Collaborative Clearinghouses: The Benefits of Decentralization

The Change Healthcare clearinghouse is an influential player in the healthcare world.  It fosters data transfer between providers and payers, allowing physicians to get paid for their work.  On the whole, it processes about 50% of medical claims in the United States, which equates to the claims of roughly 900,000 US physicians.  Over the course of a year, the Change Healthcare clearinghouse handles 15 billion healthcare transactions, which is 1 in 3 US patient records.  

Unfortunately, the Change Healthcare clearinghouse recently experienced an outage that resulted in delayed payments.  This outage followed a cyber attack and impacted the largest processor of prescription medication in the United States, leading to extensive financial challenges.

This outage has revealed the importance of putting safeguards into place to ward off cyber attacks and bounce back quickly after challenges.  One of these safeguards is payer gateway connection redundancy

Redundancy is critical in avoiding situations like what happened to the Change Healthcare clearinghouse.  In order to develop redundancy, clearinghouses must establish communications with each other, forming a network of collaborative clearinghouses that work together to ensure on-time payments.  No single system is immune to cyber attacks, but collaboration amongst several systems can provide backup if one clearinghouse faces an outage. 

How can clearinghouses establish this decentralized communication?  The key is choosing the right system.  An effective system has the ability to communicate with multiple clearinghouses, is built on modern architecture, is highly scalable, and remains operational during outages. 

Orbit Healthcare offers a system to connect clearinghouses.  It strives to help every payer request go through, even if any single clearinghouse runs into problems.  There are already several clearinghouses that Orbit Healthcare supports: Change Healthcare, Availity, Waystar, and Experian Health. 

Clearinghouse outages have big impacts, and redundancy may be the key to alleviating these impacts and continuing to process payments.  Clearinghouses should emphasize decentralized communication, allowing them to work together to avoid total shutdowns. 

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare

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