Our Response to Change Healthcare’s Cybersecurity Incident

On Feb. 21, we were made aware that Change Healthcare, a subsidiary of Optum, experienced a cybersecurity incident that has caused a disruption to their systems. Change Healthcare interacts with Point32Health and its family of companies — including Tufts Health Plan, Tufts Health Public Plans, Harvard Pilgrim Health Care and CarePartners of Connecticut — as a provider clearinghouse, through the use of their Interqual® criteria, and for other services.

This incident impacted Change Healthcare systems, and there is no current threat to our Point32Health systems. We are continuing to conduct all business operations — including processing claims, referrals, notifications, and authorization requests. After initially suspending services, system access, and data transmissions between Point32Health and Change Healthcare, we have brought certain connections back after determining that it is safe to do so.

However, providers who utilize Change Healthcare — and some of its affiliates — as a clearinghouse will be affected by this suspension of system access. We have developed workarounds and business processes to support impacted providers. In addition, we are monitoring Change Healthcare’s response to this incident and will work with them to restore normal operations as quickly as possible.

Please refer to this Optum/Change Healthcare page for the latest updates on their cyber response, including estimated timelines for restoration of services.

For all providers

Electronic Payment and 835s

Point32Health utilizes Payspan for electronic payment for the Harvard Pilgrim Health Care Commercial products, Harvard Pilgrim Health Care StrideSM (HMO/ HMO-POS) Medicare Advantage Plans, Tufts Health Plan products (including Tufts Health Commercial, Tufts Health Public Plans, and Tufts Health Senior Products), and CarePartners of Connecticut lines of business. We have coordinated with Payspan and they have confirmed that they are holding any transactions with Change Healthcare until it is deemed safe to resume service. This includes holding all 835s (Electronic Remittance Advice) that would have been sent to Change Healthcare or one of their subsidiaries. If you utilize Change Healthcare, you will not be able to retrieve your 835s from their site at this time. However, you can access your 835s via the Payspan website.

Requesting prior authorization for medical services — Interqual available

  • Point32Health is continuing to accept and process prior authorization requests without interruption. Please continue to submit notifications and requests for authorization for any services that require notification or authorization.
  • The process for requesting prior authorization for pharmacy or medical benefit drugs is unchanged. For information on requesting authorization on pharmacy and medical drugs for Harvard Pilgrim Health Care and Tufts Health Plan, please refer to this page
  • If you utilize Change Healthcare to submit referrals or prior authorization requests for medical services, please refer to the chart below for alternatives.
  • A portion of our medical policies utilize Interqual® criteria to determine medical necessity. This criteria is available again, after being temporarily available. You may request authorizations as you have previously – electronically through our secure portals or by FAX (Refer to the FAX numbers on the Medical Necessity Guidelines.)

For Providers Using Change Healthcare as a Clearinghouse 

The primary impact to providers is for those who utilize Change Healthcare as a clearinghouse. Point32Health offers additional ways to submit and check the status of your claims, verify member eligibility, and request prior authorizations and referrals, and we encourage you to utilize these while Change Healthcare does not have access to our systems (see chart below).

Please note that across all lines of business the process for requesting authorization for pharmacy and medical drugs remains unchanged.

Claims timely filing limit and adjustment extension for providers affected by the Change Healthcare cyber event
In an effort to support providers who utilize Change Healthcare to submit claims via EDI, Point32Health will be temporarily waiving claims timely filing limits for these affected providers as follows:

  • Claims timely filing: for Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Public Plans, Tufts Health Senior Products, and CarePartners of Connecticut we will extend timely filing limits for claims for 60 days from when connections are restored among Change Healthcare, Point32Health and providers. As Harvard Pilgrim Health Care StrideSM (HMO/ HMO-POS) Medicare Advantage Plans and both Harvard Pilgrim and Tufts Health Plan Medicare Supplement products have a claim filing limit of 365 days, we will evaluate requests for timely filing extensions on a case-by-case basis.
  • Claims adjustments/replacement claims: for Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, and Tufts Health Public Plans, we will extend limits for claims adjustments for 60 days from when connections are restored among Change Healthcare, Point32Health and providers. Based on the existing extended claims adjustment timelines for Harvard Pilgrim Health Care StrideSM (HMO/ HMO-POS) Medicare Advantage Plans, Tufts Health Plan Senior Products, CarePartners of Connecticut, and Harvard Pilgrim and Tufts Health Plan Medicare Supplement products, we will evaluate requests for claims adjustment filing extensions on a case-by-case basis.

We will update this section with additional details — including the date of Change Healthcare’s resumption of EDI claims activity — as it becomes available.

Waiver of authorization for admission to Massachusetts sub-acute and rehab facilities

Point32Health is extending our waiver of prior authorizations from April 1, 2024 to Aug. 1, 2024 for admissions from acute care hospitals to Massachusetts sub-acute care facilities and rehabilitation facilities for all applicable* Harvard Pilgrim Health Care and Tufts Health Plan products (commercial, Medicare Advantage/Senior Products, and Public Plans lines of business). For complete details, please refer to this webpage.

*Please note that the prior authorization waiver does not apply for US Family Health Plan, a TRICARE Prime health plan for eligible military families for which Tufts Health Plan provides administrative services.

Alternative mechanisms for common transactions

For Providers Using Change Healthcare as a Clearinghouse Only – Affected Transactions
837 Claims Submission 276/277 Claims Status Inquiry 270/271 Eligibility and Benefits Inquiry Response 278 Referral and Authorization
Connection to Change Healthcare temporarily disabled for these lines of business Harvard Pilgrim Health Care Commercial (including Harvard Pilgrim group Medicare Supplement products)

Harvard Pilgrim Health Care Stride

Tufts Health Plan Commercial

Tufts Health Public Plans

Tufts Health Senior Products

CarePartners of Connecticut

Health Plans, Inc.

Tufts Health Plan Commercial

Tufts Health Public Plans

Tufts Health Senior Products

CarePartners of Connecticut

 

Harvard Pilgrim Health Care commercial (including Harvard Pilgrim group Medicare Supplement products)

Tufts Health Plan commercial

Tufts Health Public Plans

Tufts Health Senior Products

CarePartners of Connecticut

Health Plans, Inc.

Tufts Health Plan commercial

Tufts Health Public Plans

Tufts Health Senior Products

CarePartners of Connecticut

 

Alternate mechanisms
  837 Claims Submission

(You may opt to hold claims as Change Healthcare resolves this issue or to utilize one of the following alternatives.)

276/277 Claims Status Inquiry 270/271 Eligibility and Benefits Inquiry Response 278 Referral and Authorization
Harvard Pilgrim commercial, including Harvard Pilgrim group Medicare Supplement products Alternative clearinghouse, direct submission, through our secure portal HPHConnect or by paper submission

(batch set up not recommended; single claim entry only available for professional claims)

No impact — business as usual NEHEN, HPHConnect, or by calling the Provider Service Center. No impact — business as usual
Tufts Health Plan commercial, Tufts Health Public Plans, Tufts Health Senior products Alternative clearinghouse, direct submission, or by paper submission NEHEN, Tufts Health Plan portal, or calling Provider Service Centers NEHEN, Tufts Health Plan portal, or calling Provider Service Centers. NEHEN, Fax (refer to the fax numbers listed on the Medical Necessity Guidelines) or Tufts Health Plan portal. Paper referral forms are also available.
Harvard Pilgrim Health Care StrideSM (HMO/ HMO-POS) Medicare Advantage Plans Via paper to Harvard Pilgrim Health Care, Inc., c/o Stride Claims Processing, P.O. Box 211067, Eagan, MN 55121 No impact — business as usual No impact — business as usual No impact — business as usual
CarePartners of Connecticut You may hold claims temporarily until this is resolved or submit via another clearinghouse (using payer ID 16307) or paper to CarePartners of Connecticut, P.O. Box 478, Canton, MA 02021-0478. NEHEN, CarePartners of Connecticut Provider Portal, or by calling the Provider Service Center. CarePartners of Connecticut Provider Portal, NEHEN, or by calling 888-341-1508. Fax at 857-304-6463 or utilizing our secure provider portal. Paper referral forms are also available.
Health Plans Inc. An alternative clearinghouse (use the HPI payer ID 44273 or the Harvard Pilgrim payer ID 04271). No impact — business as usual Via telephone Prior authorization requirements vary by plan. Please refer to the member’s Summary Plan Description for plan requirements. You may also visit the HPI website at hpiTPA.com or call the phone number listed on the back of the member’s ID card.
Clearinghouses with connections to Point32Health (availability varies by product)
AdvantEdge Healthcare Solutions

Apex EDI

ASP. MD, Inc.

Availity

ClaimRemedi

Claimsnet

Cortex

EDIEligible, Inc.

Encoda

FinThrive

GHN Online

IDX

iEDI (Optum)

Inovalon

InstaMed

NEHEN (offering rapid onboarding; if interested, complete interest form on their website)

NextGen

Nuesoft

Office Ally

Origin Health Care

 

Passport Health Communications

PHICure

PNC Xpack Network Services

Quadax

RelayHealth

Rycan Technologies

Siemens HDX

 

SSI Group

SSIMED-Origin Health Care

Trizetto Provider Solutions

Veradigm

Waystar

WiseTime

Provider Service Center phone numbers

Harvard Pilgrim Health Care Commercial: 800-708-4414

Tufts Health Plan Commercial: 888-884-2404\Tufts Health Public Plans: 888-257-1985 for Massachusetts, 844-301-4093 for Rhode Island

Tufts Health Plan Senior Products: 800-279-9022

CarePartners of Connecticut: 888-341-1508

Health Plans Inc.: Call the phone number listed on the back of the member’s ID card.

For information on direct submission of batch claims to Point32Health, please refer to the following resources or contact the electronic data interchange (EDI) team at edi_operations@point32health.org for Tufts Health Plan or edi_team@point32health.org for Harvard Pilgrim:

Harvard Pilgrim 837 Professional Companion Guide

Harvard Pilgrim 837 Institutional Companion Guide

Tufts Health Plan 837 Institutional and Professional Companion Guide

CarePartners of Connecticut 837 Institutional and Professional Companion Guide

Publication information

4.8.24 — Updated clearinghouse chart to note that we resestablished our connection with RelayHealth. Also updating the chart noting alternative options for clarification.

3.18.24 — Added iEDI as an accepted clearinghouse.

3.13.24 — Added information on extension of timely filing deadlines for claims and prior authorization waiver for sub-acute care.

3.8.24 — Updates information on restoration of certain connections; added information about NEHEN rapid access; updated link to Optum/Change Healthcare page for more information.

3.7.24 — Updated information to note availability of Interqual criteria.

3.1.24 — Added information on clearinghouses available.

2.26.24 — Published information on Change Healthcare incident information.