March 13, 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
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.
Reminder
Claims submission
Providers utilizing CHC to submit claims to Molina prior to this outage may now 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 Registration Form located online at https://products3.ssigroup.com/ProviderRegistration/register.
Providers can register with Availity Essentials to key in claims for submission at https://www.availity.com/molinahealthcare.
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.
Provider payments
Molina has established a direct connection with ECHO, a CHC partner, to resume provider payment processing. ECHO has not been impacted by this outage. Payments have resumed and will 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. Please note there may be slight changes to the format of the EOP; however, all required data elements are included.
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.