Provider Frequently Asked Questions (FAQs)

On February 21, 2024, Change Healthcare (CHC), a subsidiary of Optum, took several services offline in response to a cybsersecurity incident. As soon as Molina Healthcare, Inc. (Molina) became aware that CHC experienced a cybersecurity incident, on February 21, 2024, we promptly disconnected our systems to CHC to ensure our own systems would remain secure. In addition, we immediately activated our Incident Response Plan team and contingency plans to manage any associated impact of the CHC incident to Molina, our network providers and our members. At this time, there is no indication Molina systems were compromised, nor has CHC notified us that Molina data has been compromised. As of the date of these FAQs, CHC has begun initial outreach to start the reconnection process with its customers.

Below are frequently asked questions related to the CHC service interruption and Molina contingencies. We will continue to share additional information as it becomes available.

General FAQs

1. What Molina Healthcare, Inc. (Molina) services have been impacted in connection with the Change Healthcare (CHC) cybersecurity incident and outage?

For Molina, the Change Healthcare (CHC) incident impacted Electronic Claims Submission, and Payment and Settlement Services.

4/4/24 Update Provider Payments: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received. This process utilizes the same coding and logic that was in place prior to the incident.

2. I am a Provider impacted by the Change Healthcare (CHC) outage/incident. How can I get in touch with someone at Molina to assist me?

• Molina has established a dedicated contact center to assist providers impacted by the CHC outage. Agents can assist with claim(s) submission, emergency financial assistance requests, or other concerns related to the CHC outage. The contact center is available Monday-Friday from 5:00AM PST to 6:30PM PST. The contact center number is (844) 548-7684.
• Contact your state or market-specific Provider Services Contact Center.
• Contact your Molina Provider Services Representative.

3. What alternative solutions are implemented to mitigate the impact on services and ensure continued support for members and providers?

Molina responded swiftly to the CHC incident to limit the impact to our provider community. We enacted our business continuity plan, which included alternative solutions to continue electronic claims intake and payment to providers.

Outlined below are the options for our providers until we deem it is safe to resume our regular processes with CHC:

• Clearinghouse Options: Providers utilizing CHC to submit claims to Molina prior to the outage may now do so via our alternate established connection with SSI Claimsnet, LLC (SSI Group) clearinghouse or another clearinghouse of their choice. Providers who are not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission.
• Provider Portal: Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key-in claims for claims submission.
• 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.
  
  4/4/24 Update Provider Payments: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received. This process utilizes the same coding and logic that was in place prior to the incident.
• Eligibility: Molina has reestablished batch 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.

The following functions have not been impacted by the CHC incident:

• Authorization and Utilization Management: The process to request authorizations has not been disrupted and all utilization management decisions will follow our standard process.
• Notice of Admissions: The CHC incident has not impacted the notification of admissions process. Notice of an admission allows us visibility into the care of our members. Additionally, it allows us to assist with discharge planning to ensure our members have a smooth transition from acute care.

We are continuing to monitor the incident, and our contingencies, and will make any needed adjustments as appropriate, as the situation develops. Molina is committed to continue alternate provider claims submission and provider payment contingencies until such time as Molina has determined that the CHC services can be restored in a stable and secure manner. In preparation for reconnecting with CHC, we are establishing additional plans to limit disruption to our providers and members when that reconnection occurs.

We encourage providers to continue with their contingencies and alternate clearinghouse services. At this time, Molina’s alternate clearinghouse, SSI, will continue to accept claims from all clearinghouses. Note Regarding Electronic Claims: As of the 4/4/24 updates, electronic claims submissions continue to follow our alternate process, as Molina has not reconnected to CHC for any EDI clearinghouse services nor established connectivity to any of CHC's affiliate clearinghouses (iEDI/Relay) at this time.

Claims Submission

4. How do I submit claims electronically?

• Providers not directly utilizing Change Healthcare (CHC) can and should continue utilizing their current clearinghouse for 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, or another clearinghouse of their choice.
• Our Availity Essentials Provider portal solution was not impacted by this outage and remains available as another option to key-in claims for claims submission.
• Register with SSI for claim submission via the Claimsnet’s Molina Provider Registration Form located online at: https://products.ssigroup.com/molinaregistrationportal/register
  SSI dedicated contact center for Molina Providers 844-750-4274.
• Providers can register with Availity Essentials to key-in claims for submission at: https://www.availity.com/molinahealthcare
  Support is available with Availity at 1-800-AVAILITY (282-4548). Additional support resources:
  • How to register on the Availity Portal (incl. links to video, live webinar schedule and How To register): https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/
  • Availity’s page on self-service during this security incident: https://www.availity.com/availity-lifeline-self-serve-resources
  • Availity’s Quick Reference Guide https://www.availity.com/documents/learning/QSG_Atypical_Registration.pdf

SSI has established connections to the following Molina Healthcare Plans:

Health Plan	Payer ID		Health Plan	Payer ID
Molina Complete Care of Arizona	MCC01		Molina Healthcare of New Mexico	09824
Molina Healthcare of California	38333		Molina Healthcare of Nevada	MLNNV
Molina Healthcare of Florida	51062		Molina Healthcare of New York	16146/SWHNY
Molina Healthcare of Iowa	MLNIA		Molina Healthcare of Ohio	20149
Molina Healthcare of Idaho	61799		Molina Healthcare of South Carolina	46299
Molina Healthcare of Illinois	20934		Molina Healthcare of Texas	20554
Molina Healthcare of Kentucky	61325		Molina Healthcare of Utah	SX109 (837P) 12X09 (837I)
Senior Whole Health of Massachusetts	SWHMA		Molina Complete Care of Virginia	MCC02
Molina Healthcare of Michigan	38334		Molina Healthcare of Washington	38336
Molina Healthcare of Mississippi	77010		Molina Healthcare of Wisconsin	ABRI1
Molina Healthcare of Nebraska	MLNNE

 

5. I have not received confirmation of receipt or payment for a prior claim submitted on 2/21/24 or after?

If you have submitted electronic claims to Molina via a clearinghouse, on or after 2/21/2024, and have not received acknowledgement from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to providers submitting directly to SSI Group, UHIN, TMHP, COBA, or via our Availity portal solution.

6. I registered with Molina’s alternate clearinghouse SSI. I am still not able to submit claims and have not received payment.

Contact the SSI dedicated contact center for Molina Providers at 844-750-4274 to confirm they have completed your Provider registration.

7. I am currently submitting paper claims. Is there anything I need to do?

The process for paper claims submission has not changed, however, during this outage the process may be delayed. We encourage all our providers submitting paper claims to explore our electronic submission options.

8. I am a Provider, and SSI rejected my claim submission(s). What should I do?

Molina is working closely with our alternate clearinghouse, SSI, to process claims smoothly. If your claim(s) submission was rejected since we announced SSI as our alternate clearinghouse, you will not need to resubmit your claim. SSI will automatically re-process your claim(s) submission. You will receive a confirmation from Molina once your claim has been received. If for some reason, you have not received a confirmation within 5 business days, please re-submit your claim(s) to SSI. If you continue to receive rejections, please contact Molina’s dedicated SSI support line at 1-844-750-4274 for 24 hour/7 day per week support.

9. I am a Provider using the UHG iEDI clearinghouse. Will Molina be able to receive and process my claim(s)?

Yes. SSI Group, Molina’s alternate clearinghouse, does have a connection with the UHG iEDI clearinghouse. UHG iEDI can receive and transmit to us any Molina Healthcare claims they receive.

Claims Payment

10. When will my claim be paid?

Molina utilizes ECHO, a CHC partner, to issue provider payments. ECHO has not been impacted by this outage. Molina has established a direct connection with ECHO and resumed provider payment processing. Payments are current.

4/4/24 Update: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received.

This process utilizes the same coding and logic that was in place prior to the incident.

Note Regarding Electronic Claims: As of the 4/4/24 updates, electronic claims submissions continue to follow our alternate process, as Molina has not reconnected to CHC for any EDI clearinghouse services nor established connectivity to any of CHC's affiliate clearinghouses (iEDI/Relay) at this time.

11. Will I receive 835 Electronic Remittance Advice Files?

835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will be available as usual on providerpayments.com. 835 files will also be sent to any clearinghouse you currently have configured with ECHO. Please note there may be slight changes to the format of the EOP, however, all required data elements are available.

4/4/24 Update: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. This process utilizes the same coding and logic that was in place prior to the incident. 835 Electronic Remittance Advice files have returned to their pre-outage layouts and formats.

12. Will I receive Explanation of Payment (EOP) files? Why is the usual information and/or notations is not on my EOP file?

Explanation of Payment (EOP) will be available as usual on providerpayments.com. Please note there may be slight changes to the format of the EOP, however, all required data elements are available. For example:

• Customer remit messages that populate as a results of claims remarks might display in a different format than previous.
• Patient Responsibility (PR) CARC may be more generic than our previously detailed CARC. However, PR will be clearly indicated on the PDF EOP via the remit message.
• For Marketplace, if a claim is denied and you are out of Molina’s network, the federal or state disclosures specific to the No Surprises Act will not be displayed. Communications related to these claims will be addressed separately.

4/4/24 Update: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. This process utilizes the same coding and logic that was in place prior to the incident. Explanation of Payments (EOP’s) have returned to their pre-outage layouts and formats.

13. I am unable to access my Explanation of Payments (EOP) issued before 02/20/24. Why is that and what can I do?

• If you are an EFT provider, your Explanation of Payment (EOPs) documents are still be available on providerpayments.com. Please access them there.
• If you are a provider that was receiving checks or virtual cards, the PDF Explanation of Payment will not be available, as this is housed with Change Healthcare. We are working on an alternative solution and will provide an update when it is available.

14. I do not use Change Healthcare (CHC) to submit claims, and I have not received payment?

Contact your clearinghouse and confirm they are submitting your claims to Molina’s alternate clearinghouse SSI (SSI Claimsnet, LLC).

15. How many days a week are claims being paid?

Claims are being processed and paid according to the usual payment schedule.

16. I am a Provider, and I don’t see my refund amount on the 835?

As a workaround, refund amounts can be found on the Explanation of Payment (EOP), until we are able to resume including that information in the 835 files.

4/4/24 Update: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. This process utilizes the same coding and logic that was in place prior to the incident. 835 Electronic Remittance Advice files have returned to their pre-outage layouts and formats, which includes refund amounts.

17. I am a Provider, and I am in financial distress due to the CHC outage?

Molina is here to help. Contact our dedicated contact center to assist providers impacted by the CHC outage, which is available Monday-Friday from 5:00AM PST to 6:30PM PST. The contact center number is (844) 548-7684.

4/4/24 Update: Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. This process utilizes all coding and logic that was in place prior to the incident.

18. I am a Provider, and I am in financial distress due to the CHC outage?

Molina is here to help. Contact our dedicated contact center to assist providers impacted by the CHC outage, which is available Monday-Friday from 5:00AM PST to 6:30PM PST. The contact center number is (844) 548-7684.