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Geisinger becomes the first member of Risant Health

Change Healthcare, which is one of the largest healthcare technology companies in the United States, experienced a cybersecurity issue on Wednesday, Feb. 21, that disrupted a number of its systems and services. Change Healthcare is a vendor to many hospitals, providers, retail pharmacies and health plans across the country, including Geisinger. When we learned of this issue, we immediately severed all connections between Change Healthcare and Geisinger systems.

This is impacting several areas of our system. We’re developing workarounds and processes to ensure business continuity and meet patients’ and members’ needs without disruption.

Read through these reminders and options to obtain necessary information from patients and members so as not to disrupt any service.


Electronic claims submission clearinghouse

UPDATE – Geisinger Health Plan has partnered with Availity to implement its Lifeline clearinghouse service.  As of March 26, Availity is available as an additional clearinghouse for electronic claims submission to Geisinger Health Plan.  Individual hospitals and providers can register with Availity. For more information, visit Availity’s Lifeline website.

Geisinger Health Plan partners with Veradigm® (formerly Allscripts) as a clearinghouse for electronic claims submission. Veradigm will partner with providers on an individual basis to provide services for electronic claims submission. For more information, call 800-334-8534 or visit Veradigm's website. 

 

Electronic fund transfer and explanation of payment

Electronic fund transfer and electronic explanation of payment through InstaMed have not been affected by the Change Healthcare disruption. To have payments directly deposited into your bank account and receive electronic remittance advice, register at instamed.com/eraeft.

Questions about registering for EFT?
Contact InstaMed at 866-945-7990 or connect@instamed.com

 

Claims inquiries

For efficient and timely reconsideration of claim payment disputes and denial appeals, use the claims research request form (CRRF) to initiate a reconsideration of a previously paid or denied claim. The CRRF can also be submitted electronically through the claims inquiry function under Workflows for this plan on NaviNet.

 

Timely filing

Due to the circumstances surrounding Change Healthcare’s cybersecurity event, timely filing requirements may be extended or waived if certain criteria are met. The extension or waiver of timely filing will only be applicable where it is reasonably determined that electronic claim submissions to Geisinger Health Plan have been impacted by the current disruption with Change Healthcare. Geisinger Health Plan continues to monitor the status of the cybersecurity event and will determine the extent of any extension as well as the date when the timely filing waiver will end. For additional details or if you have questions regarding timely filing, please contact your account manager.  

 

Medical prior authorizations

There’s no indication the Change Healthcare disruption affected any of our prior authorization processes. Regardless, we’d like to remind you of the methods you can use to send us prior authorization requests for inpatient and outpatient services that require it.


Inpatient

  • Use the prior authorization request forms available on NaviNet and the For Providers section of the website under Resources.


Outpatient (except high-dollar radiology)

  • Use the Cohere portal for the best experience.

  • Users must be registered to use the Cohere portal. Providers can register directly on Cohere’s website: Register - Cohere Health. A step-by-step guide details how to register as well as training webinars and other resources.

  • View Cohere contact information.

  • Providers can also use the prior authorization form found on NaviNet and the For Providers section of the web site under Resources.


GHP Medical Management – Providers can contact the medical management department for help with prior authorizations.

  • Phone: 800-544-3907

  • Fax: 570-214-3572

  • Our prior authorization list can be found on NaviNet and the For Providers section of the web site under Clinical policies.


DME ordering through Tomorrow Health 

  • All DME orders should be placed through Tomorrow Health.

  • Phone: 844-402-4344

  • For DME services that require prior authorization, request authorization through the Cohere portal or use the DME request forms on NaviNet and the For Providers section of the web site under Resources.


High-dollar radiology authorization through HealthHelp

  • Phone: 877-391-7293

  • Fax: 877-391-7294

  • Find information on how to request prior authorizations, along with resources, on the HealthHelp Client Landing Page.

Member eligibility inquiries

Check member eligibility and benefits on NaviNet. Click on Eligibility & Benefits under Workflows for this plan. Or call 844-447-7768 and select option 3 (“Benefits, eligibility and prior authorization information”).

Pharmacy prior authorization

Send prior authorization requests using the Geisinger PromptPA portal or the prior authorization request forms available through NaviNet and the For Providers section of the website under Pharmacy forms. Questions? Call 800-988-4861.

 

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