Improving the Redundancy of Healthcare Claims

Clearinghouses are a very important part of the healthcare process, because they ensure that providers get paid for providing care to patients. They are platforms that allow a data transfer between providers and patients, usually in regards to a medical claim. Change Healthcare has one of the largest clearinghouses in the United States, processing 50% of all medical claims in the US, which is about 15 billion healthcare transactions annually. This translates to ensuring about 900,000 physicians are being properly paid for their services. 

That is why it was such a major disruption when a cyberattack has made the Change Healthcare clearinghouse sustain an outage since the 3rd week of February 2024. The attack impacted the largest processor of prescription medicine, which handles billing for more than 67,000 pharmacies across the country. This created a huge financial challenge with the possibility of millions of dollars being aged until systems are stabilized. 
One of the best ways to avoid a problem like this in the future is to pursue a decentralized system to ensure redundancy of payer systems. That way, if one of the clearinghouses is victim of a cyberattack, the transaction records will still be able to be recovered at another. Several companies’ clearinghouses are already beginning to pursue this decentralization method.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare

Leave a Comment