Change Healthcare Affected Claims

We understand the difficult circumstances this breach has created for our clients. At Avea, our goal is to provide your team with guidance and support to help minimize the disruptions this incident has caused. To achieve this, we highly recommend identifying and tracking affected claims.

Resubmitting Claims

While some previously held claims have been released to the payer, others are still being held. Let's review each delivery method to determine which is right for you.

Electronic Claims

Please be informed that Waystar is still holding claims that have not been processed yet. You can identify these claims by checking the rejection message generated by Waystar in the Processing Events. In case you find that sending paper claims is not a suitable option for you, Waystar will take care of releasing all claims to each payer. This process will take 2-5 business days after a new route is established. However, please be aware that this timeframe may vary depending on payer limitations and the volume of claims. Processing Events for those claims are expected within 24 business hours of release.

Paper Claims

Currently, most payers, including Medicare, are accepting paper claims instead of electronic claims. Before generating and submitting any paper claims, a user will need to verify the payer's mailing address is listed in the payer profile.

1. To update the payer address, navigate to the Practice Admin > Payers section.
2. Select the desired payer to open up their profile.
3. Select the Pencil icon next to the Baseline.
4. Next, input the payer's mailing address.
5. Finally, scroll to the bottom and select Save to complete the process.

Two methods can be used to convert electronic claims to paper: Service Grouping Rules and Force to Paper. For practices with less than 20 services, we recommend creating Service Grouping Rules to allow the system to generate corrections for them overnight. For practices with more than 20 services, we recommend using the Resubmission option located under the Claims section of the patient profile.

1. Navigate to Management Center > Claim Rules.
2. Select Create Service Grouping Rule.
3. Select the Practice, then Name the rule.
4. Choose the Service you want to apply the rule to.
5. Under Conditions, select Claim Method and update the dropdown to Electronic.
6. Next, select Current Sequence Behavioral Payer, Current Sequence Medical Payer, and Current Sequence Home Plan Payer.
7. Under each of those conditions, add all affected payers from your payer list.
8. Next, select Set Values then Set Claim Method To before selecting Paper in the dropdown.
9. Once the selections have been made, select Create to implement the rule.
10. Once your rule has been created, click on the rule to open its profile.
11. Next, select Create Scheduled Change Set.
12. We recommend selecting 02/20/2024, one day before the incident occurred. If you submitted earlier dates of service on or around the 20th, use the earliest date of service in those batches.
13. Finally, select Create to complete the process.
14. Complete this process again for medically classified service within your practice.
15. Once all rules have been created, the system will then perform its nightly scrub and generate corrections to be reviewed. Follow the process outlined here to generate and process your corrections.
1. Navigate to the Patient > Treatment Episodes section of the profile.
2. Select the Claims quick link.
3. In the Claims screen, select the caret icon to expand the details on all open claims.
4. Select the Resubmit link to generate the resubmission.
5. In the resubmission window, toggle on Submit as a New Claim if no ICN is available.
6. Next, toggle-on Force to Paper Claim.
7. Select your Issue Source and Type to identify why the claim was resubmitted. Existing Issue can be used if you have already created at least one resubmission for the same issue.
8. Finally, select Submit to generate the resubmission.
9. Once all resubmissions have been generated, navigate to the Work Center > Insurance Claims > Submit Claims to submit the paper claims.

Affected Payers

Waystar has provided us with several lists that can utilized when identifying affected payers.

For a list of payers that have been rerouted, click here.
For a list of payers that have not been rerouted, click here.
For a list of all Change Healthcare payers, click here.

Identifying Affected Claims

Some previously held claims have been released when a new route was established. Processing Events for those claims should be updated within 24 business hours of release. On March 11th, 2024, Waystar reprocessed all non-rerouted claims to generate a rejection message.

These rejections can be viewed by navigating to the Work Center > Insurance Claims > Currently Rejected/Held Claims and hovering over the rejection message.

Track and Manage Affected Claims

To monitor and manage the affected claims, we highly recommend creating a custom Queue, Status, and/or Issue. These customizations can only be completed by Managing Organization Admin.

For instructions on creating a custom Claim Queue, click here.
For instructions on creating a custom Claim Status, click here.
For instructions on creating a custom Issue and Type, click here.

Managing Claims

Two areas in Avea allow users to assign, monitor, and update open claims in bulk. Let's review each area and how to assign, monitor, and update the affected claims.

1. Navigate to the Work Center > Insurance Claims > Work Claims.
2. Update the Claims dropdown to Open, All before selecting Update.
3. Under the Claim ID column, locate the affected Payer's name.
4. Check the Select All box.
5. After you've made your selections, select Bulk Update Workflow/Notes.
6. In the bulk update window, check Claim Queue and update the dropdown to assign all selected claims to a specific queue.
7. To assign a new status, select the Claim Status box and update the dropdown.
8. Once all selections have been made, click Save to update the claims.
1. Navigate to the Patients section.
2. Update the Payer dropdown to only display patients with the specified insurance.
3. Please note this section only displays the primary payer name. Patients who have the specified payer as a secondary or tertiary will also be displayed but with a different primary payer.
4. Next, click the patient's name to open the Treatment Episodes section of their profile.
5. Next, select the Claims quick link.
6. Check the box below the Member ID to select all Open claims.
7. Next, select Bulk Update Workflow/Notes/Issues.
8. In the bulk update window, check Claim Queue and update the dropdown to assign all selected claims to a specific queue.
9. To assign a new status, select the Claim Status box and update the dropdown.
10. Click Save to update the claims.