March 6, 2024
On February 21, Change Healthcare, a software and data analytics subsidiary of UnitedHealth Group’s Optum unit, experienced a cybersecurity incident that has impacted its network and operations. The cybersecurity incident has created a service disruption impacting Wellcare members and provider network in several ways.
As of now, Change Healthcare has not provided a timeline for resolution. To protect our members and providers, Wellcare fully disconnected system access to and from Change Healthcare on Feb. 21. We are working on multiple solutions to restore provider functionality and ensure continuity of care for our members. We will continue to provide updates as this situation evolves.
Electronic Claim Submission (Potential Impact to Wellcare)
The ability to electronically submit claims to Wellcare through Change Healthcare is currently down. Providers can easily submit electronic claims to Wellcare via many alternative methods including other claims clearinghouses, our secure provider portal, fax or mail. Our preferred clearinghouse for electronic claims submission is Availity. To enroll, please visit Availity.com and/or call Availity Client Services at 1-800-AVAILITY (1-800-282-4548). For step-by-step instructions, visit the Availity Lifeline page. Additional information on claims submission can be found in our Wellcare Medicare Advantage Provider Manual (PDF).
Reimbursement via Paper Check and Virtual Credit Card (VCC) (Potential Impact to Wellcare)
Some paper check and virtual credit card payment processes for Wellcare have been disrupted due to this incident. We apologize for any inconvenience this causes. Please know we are working quickly to implement a new process to ensure payments are operational as soon as possible. An alternate way to speed up your payment process is to set up an automated clearing house (ACH) for electronic funds transfer (EFT). Wellcare’s preferred ACH/EFT partner, PaySpan (now part of Zelis), has offered to help expedite the sign-up process for providers by calling 1-877-331-7154 or visiting PaySpanHealth.com.
Chart Retrieval (Potential Impact to Wellcare)
Change Healthcare performs retrieval of medical records for several of our programs, such as HEDIS® and Risk Adjustment. You may have received a request via phone or fax from Change Healthcare on behalf of Wellcare, where you either scheduled appointments or provided medical records. Change Healthcare is unable to honor any fulfillment requests at this time; however, we will be employing two of our existing medical record retrieval vendors, Datavant (formerly Ciox) and Datafied, to satisfy these prior commitments.
These retrievals are required to report on clinical quality measures and diagnosis data to Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). We ask that you please honor the same commitment dates for these vendors, even if you have already committed to providing medical records to Change Healthcare. If you have provided medical records from the time period of Feb. 19, 2024 to current, you may be asked to provide these medical records again.
Prior Authorizations
Prior Authorizations were not impacted by this incident.
Additional Information
Thank you for your patience and partnership as we navigate this situation. We apologize for any inconvenience in this matter. If you have any questions, please contact your Provider Engagement representative or our Provider Services team at 1-866-999-3945, or visit our Change Healthcare Provider Resources page.
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