Change Healthcare Cyberattack News: Optum Rx Pauses Audits, CMS Announces New Flexibilities

Published: March 18, 2024
Advocacy Breaking News

ASHP has received updated information from Optum Rx on changes to its auditing process in response to the recent Change Healthcare cyberattack:

  • “The Optum Rx Pharmacy Audit team has implemented a “Do Not Audit” block on pharmacies that use Change claim switch exclusively through early April.

    In addition, the Optum Rx Pharmacy Audit team is working to implement a claim-level logic that will permanently exclude impacted claims filled during the outage period from being selected for Optum Rx pharmacy audits. If, for any reason, impacted claims are selected for audit, upon notification from the pharmacy, Optum Rx will remove the claims and/or clear any audit findings from those claims.

    Until the claim-level logic is in production, it is possible that a pharmacy may receive a Prescription Validation Review (PVR). This should stop occurring after this week. In the meantime, the pharmacy simply needs to notify Optum Rx that the selected claims are for during the outage and the audit will be removed.

    For Centers for Medicare & Medicaid Services (CMS)-directed audits, we have confirmed an extension with CMS into June. If further extensions are needed beyond that time, we will address those down the line.”

ASHP advocated that health plans and pharmacy benefit managers be prohibited from conducting audits or compliance reviews until the cyberattack has been resolved.

CMS also announced additional flexibilities to assist providers in the wake of the cyberattack. Specifically, CMS announced changes to help ensure that states can start making interim payments to providers affected by the cyberattack. The agency has also recommended that states “submit Medicaid state plan amendments for authority to make certain interim payments for services providers have rendered but for which the provider cannot submit claims.”

We encourage members to review new resources shared on Friday for support following the Change Healthcare cyberattack.

ASHP will continue to monitor this ongoing issue and provide critical advocacy to ensure our members receive the resources they need. Please reach out with any questions and concerns to ASHP’s Jillanne Schulte Wall at [email protected] so that we can communicate this information to Change Healthcare, Optum Rx (the parent company of Change Healthcare), and SureScripts.

Posted March 18, 2024

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