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Welcome Aspirus Medicare Advantage Providers

Change Healthcare/Optum Outage

Page last updated September 24, 2024

Change Healthcare is experiencing a nationwide network interruption related to a cyber security issue that started Feb. 21, 2024. Aspirus Health Plan is monitoring this evolving situation and will update the information on this page as we learn more. Please check back regularly.

Recent changes:

  • Sept. 24, 2024 – Within the “Remittances” section, removed information about the delay in sending paper payments for dates Aug. 16, 2024, to Sept. 11, 2024.

Impact to Aspirus Health Plan Medicare Advantage systems

The following electronic data interchange (EDI) transactions are impacted by the outage:

  • 837s/277CA - Electronic Claims/Claims Response - Providers may check individual claims through the Aspirus Health Plan Medicare Advantage Provider Portal. Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity are receiving transactions.
  • 276/277 - Claims Status Inquiry and Response - Providers may check individual claim status through the Aspirus Health Plan Medicare Advantage Provider Portal.
  • 999 - Implementation Acknowledgement - Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity are receiving transactions.
  • 270/271 - Eligibility Benefit Inquiry and Response –Aspirus Health Plan’s Medicare Advantage payer ID is live for 270/271 transactions.
  • 835 - Electronic Remittance Advice – Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity for 835s will have the option to receive electronic remits.

Aspirus Health Plan is working with Change Healthcare. We will continue to update this page as services are restored. 

Claim submissions

Providers may submit claims in the following ways:

  • Aspirus Health Plan accepts claim submissions from Availity.
    - Providers can enroll directly with Availity or a provider’s clearinghouse can enroll with Availity.
    - For providers needing emergency assistance, connection to all payers via Availity Essentials will be offered at no cost (Direct Data Entry (DDE) for single claim submission is excluded) for the time being. Click here to learn more. We will share information as we learn more.
  • Submit a paper claim. See the Aspirus Health Plan Medicare Advantage Provider Manual (Claims & Payment chapter) for details.
  • For claims that are affected by this outage, Aspirus Health Plan will extend timely filing by 30 days. Aspirus Health Plan will reprocess claims with receipt dates of Feb. 28, 2024, to April 12, 2024, that have denied for timely filing in situations where the number of days past the timely filing deadline does not exceed 30 days. If you feel you have a claim that meets these criteria but did not get reprocessed, please contact us using a Reconsideration Form, and we will review.

Tips for submitting paper claims

  • Taxonomy Code Requirements: Professional and facility claims received by Aspirus Health Plan, must be submitted with taxonomy codes for billing and rendering or attending provider. When providers submit NPI(s) anywhere on a claim, the corresponding taxonomy must also be submitted. Provider types that are not required to submit NPI are not required to submit taxonomy on claims to Aspirus Health Plan.
  • If an unlisted procedure code is used, a narrative description is required on both the CMS 1500 and UB-04.
  • All services should be billed line by line and identified by Revenue, CPT or HCPCS codes, ICD-9-CM or ICD-10-CM codes, modifiers (when appropriate), location codes and units.
  • For paper claims, submit an original UB-04 or CMS-1500 form, and not a facsimile copy. Additionally, remove all staples, ensure print is dark enough to read and that you are using a standard-size font. Do not stamp over billing data—claims must be legible, and all data must be readable.
  • If the member has other insurance, submit a remittance advice from the primary insurance carrier with the claim.
  • Only one member or provider per claim.
  • Non-clean claims or unreadable claims will be returned to the provider.

Claim payments

Aspirus Health Plan is back to standard claims payment processes. Please see the Provider Manual for Claims information.

Remittances

Providers who were enrolled with Availity or whose clearinghouse was enrolled with Availity to receive ERAs by April 28, 2024, received retro 835s back to for payment date Feb. 23. Providers who enroll April 29, 2024, or later will need to contact Aspirus Health Plan’s Provider Assistance Center at 715.631.7412 or toll-free at 1.855.931.4851 to request any retro 835s. Due to system limitations, we can only provide electronic remits within the last 90 days. For anything over 90 days, we can provide a copy of the EOP (paper remit).

Once enrolled with Availity for ERA submissions, Aspirus Health Plan no longer requires providers to populate an Electronic Remittance Advice form on the Aspirus Health Plan Medicare Advantage Provider Portal.

EOPs dated Aug. 16, 2024, and forward are available on Aspirus Health Plan’s Provider Portal effective Sept. 9, 2024. Aspirus Health Plan will only mail paper remits to providers signed up to receive paper EOPs. Previously, all providers were receiving paper remits. To obtain a copy of a historical paper EOP, please contact Aspirus Health Plan’s Medicare Advantage Provider Assistance Center. Aspirus Health Plan has discontinued sending paper EOPs for providers who are receiving 835s.

FAQ - Aspirus Health Plan has developed a list of frequently asked questions for what providers can expect with ERAs after the Change Healthcare outage is resolved.