AHIP, HHS Diverge On Relaxing Prior Authorizations After Change Attack

Suspending prior authorization requirements as providers continue to to face disruptions from the Change Healthcare hack could do more harm than good, according to AHIP.

“Broad exemptions in prior authorization at a time of advanced payments could expose patients and employers to fraud, waste and unnecessary costs,” AHIP President and CEO Mike Tuffin said in a March 12 news release. 

HHS has urged insurers to pause prior authorizations and other utilization management requirements and provide leeway on deadlines while providers recover from the outage.

“We are asking private sector leaders across the healthcare industry — especially other payers — to meet the moment,” HHS Secretary Xavier Becerra and Acting Department of Labor Secretary Julie Hu wrote in a March 10 letter. 

Mr. Tuffin said health plans have taken “immediate and comprehensive” steps to ensure providers are receiving timely payments during the outage.

“Given the very wide variability of impact across the system, individual plans and providers are in the best position to assess how to maintain appropriate payments in a timely manner — and also to minimize the need for reconciliation processes,” Mr. Tuffin said.

In a March 14 statement, AMA President Jesse Ehrenfeld, MD, said “it is dumbfounding that following weeks of silence and a lack of assistance to struggling practices in the wake of the Change Healthcare cyberattack, AHIP’s response is a ‘business as usual’ approach to prior authorization. This approach is particularly galling since service outages have exacerbated the administrative burdens and care delays already associated with this process. Prioritizing profits over the stability and solvency of our care delivery system starkly contrasts with the Biden Administration’s appeal to health plans to ‘meet the moment.'”

Change Healthcare, which processes 1 in 3 healthcare claims in the U.S., was hacked by a ransomware group on Feb. 21.

Change’s electronic platform is expected to be available beginning March 15, according to a March 7 news release from parent company UnitedHealth Group. Medical claims network and software is expected to start testing for reconnection on March 18.

Though systems could come back online soon, the American Hospital Association said it could take months for providers to fully recover from the attack.

UnitedHealthcare has temporarily suspended prior authorization requirements for most outpatient services in Medicare Advantage, according to a March 7 news release. 


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