payer system

Improving the Payer Clearinghouse System

Clearinghouses play a critical role in the healthcare industry by guaranteeing payment to providers for their services. One of the most significant clearinghouses in the country, Change Healthcare, handles over half of all US medical claims. Their services directly impact more than 900,000 doctors and 15 billion transactions yearly. 

However, in February 2024, Change Healthcare suffered a cyberattack that resulted in an outage for several weeks. Millions of dollars worth of payment claims were at risk of becoming delayed. The prescription medicine processor was most directly impacted and could potentially impact the invoicing systems of 67,000 pharmacies. These attacks involve a considerable financial risk due to the potential for millions of dollars’ worth of unfulfilled transactions. Concerns were raised about the vulnerabilities of the clearinghouse system, especially how there are no redundancy systems in place to salvage any transactions that are in the affected clearinghouse. 

To lower these risks, healthcare organizations must improve cybersecurity procedures and decentralize their information across clearinghouses. These decentralized clearinghouse systems would communicate information between multiple clearinghouses so payments remain operational during outages. Many clearinghouses, including Waystar, Availity, Change Healthcare, and Experian Health, have embraced decentralization as a means of enhancing clearinghouse system stability.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare