Pharmacies can start billing Utah Medicaid to fill prescriptions for members
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March 12, 2024 – After more than three weeks of Change Healthcare’s network and system outage, pharmacies are once again able to bill Utah Medicaid directly and get claims paid for member prescriptions. The launch of the system in a new operating environment brings Utah Medicaid closer to a full restoration of pharmacy claims processing and payment for Medicaid members. Some normal operating processes, like requirements for prior authorizations and member copays, will be suspended during an interim period while Change Healthcare works towards full restoration of its system for Utah Medicaid.
With this launch, all Medicaid members will be able to get their prescriptions filled. If members have difficulties getting their prescriptions filled, they can call Utah Medicaid at 1-866-608-9422 from 8 a.m. to 5 p.m., Monday through Friday.
“We are working with our federal partners to make pharmacies whole after this significant business disruption,” said Tracy Gruber, executive director of the Utah Department of Health and Human Services. “We want to express our appreciation and gratitude for the Utah pharmacies and pharmacists who never hesitated to work with us to ensure Medicaid members were able to get their medications.”
Since the system outage, pharmacies have experienced a significant amount of extra work to fill short-term prescriptions, as well as complete the workarounds to do so. For this reason, Medicaid will continue to allow additional flexibilities, like paying additional dispensing fees, during this interim period.
“We will continue to work closely with Change Healthcare until a full restoration of operations and functionality are complete,” said Jen Strohecker, Utah Medicaid director. “We are grateful that our members will be able to access their life-saving medications and pharmacies can be paid for their services. We won’t stop until this disruption is entirely resolved.”
Pharmacies with questions can call the Medicaid pharmacy program at 801-538-6155 option 3,3,2 from 8 am to 5 pm, Monday through Friday. Additional resources and updates are on the Medicaid website.
Background
On Wednesday, February 21, Change Healthcare, which operates as the Utah Medicaid pharmacy vendor for members whose prescriptions are paid directly by Medicaid (known as fee for service), reported they were experiencing a cyber security issue on their systems. Change Healthcare took immediate action and disconnected their systems to reduce further impact.
With the network and system outages, Medicaid staff have been unable to access any pharmacy claim information, including placing overrides and prior authorization information for these members. This outage is impacting Medicaid members who are attempting to fill a prescription and are not enrolled in a managed care plan or seeking to fill a behavioral health medication.
This issue is not limited to Utah Medicaid members and providers. Change Healthcare, and its parent companies, Optum and United Health Group, provide technology and data to insurance companies and healthcare services nationally.
Change Healthcare is providing updates on their website and UnitedHealth Group is providing updates here.