As recently communicated, on February 21, 2024, Jefferson Health Plans was alerted by Change Healthcare about a cyber security incident they’ve experienced that is disrupting Change Healthcare’s ability to deliver services.

We will continue to monitor this situation and, dependent on the duration and/or severity of the incident, may modify the below interim process changes upon written notice.

FAQs are posted below to answer overall questions; this posting is to clarify questions specifically around our authorization process during this incident.

• Authorization requests should continue be submitted through our provider portal, as that is the most efficient flow of authorization submissions 
• We will still require notification of admissions
• Clinical documentation will still be required to be submitted as soon as it is available
• We will still adhere to regulatory timelines in rendering decisions
• Acute inpatient admission requests will be reviewed based on a combination of InterQual guidelines and medical necessity.
• For the Medicaid and CHIP lines of business, we will allow reconsiderations to be submitted at any time during the incident, and for 30 days post outage resolution
• For Medicare, we will continue to utilize the “2 midnight rule” along with NCD/LCD to facilitate medical necessity determinations
• Prior authorization requirements will remain in place following regulatory timeframes and requirements

Thank you for your attention to this matter.