions.

This page also details accommodations that we have in place to support providers who utilize Change Healthcare, including information on claims timely filing. We encourage you to visit it regularly for updates on our response to the Change Healthcare incident.

If you need guidance with electronic transactions, please contact our electronic data interchange (EDI) team at [email protected] for Tufts Health Plan or [email protected] for Harvard Pilgrim Health Care.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

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