Change Healthcare, which operates Vermont's Medicaid pharmacy claims system, experienced a significant cyber security issue last week. In an earlier press release, the Department of Vermont Health Access (DVHA) had confirmed that this issue has impacted pharmacies and providers across Vermont and New England. The Department has since learned that this cyber security issue has caused service interruptions in all 50 states, and that more provider types than just pharmacies have been impacted.
To ensure that all impacted providers are identified and can continue providing access, DVHA is asking providers who have been impacted by this cyber security issue to please contact AHS.DVHAChangeHealthcareServiceOutage@vermont.gov.
Optum Solutions, the parent company of Change Healthcare, is working to resolve the current service outages and continues to update the Department. This outage is expected to continue through the week, and Optum has not provided a timeline for when full service will be restored.
The Department is working to ensure that pharmacies have the resources and instructions they need to continue providing access to prescriptions for eligible members. Last week, DVHA issued payments to pharmacies according to their average weekly claims in order to ensure that they are able to remain operational while the Change Healthcare system is down. The Department is working closely with pharmacies to ensure their needs are met, and we will continue to do so.
To ensure Medicaid members receive necessary services and providers have necessary guidance we offer the following:
Claim Processing: Claims are not processing currently. Claims will be processed once the Change Healthcare system issues have been resolved. It is expected that providers will adhere to the provider agreements, which prohibit billing members when Medicaid will pay for services. Please refer to the provider manual for the limitations on billing members Vermont Medicaid Provider Manual (vtmedicaid.com).
Eligibility: Eligibility must be verified through the automated Voice Response System (VRS), 800.925.1706, option 1 and then option 1 again or by utilizing online Transaction Services (https://vtmedicaid.com/#/home). For those members indicating new enrollment as of 2/23/24, please call Maximus at 855-899-9600 during business hours and for afterhours please call the automated Voice Response System (VRS).
- Prior Authorizations: The outage is impacting the ability to issue prior authorizations. Therefore, prior authorization will be retroactively reviewed and applied for prescriptions filled during the system outage
The Department remains committed to transparency and open communication with pharmacies, members, and the public. We will continue to provide updates as the situation develops. We are asking for patience and flexibility from providers, pharmacies, and members as we work diligently with our partners to resolve this issue.