Establishing Decentralization for Clearinghouses

A huge cyberattack struck Change Healthcare in February 2024, causing a prolonged outage. Change Healthcare is a crucial clearinghouse that helps with medical claims processing. A clearinghouse is a platform that allows for data transfer between providers and payers. Change Healthcare in particular is responsible for processing around half of all medical claims in the US, for about 900,000 physicians. Therefore the consequences of the outage were severe and had a huge financial impact on numerous healthcare organizations and providers throughout the United States. 

The recent attack mainly impacted the processor of prescription medication, which was the largest in the country. Over 67,000 pharmacies in the US healthcare system had their billing managed by Change Healthcare. This clearinghouse handled an astounding 15 billion healthcare transactions a year, which is equivalent to almost one-third of all US patient information. The cyberattack disrupted the flow of these transactions, which put healthcare providers in serious financial danger and caused payments to be delayed by months. Millions of dollars worth of payments were aged due to not being able to be paid and fulfilled. 

It is clear that clearinghouses play a vital role in streamlining healthcare transactions, and their current vulnerability might result in severe repercussions for the financial side of the healthcare industry. Steps should be taken to reduce these vulnerabilities in the event of upcoming cyberattacks. Decentralization is a key tactic, which includes implementing the use of backup and redundancy systems to circumvent the effects of possible outages.

One method for achieving decentralization is to send transaction information through multiple clearinghouses. This can help to reduce the possibility of delayed payments in the case of a single clearinghouses’ failure by diversifying the paths in which transactions are processed. Using highly scalable solutions and modern architecture strengthens resistance to cyberattacks and guarantees that systems continue to function even when disruptions, such as those sustained by cyberattacks, occur. 

Orbit Healthcare is putting this method into practice by establishing connections with multiple clearinghouses. Therefore, payer requests can be protected from outages within any single clearinghouse. This strategy ensures smooth operations across a variety of healthcare payment procedures across the transaction process, such as eligibility verification, claim submission, claim validations, claim status, ERA, and custom reports. 

With the help of these decentralization and redundancy strategies, clearinghouses can protect the integrity of medical transactions and ensure stability for provider payments in the case of outages suffered by cybersecurity threats.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare