New York City-based NYC Health + Hospitals has been expediting its switch from Change Healthcare because of the cyberattack on the claims processing vendor.
The country's largest municipal public health system has been transferring to Experian earlier than expected after Change turned many of its IT systems offline following the Feb. 21 hack, executives said at a May 6 finance committee meeting. That left NYC Health + Hospitals unable to do automated eligibility checks on patients, send claims, or receive remittances.
Prior to the ransomware attack, the health system signed a contract to move to Experian on July 1. But NYC Health + Hospitals started transferring to the vendor in the weeks after the hack, going live with claims processing and batch eligibility April 1.
"Between April 1 and April 16, we sent out close to 400,000 claims to catch up on all of the backlog," Chief Revenue Officer Marji Karlin said at the meeting. "And we are now live and caught up, with the exception of dental claims, and we are working fast and furiously to be able to get those claims out. They're highly specialized and difficult to program, so we prioritized everything else."
The health system plans to go live with Experian's real-time eligibility and remittance platforms June 1.
"Our biggest sort of quagmire has been with remittance files," Ms. Karlin said. "As we got caught up with claims starting in probably mid-April, we started seeing the payments come through, which is great in the bank, but unfortunately we are not live on remittance files, which posts those payments back to the patient accounting system."
The health system has also been experiencing higher-than-usual rates of claims denials from having real-time eligibility offline but hopes payers will extend their timely filing deadlines because of the cyberattack.
President and CEO Mitchell Katz, MD, posed a question to committee member Sally Hernandez-Piñero: "Sally, as the only lawyer at the table, if we were to lose money because of insurers' unwillingness to go beyond the date, would we not have a legal case claim against Change?"
"I think we have to get in line," she said.