WIProviderBulletin

April 5, 2024

Optum-Change Healthcare outage

Molina Healthcare, Inc. (Molina) is advising our providers of a critical outage of our third-party vendor, Optum-Change Healthcare (CHC), resulting in impacts to Electronic Claims Submission, Payment and Settlement Services.

 

Status Update

Provider payments

As of April 4, 2024, Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received.

835 Electronic Remittance Advice files and Explanation of Payment

835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will continue to be available on providerpayments.com. These files have returned to pre-outage layouts and formats.

Electronic claims submission

As of the 4/4/24 updates, electronic claims submissions continue to follow our alternate process, as Molina has not reconnected to CHC for any EDI clearinghouse services nor established connectivity to any of CHC's affiliate clearinghouses (iEDI/Relay) at this time.

 

Contact Us

Molina has established a dedicated contact center to assist providers impacted by the CHC outage. Agents can assist with claim submission, emergency financial assistance, or other concerns related to the CHC outage. The contact center is available Monday-Friday from 5:00AM PST to 6:30PM PST.

The contact center number is (844) 548-7684.

 

Reminders

Claims submission

As previously communicated, providers utilizing CHC to submit claims to Molina prior to the outage may do so via our alternate established connection with SSI Claimsnet, LLC (“SSI Group”) clearinghouse or another clearinghouse of their choice. Providers not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission. Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key in claims for submission.

  • Providers can register with SSI Group for claim submission via Claimsnet’s Provider
    • Providers can register with Availity Essentials to key in claims for submission

During this transition, we encourage all our providers submitting paper claims to explore our electronic submission options.

 

For those providers who have submitted electronic claims to Molina via a clearinghouse on or after 2/21/2024 and have not received acknowledgment from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to any providers submitting directly to SSI Group, UHIN, TMHP, COBA, Ohio Medicaid Enterprise System (OMES) or via our Availity portal solution.

 

Eligibility Verification

Molina has reestablished member eligibility verification (270/271) services using SSI Group, our alternate clearinghouse. In addition to online verification with SSI Group, eligibility verification continues to be available via the Availity Essentials portal, the Molina Contact Center and IVR. Molina’s member eligibility continues to be updated timely.

 

Questions?

We understand that the CHC outage can disrupt you and your practice. Molina is in regular contact with CHC, ECHO, SSI Group and Availity Essentials to help mitigate this outage, and we will continue to update our provider community regarding this situation. We appreciate your patience and understanding during this unprecedented time of disruption. Thank you for your continued partnership.

All questions should be directed to Molina’s Provider Contact Center at (855) 326-5059 or MHWIProviderNetworkManagement@molinahealthcare.com.