Update as of 11/5: Eight months after the initial cybersecurity breach, Change Healthcare confirmed on October 24 that over 100 million clients’ data was compromised—representing nearly a third of the U.S. population. As the largest healthcare data breach in U.S. history, the incident has placed significant strain on its parent company, UnitedHealth Group. The exposure has left affected clients vulnerable to identity theft, fraud, and targeted scams. Essential operations have been disrupted, and numerous providers are moving to other vendors such as Paradigm to avoid ongoing service delays. Despite the industry-wide outages, agencies using Paradigm have reported little to no disruptions in their revenue flow and payroll processing, enabling them to continue billing without incident.
2/29/24: Change Healthcare experienced a cybersecurity incident last week, which forced them to take their system offline to halt further data breaches. This has particularly affected home care agencies that depend on third-party payers for billing and payroll, and has had an extensive impact across various user groups:
- Direct Users: Individuals or entities that directly access Change Healthcare may be able to access Change Healthcare, but the functionality is limited, and claims are not being transmitted as expected.
- Integrated AMS/Scheduling Software Users: Agencies using Change Healthcare as a direct integration with their AMS (Agency Management Software) or scheduling software have lost this capability.
- Payers: Some payers require agencies to submit claims or receive remittances via Change Healthcare. Therefore, these agencies may be affected either by an inability to submit claims or receive payments due to the system being offline.
Change Healthcare says they are actively working to restore their system, yet the delay has significantly impacted home care agencies, particularly those reliant on regular cash flow. The lack of a contingency plan has only heightened the frustration among providers across all payer lines.
How it Affects VA Providers
For home care providers serving Veterans under the VA Community Care Network, the cybersecurity incident at Change Healthcare has led to significant disruptions. Direct integrations with Change, utilized by AMS platforms like Wellsky or Generations, are currently non-operational.
While there are alternative clearinghouses available, such as Availity or myVACCN, transitioning to these platforms can be cumbersome and time-consuming.
For providers still billing the VA directly, not TriWest or Optum, are likewise affected by this, as the VA uses Change Healthcare to process claims on their end and therefore are at a standstill.
How it Affects Medicaid Providers
Similarly, Medicaid service providers have faced challenges due to the outage at Change Healthcare. Many payers use Change Healthcare for processing on their end and therefore their claims processing is at a standstill.
Alternatives do exist, with some providers having the option to switch to other clearinghouses, yet this transition may not be straightforward for all.
How Paradigm Helps
Paradigm employs a distributed network of clearinghouses, ensuring uninterrupted billing with redundancy. In the event of a cyber incident at one clearinghouse, we automatically reroute your billing through another in our network, and if need be, through an alternative method such as, paper billing, direct payer connections, or portals to ensure zero downtime.
This ensures a reliable alternative to those solely dependent on Change Healthcare and safeguarding against system collapses.
Despite the industry disruption, home care providers using Paradigm have maintained their revenue flow and have been able to process payroll without interruption.
In some cases, Paradigm also provides advanced funding to eligible providers, ensuring they can sustain their billing and payroll operations, even when industry-wide outages occur.
More than anything, Paradigm possesses unparalleled knowledge and experience in the home care space. We are dedicated to remaining at the forefront of the home care industry, which allows us to react promptly and effectively in critical situations, ensuring the highest level of support for our clients.
It’s Time for a Paradigm Shift
Paradigm is not a clearinghouse; it's a comprehensive solution for managing third-party payer interactions. Our services extend beyond simple transactions, offering enrollment and expansion support, auditing for fund recovery, and advanced software checks that ensure a 99.9% first-pass success rate for billing and payroll security.
Moreover, Paradigm is dedicated to your growth, with Paradigm providers experiencing an average growth of over 300% in 2023.
If the Change Healthcare incident has impacted you, contact us. Our specialized team is prepared to expedite your onboarding, ensuring seamless invoice processing.
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