Off the Cuff: When Clearinghouse Convenience Comes Home to Roost

Insurance claim clearinghouses are essentially hubs where medical providers submit claims electronically. All our medical claims from multiple insurance companies transmit in a single electronic “claim file” that securely goes to the clearinghouse, which then sends these claims out to all the individual insurance plans for us. This claim file contains info about our office, the doctor who provided care, the patient’s insurance IDs, procedures we’re billing and the associated diagnosis codes for these procedures. It’s very convenient. Not only do we submit claims via these services, if our billers made an error that got by our systems, the clearinghouse can catch problems before it gets sent to the plan. Some insurance carriers can process the claim and send a file back to our systems to post the insurance payments to each appropriate patient's ledger. It’s automated billing, processing, posting and payments. Again, it’s all very convenient… until last week.

In our office, we use the web-based Compulink Advantage electronic medical records system. When we signed up, the only clearinghouse option was Emdeon which later became Change Healthcare and in 2022 was bought by United Healthcare/Optum. Anyway, it takes about 2-3 weeks to get the clearinghouse all set up with the different medical plans we accept. Last week I went to send a claim file and got an error message. No worries. It’s pretty rare. It has happened before when they’re running maintenance, or sometimes the file that generated is bad and it just has to be deleted and recreated. The alert said to try again later. The next day I got the same error. Very odd. I had my staff call Compunlink, and they said there’s an outage at Change Healthcare and to try again on Monday. Later I found an email sent Feb 22 that talked about the server outage. The following day another email came stating that Compulink was meeting with Change about the outage. Excellent. The next email that day was not so excellent. Change Healthcare/Optum’s servers weren’t just down, they were successfully cyber attacked “by foreign state” actors. The FBI and Homeland security are involved. On Monday more details came out that the ransomware group BlackCat was responsible, and Change/Optum doesn’t know if or what protected health information was compromised. This attack isn’t affecting only optometry. Thousands of healthcare companies and pharmacies are affected.

Compulink has been very transparent. They’ve been working on processes to allow us to submit claims directly to plans (hopefully up and running by Monday, March 4), essentially going around the clearinghouse, and even suggesting jumping ship to new clearinghouses. Signing up with a clearinghouse usually takes weeks to accomplish even when there isn’t a mass exodus of providers. I’m sure this would be a considerably longer process now.

At the time I write this, there’s been no new updates on the status of the Change Healthcare/Optum servers. Without medical claim submissions, there’s no revenue from medical services. Because of this, Optum Pay has set up a relief program with a payment relief website to get money to providers to continue running their practices based on averages that were being paid prior to the outage. As for me, I’m waiting to see how this plays out. I have enough in reserves to keep everything running for a while. Fortunately, as optometrists, we still have revenue coming in from vision plans. While I don’t want to be reactionary and potentially create bigger problems for my office, I think it’s prudent to stay informed, monitor the situation, and make smart decisions when decisions need to be made.

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Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.