Introducing Decentralization to the Clearinghouse Process

Clearinghouses play a vital role in the healthcare industry by helping to facilitate data transfers between payers and providers. This is how providers are ultimately paid for their services, so clearinghouses are essential to maintaining the stability of this industry. Change Healthcare is one of the most prominent clearinghouses in the country, handling about half of all US medical claims for over 900,000 physicians. They process an astounding 15 billion healthcare transactions a year.

However, a cyberattack that targeted Change Healthcare’s prescription drug processor in February 2024 caused a major outage for several weeks. This attack had the ability to affect the billing systems for over 67,000 pharmacies across the U.S. healthcare system. This incident brought to light flaws in the current clearinghouse system, raising questions about its security and ability to continue to process transactions effectively in the event of a cyberattack. 

There are significant financial dangers connected to compromised clearinghouses, which could result in unfulfilled transactions worth millions of dollars. Healthcare companies need to diversify their transaction channels in order to reduce these risks. By linking several clearinghouses, the adoption of decentralized clearinghouse systems can improve resilience in the case of an attack. Change Healthcare, Availity, Waystar, and Experian Health are all clearinghouses that have utilized decentralization to strengthen system stability.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare