What does Change Healthcare do?

Change Healthcare processes medical billing, insurance claims, and payments as a giant digital middleman for the United States health system.

It operates as a central hub (called a clearinghouse) that connects doctors, hospitals, pharmacies, and insurance companies. The company is owned by Optum, a part of UnitedHealth Group.

Core Services

• Claims Processing: It acts as a clearinghouse. It handles roughly 15 billion medical transactions and about 40% of all medical claims in the U.S. each year.
• Eligibility Verification: It checks if a patient has active insurance coverage and what benefits they can use before a doctor provides care.
• Prior Authorizations: It manages the digital paperwork and clinical rules required for insurance companies to approve treatments or medications ahead of time.
• Payment Management: It helps healthcare providers handle their revenue cycles, billing, and financial reimbursements from insurance payers.

Why It Matters

Because it sits in the middle of so much data, a disruption to its systems affects the entire country. When its network goes down, doctors cannot check insurance, hospitals cannot get paid, and pharmacies struggle to fill prescriptions.

Change Healthcare is a massive healthcare technology and payment processing company in the United States. It operates as a vital clearinghouse that connects doctors, hospitals, pharmacies, and health insurance companies.

Core Functions

• Claims Processing: It handles billions of medical and pharmacy claims every year. It processes roughly 40% of all medical claims in the U.S.
• Revenue Cycle Management: It provides software and tools that help healthcare providers manage billing, check patient eligibility, and collect payments.
• Data and Network Solutions: It facilitates the secure exchange of clinical and financial data across different healthcare systems.

Ownership

• Subsidiary of UnitedHealth Group: Optum, a major health services division under UnitedHealth Group, acquired the company in 2022 for $13 billion.
• Scale: Because of its central role in medical billing, a major cyberattack on its systems in 2024 severely disrupted payment and prescription operations for healthcare providers nationwide.

Change Healthcare is a legitimate, large-scale healthcare technology and payment processing company owned by UnitedHealth Group.

What Change Healthcare Does

• Acts as a clearinghouse that routes medical claims, eligibility checks, and prior authorizations between doctors, pharmacies, and insurance companies.
• Processes billions of medical claims annually, accounting for a major portion of the U.S. healthcare administrative network.

The Data Breach and Scams

• Real Breach: The company experienced a massive, legitimate cyberattack and data breach in February 2024 that exposed sensitive personal and health information for millions of Americans.
• Legitimate Letters: If you received an official notification letter in the mail regarding this breach, it is real. Change Healthcare has been offering affected individuals two years of free credit monitoring and identity theft protection.
• Impostor Scams: Because the breach is well-known, scammers often send fake text messages, emails, or make unsolicited phone calls pretending to be Change Healthcare.

How to Protect Yourself

• Do not click links or call numbers provided in unsolicited texts or emails.
• Verify any communication by going directly to your insurance provider's official website or calling the customer service number printed on the back of your insurance card.
• Monitor your credit reports and bank statements for unusual activity.

Virtually all major national health insurance companies, hundreds of regional plans, Medicare, and state Medicaid agencies use Change Healthcare as an electronic clearinghouse or technology partner.

Major National Insurers

• UnitedHealthcare: Owned by UnitedHealth Group, which also owns Change Healthcare's parent subsidiary, Optum.
• Aetna (CVS Health): Uses the network for claims management and eligibility verification.
• Cigna: Uses the system for payment integrity and transaction routing.
• Blue Cross Blue Shield: Various regional BCBS licensees utilize the platform for data analytics and provider connectivity.
• Humana: Relies on the platform for revenue cycle management.

Other Participating Networks

• Molina Healthcare
• Moda Health
• Numerous state Medicaid agencies, Medicare administrative contractors, local independent practice associations (IPAs), and third-party administrators (TPAs).

Change Healthcare provides healthcare technology, software, and network services that connect providers, payers, and patients to streamline administrative, financial, and clinical processes. Now part of Optum (a subsidiary of UnitedHealth Group), the company operates a massive data and payment exchange network in the U.S. healthcare system.

Core Services and Solutions

• Revenue Cycle Management (RCM): Tools that help healthcare providers manage billing, optimize revenue, and accelerate cash flow.
• Clearinghouse and Electronic Data Interchange (EDI): Processing and routing millions of electronic medical claims, prescriptions, and administrative transactions between providers and insurance payers.
• Payment Accuracy and Integrity: Solutions to verify claims, reduce administrative waste, and ensure correct payment processing.
• Pharmacy Services: Pharmacy claims switching, routing, and management services.
• Clinical and Health Information Exchange: Secure networks allowing providers, laboratories (such as Quest Diagnostics and LabCorp), and hospitals to share clinical data and order or track lab results.
• Patient Experience and Engagement: Tools to help patients understand healthcare benefits, access personal health information, and navigate medical billing or financial assistance options.