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Introducing Redundancy to the Clearinghouse System

Healthcare is continuously growing and upgrading how it functions with new medical technology. However new technology hasn’t fully made its way to prevent cyberattacks yet. One area in which reform has been needed is in the processing of payments. To process payments from payers to providers, clearinghouses are needed to facilitate these data transfers. Change Healthcare is one of the most important clearinghouses in the country, serving about 900,000 providers and processing half of all American medical claims. They handle a whopping 15 billion healthcare transactions annually, which is 1 in 3 patient records in the United States. 

However, in February 2024, this important clearinghouse sustained a cyber attack that resulted in an outage for several weeks. This outage resulted in millions of dollars of medical transactions that went unfulfilled, which created a financial gap until systems were stabilized. The attack specifically affected Change Healthcare’s prescription drug processor, which then directly affected the billing for 67,000 pharmacies across the country. The clearinghouse system’s flaws were made very clear by this occurrence, which raised questions about its current system setup. 

Healthcare organizations need to deploy decentralized clearinghouse systems to diversify their transaction routes. That way, in case of an attack, transaction information can still be processed because it can be found within several clearinghouses. This decentralization tactic is already being adopted by Change Healthcare, Availity, Waystar, and Experian Health in order to support system stability and guarantee continuous transaction processing in the age of cyberattacks.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare

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