Optum-Change Healthcare outage

Molina Healthcare, Inc. (Molina) is advising our providers of a critical outage of our third-party vendor, Optum-Change Healthcare (CHC), resulting in impacts to Electronic Claims Submission, Payment and Settlement Services.

Updates

Molina Healthcare of New Mexico, Inc., a licensed insurer, is complying with the Order issued on March 21, 2024 by the New Mexico Office of the Superintendent of Insurance (OSI) regarding the recent Change Healthcare (CHC) cybersecurity incident. The OSI order can be found here -- -- and is in effect for at least 30 days from the date issued (March 21, 2024).

UPDATE: As of 4/19/2024, to comply with Order 2024-0015, the below directives are extended through May 19, 2024. The Order requires, among other items:

• That insurers suspend all prior authorization requirements issued since February 21, 2024 for non-hospital-affiliated physicians, physician groups, practices, or facilities impacted by the Change Healthcare cyber incident;
• That insurers shall not retroactively deny a claim submitted by the same provider types since February 21, 2024 due to:
  • Lack of utilization management approval;
  • Lack of prior authorization; or
  • Lack of eligibility confirmation; and
• That insurers waive timely filing deadlines for claims and appeals submitted by the same provider types for all services rendered since February 21, 2024.

If Molina providers need CHC-related payment assistance, they may call (844) 548-7684 Monday-Friday 5AM – 6:30 PST or email: CHCoutage@molinahealthcare.com.

Reminders

Claims submission

Providers utilizing CHC to submit claims to Molina prior to this outage may now do so via our alternate established connection with SSI Claimsnet, LLC (“SSI Group”) clearinghouse or another clearinghouse of their choice. Providers not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission. Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key in claims for submission.

• Providers can register with SSI Group for claim submission via Claimsnet’s Provider
  • Registration Form link https://products.ssigroup.com/molinaregistrationportal/register
  • Dedicated contact center and support for Molina Providers 844-750-4274

• Providers can register with Availity Essentials to key in claims for submission
  • Registration Form link: https://www.availity.com/molinahealthcare
  • Dedicated contact center and support for Molina Providers 1-800-AVAILITY
  • How to register guide and training: https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/

• Self-service during this security incident:

  https://www.availity.com/availity-lifeline-self-serve-resources

• Quick Reference Guide

https://www.availity.com/documents/learning/QSG_Atypical_Registration.pdf

 

During this transition, we encourage all our providers submitting paper claims to explore our electronic submission options.

For those providers who have submitted electronic claims to Molina via a clearinghouse on or after 2/21/2024 and have not received acknowledgment from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to any providers submitting directly to SSI Group, UHIN, TMHP, COBA, Ohio Medicaid Enterprise System (OMES) or via our Availity portal solution.

Provider payments

Molina has established a direct connection with ECHO, a CHC partner, to resume provider payment processing. ECHO has not been impacted by this outage. Payments are current and will be processed in the order received.

835 Electronic Remittance Advice files and Explanation of Payment

835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will continue to be available on providerpayments.com. Please note there may be slight changes to the format of the EOP; however, all required data elements are included.

Eligibility Verification

Molina has reestablished member eligibility verification (270/271) services using SSI Group, our alternate clearinghouse. In addition to online verification with SSI Group, eligibility verification continues to be available via the Availity Essentials portal, the Molina Contact Center and IVR. Molina’s member eligibility continues to be updated timely.

Questions?

We understand that the CHC outage can disrupt you and your practice. Molina is in regular contact with CHC, ECHO, SSI Group and Availity Essentials to help mitigate this outage, and we will continue to update our provider community regarding this situation. We appreciate your patience and understanding during this unprecedented time of disruption. Thank you for your continued partnership.

All questions should be directed to Molina’s Provider Contact Center or your Molina Provider Services representative for New Mexico.

UPDATE: If you are a Molina Member who has been impacted by the CHC incident, please contact our Member Contact Center at (888) 295-7651. (Monday – Friday 8am – 5pm)