COVID-19 Payer Information
Quadax is dedicated to keeping our clients up-to-date on the billing, reporting, and procedural information specific to each payer as it pertains to COVID-19.
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Latest Updates
Connections are active as of 5/6/2020. ALERT: Quadax has received confirmation from our business partner Optum360 that a new payer connection will be implemented. The new payer connection is being created as a result of the COVID Cares Act program and is affiliated with UnitedHealthcare. Below are important details regarding the connection:
• Payer Name: COVID19 HRSA Uninsured Testing and Treatment Fund
• Payer ID: #95964
• Effective date: May 6, 2020
• Effective for DOS on/after: February 4, 2020
• Includes both Professional and Institutional claims
• 999 file-level acknowledgements and 277CA claim-level reporting will be returned and will include HIPAA and ACE rejections
• 835s will not be returned – providers will be required to access them via OptumPay
• More than $186 million in claims have been paid by the COVID-19 Uninsured Program thus far
• Claims are subject to timely filing limits – within 365 calendar days from the date of service or admittance, and are subject to available funding
More Payer News
Indicates today's updates
Last Update | Payers and Organizations | Overview | ||||||||||||||||||||||
7/6/2020 | Absolute Total Care |
UPDATE - The Centers for Medicare & Medicaid Services (CMS) have released guidance for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. READ MORE |
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12/29/2020 | Aetna |
UPDATE - COVID-19 Update 12/29/20 - Medicare Advantage. READ MORE Question - If the suspension of the sequestration adjustment is extended by legislation beyond the 4/1/2021, will Aetna continue to not apply the 2% reduction? 12/23/2020 - COVID-19 Vaccine FAQs 12/23/20. READ MORE 12/14/2020 - Aetna helps members access COVID-19-related care through new and extended waivers. Aetna, a CVS Health company, announced that it is waiving member cost-sharing related to the COVID-19 vaccination for Commercial and Medicaid members. READ MORE Extended waivers include: ^^ Waiving member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 for Commercial insured and Medicare Advantage plan members, through January 31, 2021. We are closely monitoring the progress of the pandemic, federal and state policies and the associated impact on our members, customers and providers. We’ll continue to adjust our policies, as appropriate, to ensure access to care. |
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5/12/2020 | Agency for Healthcare Research and Quality (AHRQ) | AHRQ's COVID-19 Resources Provide Critical Support for Healthcare Professionals. AHRQ has posted a COVID-19 Resources web page with tools to support practice improvement, relevant data analyses, and new COVID-19-related research findings from AHRQ grantees. READ MORE | ||||||||||||||||||||||
5/6/2020 | America's Health Insurance Plans (AHIP) | America’s Health Insurance Plans (AHIP) and the Healthcare Financial Management Association (HFMA) have collaborated on providing information on billing and coding for COVID-19 services taking place in alternate inpatient settings. READ MORE | ||||||||||||||||||||||
10/21/2020 | American Hospital Association (AHA) |
AHA, Others Urge Congress to Pass Legislation to Provide Relief from Medicare Sequestration in 2021. READ MORE |
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12/21/2020 | American Medical Association (AMA) |
UPDATE - High-Level Overview of Select Provisions in the Consolidated 2020 Omnibus Legislation. READ MORE High points are: > Additional Provider Relief: 11/10/2020 - AMA Announces Vaccine-Specific CPT Codes for COVID-19 Immunizations. READ MORE For quick reference, the new Category I CPT codes and long descriptors for the vaccine products are:
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12/24/2020 | Amerigroup (Texas) |
UPDATE - COVID-19 Update 12/24/20. READ MORE Inpatient and respiratory care - - Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. These adjustments apply for our Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization is not required, we continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in our members' care coordination and management. Amerigroup reserves the right to audit patient transfers. COVID-19 Update 12/24/20 for Medicare Advantage. READ MORE Inpatient and respiratory care - - Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. These adjustments apply for our fully-insured and self-funded employer, individual, Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization is not required, we continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Amerigroup reserves the right to audit patient transfers. 6/5/2020 - Telehealth (video + audio): effective March 17, 2020 through September 30, 2020, Amerigroup will waive any normally required member cost shares for telehealth visits from in-network providers, including visits for mental health or substance use disorders, for our Medicaid, Medicare-Medicaid (MMP) and CHIP members, where permissible. For out-of-network providers, normally required cost shares will be waived through June 15, 2020. Cost sharing will be waived for members using our authorized telemedicine service, LiveHealth Online, and for care received for other providers delivering virtual care through internet video and audio services. READ MORE Telephonic - only care: effective March 19, 2020 through September 30, 2020, Amerigroup will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required. This includes covered visits for mental health or substance use disorders and medical services. Any normally required cost shares will be waived for in-network providers only. Exceptions include chiropractic services and physical, occupational, and speech therapies, and any services which require physical contact with the patient. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. READ MORE |
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4/27/2020 | Amerihealth NJ |
UPDATE - The payer is expanding its temporary suspension of prior authorization for acute in-network admissions from the emergency department to include all diagnoses (including COVID-19) and for in-network transfers and transportation between facilities. READ MORE 3/21/2020 - The payer will Cover and Waive Cost-Sharing for COVID-19 Testing (copays, deductibles, and coinsurance) when performed at a physician's office, urgent care, or ER. READ MORE |
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10/12/2020 | Anthem |
UPDATE - From March 17 through Dec. 31, 2020, Anthem will waive member cost shares for telehealth visits from in-network providers, including visits for mental health and substance use disorders, for our Medicare Advantage and Medicaid plans, where permissible. Effective from March 19 through December 31, 2020, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required. For out-of-network providers, Anthem is waiving cost shares from March 17 through June 14, 2020. Cost shares will be waived for in-network providers only. READ MORE 5/1/2020 - Anthem has provided a repository of COVID-19 information including policies, webinar recordings, and Federal Resources available to Providers under the CARES Act. READ MORE |
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3/24/2020 | Anthem BCBS Ohio | Waiving cost shares for fully insured employer, individual, MCR and MCD plans for COVID-19 test (and visits associated with the test). Effective 3/17/2020 for 90 days, waiving cost shares for Telehealth visits for the same product lines, where permissible. READ MORE | ||||||||||||||||||||||
12/30/2020 | Anthem California |
UPDATE - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). We’ve updated information about cost share waivers for COVID-19 treatment as well as cost share information for telehealth and telephonic-only care. READ MORE What member cost-shares will be waived by Anthem for virtual care through telehealth and telephone-only? For in-network providers, effective March 17, through September 30, 2020, Anthem and its delegated entities will waive member cost share for telehealth (video + audio) and telephone-only visits from in-network providers, including visits for behavioral health, for our fully-insured employer, individual and Medicaid plans where permissible. For Medicare plans, in-network providers, effective March 17, through December 31, 2020, Anthem and its delegated entities will waive member cost share for telehealth (video + audio) and telephone-only visits from in-network providers, including visits for behavioral health. For out-of-network providers, Anthem is waiving cost shares for services received from March 17 through June 14, 2020. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program. 12/23/2020 - COVID-19 Update: We recently updated information regarding prior authorization requirements for patient transfers from acute inpatient hospitals to other levels of care. READ MORE 10/16/2020 - We recently updated FAQs about telehealth and telephonic-only care. For out-of-network providers, Anthem is waiving cost shares for services received from March 17 through June 14, 2020. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program. |
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12/30/2020 | Anthem Colorado |
UPDATE - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). We’ve updated information about cost share waivers for COVID-19 treatment as well as cost share information for telehealth and telephonic-only care. READ MORE Telehealth (video + audio) - For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021. Effective from March 17 through September 30, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits from in-network providers, including visits for behavioral health, for insured health plans in Colorado under this guidance, including our fully-insured employer plans, individual plans and health savings account-qualified high deductible health plans (HSA-HDHPs). For out-of-network providers, Anthem is waiving cost shares from March 17 through June 14, 2020. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in. Telephonic-only care - Effective from March 19, 2020, through March 31, 2021, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required by law. This includes visits for behavioral health, for our fully insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in. 12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE These adjustments apply for our fully-insured and self-funded employer, individual, Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization is not required, we continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Anthem reserves the right to audit patient transfers. 12/2/2020 - COVID-19 Update - Prior Authorization and other policy adjustments. This means the transfer and admission at the receiving facility are not subject to prior authorization requirements. It is important to remember that under the executive order, providers are required to follow the protections against balance billing and identify those patients that were transferred or received during this period. Any waiver of prior authorization is not a guarantee of payment. If the claim or patient is not properly identified, or if the claim is for a transfer outside the scope of the emergency order, the claim may deny for lack of benefit or lack of prior authorization. It is also important to remember that not all plans are subject to the order and if the patient’s identification card does not have “CO-DOI” on it, the patient’s plan may have different requirements. Inpatient and respiratory care - >>>Click here to read past updates |
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12/30/2020 | Anthem Connecticut |
UPDATE - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). We’ve updated information about cost share waivers for COVID-19 treatment as well as cost share information for telehealth and telephonic-only care. READ MORE Telehealth (video + audio) - For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021. Effective from March 17 through September 30, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits from in-network providers, including visits for behavioral health, for insured health plans in Colorado under this guidance, including our fully-insured employer plans, individual plans and health savings account-qualified high deductible health plans (HSA-HDHPs). For out-of-network providers, Anthem is waiving cost shares from March 17 through June 14, 2020. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in. Telephonic-only care - Effective from March 19, 2020, through March 31, 2021, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required by law. This includes visits for behavioral health, for our fully insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in. 12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE A: Anthem is making adjustments in our policy in the provision of these telephonic-only services to address the need for expanded access outside of telehealth (audio + video) to include telephonic only visits with in-network providers and out-of-network providers where required. We expect all mental health outpatient and substance abuse outpatient will still be provided within benefits limits, authorization limits, medical necessity criteria, and within state and federal regulatory requirements and licensure requirements, including HIPAA compliance and the regulations regarding how substance use information in handled. These changes for telephonic-only visits will be effective from March 19 through December 31, 2020. We will continue to actively monitor the rapidly evolving situation. |
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12/14/2020 | Anthem Georgia |
UPDATE - COVID-19 Update 12/14/20. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to other settings. READ MORE 9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE A: Anthem is making adjustments in our policy in the provision of these telephonic-only services to address the need for expanded access outside of telehealth (audio + video) to include telephonic only visits with in-network providers and out-of-network providers where required. We expect all mental health outpatient and substance abuse outpatient will still be provided within benefits limits, authorization limits, medical necessity criteria, and within state and federal regulatory requirements and licensure requirements, including HIPAA compliance and the regulations regarding how substance use information in handled. These changes for telephonic-only visits will be effective from March 19 through December 31, 2020. We will continue to actively monitor the rapidly evolving situation. |
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12/22/2020 | Anthem Indiana | UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE These adjustments apply for our fully-insured and self-funded employer, individual, Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization is not required, we continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Anthem reserves the right to audit patient transfers. |
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12/22/2020 | Anthem Kentucky |
UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE |
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12/22/2020 | Anthem Maine |
UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 11/23/2020 - Information from Anthem for Care Providers about COVID-19. |
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12/22/2020 | Anthem Missouri | UPDATE - COVID-19 Update 12/22/20. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective November 23, 2020 through January 15, 2021. READ MORE These adjustments apply for our fully-insured and self-funded employer, individual, Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization is not required, we continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Anthem reserves the right to audit patient transfers. |
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12/22/2020 | Anthem Nevada |
UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 11/12/2020 - Information from Anthem for Care Providers about COVID-19 (updated 11/12/20). READ MORE |
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12/22/2020 | Anthem New Hampshire |
UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 11/2/2020 - Information from Anthem for Care Providers about COVID-19. READ MORE |
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12/30/2020 | Anthem New York |
UPDATE - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). We’ve updated information about cost share waivers for COVID-19 treatment as well as cost share information for telehealth and telephonic-only care. READ MORE IMPORTANT: In-network providers are reminded that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test. Telemedicine (live video + audio via app) - For COVID-19 treatments via telemedicine visits, Empire will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021. For non-COVID 19 treatments via telemedicine including covered visits for mental health and substance use disorders Empire will waive cost shares for in-network visits through November 9, 2020 or any longer period required by state law. This applies to fully insured employer plans, Individual plans and Medicaid plans, where permissible. Telehealth (telephonic with video capability) - For COVID-19 treatments via telehealth visits, Empire will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021. Effective March 16, 2020, Empire began waiving member cost sharing for telehealth visits (by phone with video capability) with in-network, providers acting within the scope of their license. Out of network visits are also covered if the member’s benefit plan has out of network benefits. This includes covered visits for medical services as well as mental health and substance use disorders services, where medically appropriate if all other requirements for a covered health service are met. Self-insured plan sponsors may have opted out of this program. This waiver will remain in place from March 19 through December 31, 2020 or any longer period required by state law for our insured employer plans, individual plans and Medicaid plans, where permissible and from March 19 through September 30, 2020 for our Medicare members. Phone/video delivery must be HIPAA compliant. 12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 11/13/2020 - Information from Empire for Care Providers about COVID-19. We recently updated FAQs about cost shares for COVID-19 testing; COVID-19 testing and visits associated with COVID-19 testing. READ MORE IMPORTANT: In-network providers are reminded that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test. |
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12/22/2020 | Anthem OH |
UPDATE - COVID-19 Update 12/22/20. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective November 23, 2020 through January 15, 2021. READ MORE 11/25/2020 - Important COVID-19 update: Prior authorization and other policy adjustments (Updated November 25, 2020). READ MORE Inpatient and respiratory care ** Prior authorization requirements suspended for patient transfers through May 30, 2020. Prior authorization will be waived for patient transfers from acute IP hospitals to skilled nursing facilities, rehabilitation hospitals, long-term acute care hospitals, and Behavioral Health residential/intensive outpatient/partial hospitalization programs, and to home health including ground transport in support of those transfers. Although prior authorization is not required, Anthem requests voluntary notification via the usual channels to aid in our members’ care coordination and management. ** Extending the length of time a prior authorization issued on or before May 30, 2020, is in effect for elective inpatient and outpatient procedures to 180 days. This will help prevent the need for additional outreach to Anthem to adjust the date of service covered by the authorization. ** Concurrent review for discharge planning will continue unless required to change by federal or state directive. ** Prior authorization requirements are suspended for COVD-19 Durable Medical Equipment including oxygen supplies, respiratory devices, continuous positive airway pressure (CPAP) devices, non-invasive ventilators, and multi-function ventilators for patients who need these devices for COVID-19 treatment, along with the requirement for authorization to exceed quantity limits on gloves and masks. ** Respiratory services for acute treatment of COVID-19 will be covered. Prior authorization requirements are suspended where previously required. |
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12/22/2020 | Anthem Virginia |
UPDATE - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE 9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE A: Anthem is making adjustments in our policy in the provision of these telephonic-only services to address the need for expanded access outside of telehealth (audio + video) to include telephonic only visits with in-network providers and out-of-network providers where required. We expect all mental health outpatient and substance abuse outpatient will still be provided within benefits limits, authorization limits, medical necessity criteria, and within state and federal regulatory requirements and licensure requirements, including HIPAA compliance and the regulations regarding how substance use information in handled. These changes for telephonic-only visits will be effective from March 19 through December 31, 2020. We will continue to actively monitor the rapidly evolving situation. |
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9/29/2020 | Anthem Wisconsin |
UPDATE - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE A: Anthem is making adjustments in our policy in the provision of these telephonic-only services to address the need for expanded access outside of telehealth (audio + video) to include telephonic only visits with in-network providers and out-of-network providers where required. We expect all mental health outpatient and substance abuse outpatient will still be provided within benefits limits, authorization limits, medical necessity criteria, and within state and federal regulatory requirements and licensure requirements, including HIPAA compliance and the regulations regarding how substance use information in handled. These changes for telephonic-only visits will be effective from March 19 through December 31, 2020. We will continue to actively monitor the rapidly evolving situation. |
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3/12/2020 | AvMed | If it is determined that coronavirus testing is needed, AvMed will cover the test under the member’s no cost-sharing preventive health benefit. Testing can also be obtained through a member’s local public health agency. AvMed is telling members to take advantage of their Virtual Visits benefit to access board certified physicians conveniently from their computer or smartphone through MDLIVE or by contact Magellan Behavioral Services concerning anxiety issues. READ MORE | ||||||||||||||||||||||
3/6/2020 | Blue Cross Blue Shield Association | Its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19 . BCBS will cover medically necessary diagnostic tests that are consistent with CDC guidance related to the COVID-19 at no cost share to member. Any care needed once diagnosis of COVID-19 has occurred will be covered consistent with the standard provisions of the member’s health benefits. READ MORE | ||||||||||||||||||||||
12/16/2020 | Blue Cross Blue Shield Alabama |
UPDATE - As COVID-19 cases increase and many hospitals across the state approach peak admissions, Blue Cross and Blue Shield of Alabama is improving needed access for patients. READ MORE 12/15/2020 - We do not reimburse providers for CPT code 99072, which is defined as: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.” Code 99072 has been added to our List of Procedures and Services Not Separately Paid, which outlines CPT and HCPCS codes that are not separately payable services. READ MORE 12/15/2020 - Codes for COVID-19 vaccines and monoclonal antibodies as well as their administration have been published on our COVID-19 Treatment page. READ MORE 12/9/2020 - DME Update: Oxygen Therapy: In response to the ongoing COVID-19 public health emergency, the suspension of the oxygen saturation requirement for both certification and recertification has been extended through the end of the federal public health emergency. Refer to our COVID-19 Treatment page for additional treatment information. READ MORE 12/4/2020 - In response to the ongoing COVID-19 pandemic, expanded telehealth services coverage for eligible Blue Cross members including Blue Advantage® will continue through the end of the federal public health emergency. Continue to check our COVID-19 Provider Update Center for important announcements. READ MORE |
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3/11/2020 | Blue Cross Blue Shield Arizona |
BCBSAZ is taking the following steps: Waiving Prior Auths where medically necessary, no cost-share for medically necessary diagnostic tests related to COVID-19, waive the member cost share for telehealth sessions. READ MORE | ||||||||||||||||||||||
6/11/2020 | Blue Cross Blue Shield Arkansas |
UPDATE - COVID-19 Telehealth Update. Arkansas Blue Cross and Blue Shield and Health Advantage described a temporary change to our policy in the March issue of Arkansas Blue Cross Providers’ News. We revised that temporary policy on March 24, 2020, making it retroactive to March 16, 2020. READ MORE |
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1/14/2021 | Blue Cross Blue Shield Federal Employee Program |
UPDATE - FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. FEP members have NO out-of-pocket costs when they receive any of the vaccines approved by the FDA with emergency use authorization. READ MORE 12/15/2020 - No member cost share for vaccines. READ MORE 3/31/2020 - FEP will waive prior authorizations for diagnostic tests and covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Similarly, FEP will waive any cost-share for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications. FEP will waive copays for all telehealth services provided by Teladoc®. READ MORE |
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12/31/2020 |
Blue Cross Blue Shield |
UPDATE - Blue Email update 12/31/2020. COVID-19 Vaccine Billing Information. Now that the Pfizer/BioNTech and Moderna mRNA-1273 COVID-19 vaccines have received emergency use authorization by the Food and Drug Administration, we want to make sure you are paid correctly for administering the vaccines. READ MORE Florida Blue Medicare Advantage: Providers should submit claims for COVID-19 vaccines to Original Medicare through your Medicare Administrative Contractor (MAC) as outlined in the Medicare institutional and professional instructions here. If a provider bills Florida Blue for a vaccine or vaccine administration for a Medicare Advantage member, it will not be reimbursed. If submitted through Availity®1 , it will be returned electronically. Other Lines of Business - Since the federal government is covering the cost for the initial doses of the vaccine, providers only need to submit a claim for the vaccine administration. Please submit your appropriate administration fee for the corresponding vaccine, using the code information below for your Commercial, Truli for Health and Federal Employee Program® members. The administration fee is covered at 100 percent of your contracted allowance, with no cost share for the member. The following codes are for vaccines for all lines of business.
12/14/2020 - Medicare Advantage Updates. Medical Test/Testing-Related Visits and Related Services cont'd. Additional visit information. READ MORE This is in effect for the following: o In-network primary care visits (office and telemedicine). COVID-19 Medical Treatment. We have extended waiving the member’s cost share for those who have a positive diagnosis for COVID-19 and must undergo treatment. ▪ In-patient and observation hospital admissions will be at $0 cost share to the member. Telemedicine. In-network primary care and behavioral health providers: o The virtual visit reimbursement will be based on your current fee schedule. |
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1/4/2021 | Blue Cross Blue Shield Illinois |
UPDATE - From Nov. 12, 2020 to Feb. 28, 2021, Blue Cross and Blue Shield of Illinois (BCBSIL) will not require a post-acute care facility to wait for prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals, skilled nursing facilities, rehabilitation facilities and in-patient hospice. The receiving facility must call and inform us of the transfer by the next business day. READ MORE 12/22/2020 - BCBS Illinois supports telehealth as an emerging and valuable mode of health care delivery that can help improve the health of our members when appropriate. READ MORE 12/21/2020 - Guidelines for COVID-19 vaccines and how it will be covered by BCBS Illinois. READ MORE 11/25/2020 - In March, we announced that, as of April 1, 2020, BCBS Illinois would start implementing new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions). READ MORE From Nov. 12, 2020 to Dec. 31, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will not require a post-acute care facility to wait for prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals, skilled nursing facilities, rehabilitation facilities and in-patient hospice. This will help promote availability of acute care capacity for COVID-19 patients. It also allows our members to continue to access medically necessary care. READ MORE |
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5/8/2020 | Blue Cross Blue Shield Kansas City MO |
UPDATE - Payer is covering telehealth services with a $0 copay for sick and wellness visits. READ MORE |
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4/29/2020 | Blue Cross Blue Shield Massachusetts |
UPDATE - Modifiers (GT, 95, GO, GQ) are required on all video/telehealth claims. READ MORE |
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8/10/2020 | Blue Cross Blue Shield Michigan |
UPDATE - BCBS of Michigan Sees Volume of Health Care Claims Returning to Pre-Pandemic Levels. READ MORE |
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1/1/2021 | Blue Cross Blue Shield Nebraska |
UPDATE - BCBSNE will continue to pay eligible providers at the assigned office fee schedule rates and prefers that providers use a HIPAA-secure platform. The video component is not required. Member cost shares will apply beginning January 1, 2021 and after but only applies to a limited number of codes when related to a COVID-19 diagnosis. READ MORE 12/11/2020 - COVID-19 Treatment and Vaccine: You can find an updated COVID-19 FAQ on NaviNet. All updated information is highlighted in yellow. This includes information on how to bill for COVID treatment and vaccines. READ MORE |
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3/7/2020 | Blue Cross Blue Shield New Mexico |
Effective immediately, payer won’t require prior authorization and won’t apply member co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control guidance. This applies to all members payer insures. With regard to treatment for COVID-19, Blue Cross and Blue Shield of New Mexico plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of your benefits. READ MORE | ||||||||||||||||||||||
11/4/2020 | Blue Cross Blue Shield New York Empire |
UPDATE - Information from Empire for Care Providers on COVID-19 (updated 11/4/20). We recently updated FAQs about COVID-19 diagnostic testing. COVID-19 testing and visits associated with COVID-19 testing. READ MORE Empire is waiving cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed. Empire looks for the CS modifier to identify visits and services leading to COVID-19 testing. This modifier should be used for evaluation and testing services in any place of service including a doctor’s office, urgent care, ER or even drive-thru testing. While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help you get to a provider who can do so. IMPORTANT: In-network providers are reminded that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test. |
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12/21/2020 | Blue Cross Blue Shield North Carolina |
UPDATE - BCBS NC will waive prior authorization requirements for all conditions, including non-COVID-19 conditions, and require notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs). READ MORE 12/21/2020 - BCBS NC will cover COVID-19 vaccines that are FDA approved for emergency use authorization (EUA) at no cost for all members, both during the public health emergency and after. READ MORE 12/10/2020 - As we anticipate an emergency use approval from the FDA for a COVID-19 vaccine soon, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is preparing so the vaccine will be available at no cost to all Blue Cross NC members. READ MORE |
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3/31/2020 | Blue Cross Blue Shield South Carolina |
3/31/2020 - "Blue Care On Demand" is for video or health provider visits for members inside or outside SC without COVID-19 symptoms. Cost is $0 for members when you use code "COVID19." "Doctors Care Anywhere" is for video visits with Doctors Care providers and should be used by members in SC with any acute symptoms. Cost is $0 for members when you use code "INS." "S.C. Department of Health and Environmental Control (DHEC)-Virtual Triage" is for video visits with health providers for members in SC who have specific COVID-19 symptoms. Cost is $0 for members when you use the code "COVID19." READ MORE |
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12/30/2020 | Blue Cross Blue Shield Tennessee |
UPDATE - BlueCross Tennessee Shares Plan to Cover Costs for COVID-19 Vaccination. READ MORE 9/24/2020 - BlueCross Extends Cost Waiver for Medicare Advantage Members Seeking Primary, Behavioral Care Through Dec. 31. READ MORE |
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1/8/2021 | Blue Cross Blue Shield Texas |
UPDATE - This article relates only to telemedicine/telehealth services rendered between March 10, 2020 and Dec. 31, 2020. READ MORE 1/5/2021 - Telehealth: Member cost share. READ MORE Members will have access to the expanded telemedicine services through Dec. 31, 2020. READ MORE 12/30/2020 - Blue Cross and Blue Shield of Texas (BCBSTX) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities through Feb. 28, 2021. READ MORE 11/30/2020 - (Originally Posted 04/15/2020) COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE We are authorizing providers to bill the following procedure codes for medical evaluation and management services delivered by a physician by telephone (audio only): Description of Services When is this effective? COVID-19: RURAL HEALTH CLINICS (RHC) and TELEHEALTH/TELEMEDICINE. READ MORE
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6/18/2020 | Blue Cross Blue Shield Vermont |
UPDATE - Update on Billing of U0001. READ MORE 3/17/2020 - For BCBSVT members to receive a zero-cost share for the coronavirus testing, services must be provided in an office (place of service 11), or Urgent Care (place of service 20) or Emergency Room (place of service 23) setting. CPT codes U0001, U0002, 87635 and 87631; refer to complete billing details. READ MORE |
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3/20/2020 | Blue Cross of Idaho | BCI will cover the COVID-19 testing performed by in-network provider with no member cost share; we will also cover the test performed by an out-of-network provider at the same rate and the OON provider is prohibited from balance billing the member under the Family First Act. READ MORE | ||||||||||||||||||||||
12/17/2020 | Blue Shield of California |
UPDATE - COVID-19 Vaccines: Here's What You Need to Know About Coverage. 10/14/2020 - Blue Shield of California Provides Over $50 Million in Premium Relief for Customers to Help Ease Financial Burden During COVID-19 Pandemic. READ MORE Blue Shield of California and its subsidiary Blue Shield of California Promise Health Plan efforts include: ^^ Extending the commitment to waive co-payments, coinsurance, and deductibles for treatment of COVID-19 through December 31, 2020.
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12/17/2020 | Buckeye Community Health Plan |
UPDATE - Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. READ MORE 7/20/2020 - Effective July 1, 2020, all medical & behavioral health prior authorizations requirements have resumed. READ MORE 7/20/2020 - Allwell from Buckeye Health Plan EXTENDS $0 MEMBER LIABILITY FOR Primary Care, Behavioral Health, and Telehealth SERVICES for Remainder of 2020. READ MORE |
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4/3/2020 | C2C Innovative Solutions, Inc. | COVID-19 Health Emergency Affects Part B Medicare Second-Level Appeals by Mail. C2C conducts second-level Medicare Part B Fee-For-Service claims appeals, for claims submitted in your MAC jurisdiction. READ MORE | ||||||||||||||||||||||
3/5/2020 | California Department of Managed Health Care | The DMHC directs all full-service commercial plans and full-service Medi-Cal plans to immediately reduce cost-sharing (including, but not limited to, co-pays, deductibles, or coinsurance) to zero for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19. READ MORE | ||||||||||||||||||||||
3/9/2020 | Capital Blue Cross | On April 16, 2020, member cost share (copays, deductibles, coinsurance) will apply for telehealth visits. READ MORE | ||||||||||||||||||||||
12/4/2020 | CareFirst BCBS |
UPDATE - CareFirst BlueCross BlueShield Extends COVID-19 Benefits into 2021, Encourages Flu and Childhood Vaccinations. READ MORE The benefits, which include the patient cost share waivers for the testing and treatment of COVID-19, were initially put in place last spring and set to expire on December 31, 2020, except as otherwise required by law. The benefits will be extended into 2021. COVID-19 vaccines are expected to gain Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration this year and will also be a covered benefit at no cost for CareFirst members. CareFirst is committed to helping communities access the vaccine as quickly and easily as possible but cautions patience as each state finalizes vaccination plans. In addition to the extensions announced today, CareFirst encouraged individuals to get a flu shot and keep up to date on the immunizations vital to their children's health. |
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12/8/2020 | CareSource |
UPDATE - COVID-19: Temporary Change to PAs for Transition to Post-Acute Care. To: Ohio Long-Term Acute Care Hospitals, Skilled Nursing Facilities, and Inpatient Rehabilitation Facilities. RE: COVID-19 Temporary Changes to PA's for Transition to Post-Acute Care. READ MORE 11/9/2020 - COVID-19 SNF Prior Authorization Process Temporary Update, Effective 11/16/20. READ MORE Impact: Beginning Nov.16 2020, upon notification of a SNF admission, CareSource will issue a 3-day authorization. A medical necessity review will be required for continued SNF stay. |
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10/6/2020 | Centene |
UPDATED - Centene will expand its Medicare Advantage offerings for 2021. READ MORE "At a time when many seniors are grappling with the effects of COVID-19, we are committed to expanding choice and access to high-quality, affordable Medicare plans that support our members' health and well-being during the pandemic and beyond," said Michael F. Neidorff, Chairman, President and CEO for Centene. |
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12/10/2020 | CGS Administrators - J15 A/B |
UPDATE - Provider Enrollment for Mass Immunizers. READ MORE NOTE: If you are already enrolled in Medicare under the institutional or non-institutional provider types listed on the CMS Enrollment for Administering COVID-19 Vaccine Shots CMS web page, no additional enrollment action is necessary. NOTE - If you are attempting to register as a centralized biller (billing in three or more MAC jurisdictions) for the COVID-19 vaccine, you must enroll with and submit claims to a single Medicare Administrative Contractor (MAC), Novitas, for payment, regardless of where you administer the shots. Please contact Novitas to be enrolled as a centralized biller. Refer to the CMS Definitions for helpful definitions for Mass Immunizers, Roster billing, and Centralized Billers. When calling the hotline number, CGS staff will collect various information from you. Please be prepared by having the following information ready before you call. CGS will either send a letter or email (if an email address is provided) notifying the applicant that they have been granted temporary billing privileges. 12/3/2020 - CGS News/ COVID-19. READ MORE
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12/3/2020 | Centers for Disease Control & Prevention (CDC) |
UPDATE - CDC Guidance for Expanded Screening/Testing to Reduce Silent Spread of SARS-CoV-2. READ MORE |
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1/11/2021 | Centers for Medicare & Medicaid Services (CMS) |
UPDATE - CMS Newsroom. CMS Launches Automated Web Tool for 1135 Waiver Requests and Public Health Emergency-Related Inquiries During Crises Like COVID-19. READ MORE Available from CMS.gov’s Waivers and Flexibilities webpage, the web tool’s user-friendly submission process will reduce burden on providers by streamlining how they document and submit 1135 waiver requests and PHE-related inquiries. It also will enhance how CMS reviews waivers and inquiries, which can now be submitted any time, any place, and for an array of qualifying emergencies. While the information providers share for 1135 waiver requests and other PHE-related inquiries will remain the same, the new web portal allows for instant inquiry or waiver application delivery and remote review for submissions on or after January 11, 2021. These improvements, coupled with faster tracking and reporting, will help CMS ensure accelerated innovation and improved health system responsiveness, especially when services and supports are constrained during national emergencies and shorter, location-specific crises like natural disasters. 1/7/2021 - CMS COVID-19 Frequently Asked Questions on MCR FFS Billing (updated 1/7/2021). Hospital Inpatient Prospective Payment Systems (IPPS) Payments. Answer: To implement this temporary statutory adjustment, the IPPS Pricer will apply an adjustment factor to increase the Medicare Severity-Diagnosis Related Group (MS-DRG) relative weight that would otherwise apply by 20 percent when determining IPPS operating payments (including the calculation of payments such as for disproportionate share hospitals (DSHs), indirect medical education (IME), outliers, new technologies, and low-volume hospitals and the hospital specific rates for sole community hospitals (SCHs) and Medicare-dependent hospitals (MDHs)) for discharges of patients with a principal or secondary diagnosis of COVID-19. For additional information regarding which claims are eligible for the 20 percent increase in the MS-DRG weighting factor, please see the Medicare Learning Network (MLN) Matters article “New COVID-19 Policies for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act” available on the CMS website at https://www.cms.gov/files/document/se20015.pdf. 1/7/2021 - MLN Connects 1/7/21 Special Edition - Physician Fee Schedule Updates. READ MORE ^^ Provided a 3.75% increase in MPFS payments for CY 2021 CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage. 1/7/2021 - MLN Connects 1/7/2021. COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit. READ MORE 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application: Deadline February 1. To further support clinicians during the COVID-19 Public Health Emergency (PHE), CMS extended the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1. For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can submit an application asking us to reweight one or more performance categories to 0% due to the current COVID-19 PHE. If you have concerns about the effect of the COVID-19 PHE on your performance data, including cost measures, submit an application and cite COVID-19 as the reason for your application. Publications: Complying with Laboratory Services Documentation Requirements — Revised. Quarterly Update to Home Health (HH) Grouper - CMS issued a new MLN Matters Article MM12047 on Quarterly Update to Home Health (HH) Grouper (PDF). Learn about diagnosis code changes for COVID-19. 1/7/2021 - CMS COVID-19 Frequently Asked Questions on MCR FFS Billing (updated 1/5/2021). READ MORE CMS will delay the filing deadline of Fiscal Year End (FYE) 10/31/2019 and FYE 11/30/2019 cost reports until June 30, 2020. CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports until August 31,2020. For the FYE 01/31/2020 cost report, the extended due date is August 31, 2020. For the FYE 02/29/2020 cost report, the extended due date is September 30, 2020. For any cost reporting period not previously identified and ending on a date falling in the period of March 1, 2020 through December 31, 2020, providers are granted an additional 60 days from the initial due date to file their cost reports. In summary the extension impacts the following cost reporting fiscal year ends for all provider types (hospitals, SNFs, HHAs, hospices, ESRDs, RHCs, FQHCs, CMHCs, OPOs, histocompatibility labs and home office cost statements). Question: Will Medicare pay for monoclonal antibody products to treat COVID-19 and their administration under Part B? Could monoclonal antibody products authorized under an Emergency Use Authorization (EUA) to treat COVID-19 be paid for under Medicare Part B, if so, how? Answer: Yes, in order to ensure immediate access during the COVID-19 public health emergency (PHE), Medicare will pay for monoclonal antibody products authorized for emergency use to treat COVID-19, furnished consistent with the terms of the EUA, or approved by the FDA to treat COVID-19. Medicare payment for monoclonal antibody products for the treatment of COVID-19 will be in accordance with Section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). As of December 11, 2020, the FDA has issued emergency use authorizations for bamlanivimab2, and casirivimab and imdevimab (administered together). Should additional monoclonal antibodies for the treatment of COVID-19 be authorized or approved by the FDA, the same Medicare payment policies would apply. Medicare will make a payment to the provider or supplier for the monoclonal antibody product to treat COVID-19 (when it is not received by the provider for free) and will make a separate payment for its administration (infusion). Medicare will not provide payment for the monoclonal antibody products to treat COVID-19 that health care providers receive for free, as will be the case upon the product’s initial availability in response to the COVID-19 PHE. 1/6/2021 - COVID-19 Update - 2021 ICD-10-CM. In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 6 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021. READ MORE The new ICD-10-CM diagnosis codes are:
12/31/2020 - MLN Matters MM12126 12/31/20 "2021 Annual Update to the Therapy Code List." CR # R10542CP, Effective Date 1/1/2021, Implementation Date 1/4/2021. READ MORE For the five codes below (2 HCPCS and 3 CPT codes), CY 2021 rulemaking made these codes permanent, meaning they are no longer restricted by the effectiveness timeline of the Public Health Emergency (PHE) for COVID-19. The HCPCS codes are G2250 and G2251. Editorial Panel for CY 2020 created CPT codes 98970, 98971, and 98972. During MPFS rulemaking for CY 2021, CMS decided to use these codes in place of G2061, G2062, and G2063, since their descriptors were similar. CR 11971 added the CPT codes for telephone assessment as “sometimes therapy” codes effective for the duration of the PHE for COVID-19. As with the other CTB services noted above, therapists in private practice and therapists who work for institutional providers may furnish these services. We are removing the following HCPCS codes from the therapy code list, effective for dates of service on and after January 1, 2021: MLN Connects 12/28/20 Special Edition. Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March. READ MORE 12/23/2020 - MLN Matters MM12093 12/23/20 "Addition of the QW Modifier to HCPCS Codes 87811 and 87428." CR Transmittal R10529OTN, Effective Date 10/6/2020, Implementation Date 4/5/2021. READ MORE • 87811 [Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 12/23/2020 - MLN Matters R10530OTN 12/23/20 Instructions to Medicare Administration Contractor (MAC) on COVID-19 Emergency Declaration Blanket Waivers for Medicare-Dependent, Small Rural Hospitals and Sole Community Hospitals. Effective Date 1/26/2021, Implementation Date 3/29/2021, CR# 12070. READ MORE Hospitals Classified as Sole Community Hospitals (SCHs) - We are waiving certain eligibility requirements as set forth in the regulations at 42 Code of Federal Regulations (CFR), Section 412.92(a), for hospitals classified as SCHs prior to the Public Health Emergency (PHE). Specifically, we are waiving the distance requirements at 42 CFR 412.92(a), (a)(1), (a)(2), and (a)(3), which require that SCHs, among other criteria, be located either more than 35 miles, 25-35 miles, 15-25 miles, or a 45-minute drive time from another like hospital, respectively. These waivers will continue for the duration of the PHE. MACs will resume standard practice for evaluation of all eligibility requirements after the conclusion of the PHE. We are also waiving the “market share” requirement at 42 CFR 412.92(a)(1)(i), which requires that no more than 25% of residents who become hospital inpatients or no more than 25% of the Medicare beneficiaries who become hospital inpatients in the hospital's service area are admitted to other like hospitals located within a 35-mile radius of the hospital, or, if larger, within its service area. Lastly, we are waiving the bed requirement at 42 CFR 412.92(a)(1)(ii), which requires that the SCH have fewer than 50 beds. Hospitals Classified as Medicare-Dependent, Small Rural Hospitals (MDHs) - - We are waiving certain eligibility requirements as set forth in the regulations at 42 CFR 412.108(a), for hospitals classified as MDHs prior to the PHE. Specifically, we are waiving the requirement that the hospital have 100 or fewer beds during the cost-reporting period at 42 CFR 412.108(a)(1)(ii). We are also waiving the requirement that at least 60% of the hospital’s inpatient days or discharges were attributable to individuals entitled to Medicare Part A benefits during the specified hospital cost-reporting periods at 42 CFR 412.108(a)(1)(iv)(C). MLN Connects 12/23/20. ICD-10 Code Files for FY 2021. READ MORE ^^ 21 procedure codes (ICD-10-PCS): CMS will implement new codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment ^^ 6 diagnosis codes (ICD-10-CM): CDC National Center for Health Statistics For More Information: Part B providers: When you select a roster bill for a COVID-19 vaccine in PC-ACE 4.8.100 software, it inappropriately auto-populates HCPCS code G0008 on the claim for the administration. This code is valid for traditional roster billing vaccines like pneumococcal and flu but not for administering the COVID-19 vaccine. Your Medicare Administrative Contractor will provide updated PC-ACE 4.9 software. Download the update to ensure proper billing of roster-billed COVID-19 vaccines. MLN Matters R10533DEMO 12/22/2020 Telehealth Expansion Benefit Enhancement under the Pennsylvania Rural Health Model (PARHM) - Implementation. Effective date 1/1/2021, Implementation date 1/4/2021, CR# 11870. READ MORE MACs will deny incoming PARHM claims if the Date of Service (DOS) on the claim is prior to January 1, 2021 using the following messages: MLN Connects 12/22/20 Special Edition. COVID-19 Vaccine Codes: Updated Effective Date for Moderna. READ MORE 12/18/2020 - MLN Connects 12/18/20 Special Edition. COVID-19: Add-on Payment for New Treatments. CMS issued an Interim Final Rule with Comment Period, which established the New COVID-19 Treatments Add-on Payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS), effective from November 2, 2020, until the end of the Public Health Emergency (PHE) for COVID-19. READ MORE To mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the COVID-19 PHE, the Medicare program will provide an enhanced payment for eligible inpatient cases that involve use of certain new products with current Food and Drug Administration approval or emergency use authorization to treat COVID-19. Visit the NCTAP webpage for more information at https://www.cms.gov/medicare/covid-19/covid-19-treatments-add-payment-nctap 12/18/2020 UPDATE - MLN Matters MM12080 12/18/20. "Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment." Effective 1/1/2021, Implementation 1/4/2021, CR Transmittal R10523CP. COVID-19 Policy Updates - Payment for High Throughput Technologies. READ MORE On October 15, 2020, CMS issued ruling CMS-2020-1-R2 which amends CMS Ruling 2020-1-R, which articulated CMS’s policy concerning the designation and payment of certain CDLTs related to COVID-19 under the Medicare Part B CLFS. CMS Ruling 2020-1-R defined certain highly sophisticated equipment called “high throughput technology.” It also established a payment amount for molecular genomic CDLTs making use of high throughput technologies for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID-19 and that are administered during the ongoing emergency period defined in paragraph (1)(B) of Section 1135(g) of the Act. C MS Ruling 2020-2-R amends CMS Ruling 2020-1-R by modifying the payment amount established in that Ruling for such CDLT based on a re-evaluation of the resources necessary for the timely administration of these tests. The ruling: 12/18/2020 UPDATED - MLN Matters MM12080 continued. We update the fees for clinical laboratory travel codes P9603 and P9604 on an annual basis. READ MORE You may bill the clinical laboratory travel codes only for traveling to perform a specimen collection for either a nursing home or homebound patient. If there is a revision to the standard mileage rate for CY 2021, CMS will issue a separate instruction on the clinical laboratory travel fees. 12/17/2020 - UPDATE - MLN Connects 12/17/20. Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List. READ MORE CMS issued a new MLN Matters Article MM12071 on Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List (PDF). Learn about the policy changes that apply to Medicare Part B. The CY 2021 changes are - Medicare Telehealth Services - - We are finalizing the proposal to add several HCPCS codes to the list of telehealth services on a permanent basis. We are also finalizing the proposal to add additional HCPCS codes to the list of telehealth services on a temporary basis until the end of the CY in which the Public Health Emergency (PHE) for COVID-19 ends or December 31, 2021. The list of codes we added to the telehealth services list are at https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes. 12/16/2020 - UPDATE - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/16/20). Pages 17 - 18 High Throughput COVID-19 Testing. READ MORE 11. Question: CMS has indicated that in order to bill Medicare for HCPCS code U0005 the majority of a laboratory’s COVID-19 CDLTs performed using high throughput technology in the previous calendar month must have been completed in 2 calendar days or less from the date of specimen collection for all of their patients (not just their Medicare patients). What does “majority” mean in this context? 13. Question: CMS Ruling No. CMS 2020-1-R2 states that for a laboratory to be able to bill Medicare for HCPCS code U0005, the test described by HCPCS code U0003 or U0004 must be completed in 2 calendar days. Please clarify when the 2-calendar day timeframe begins and ends. 12/14/2020 - UPDATE - MLN Connects 12/14/20 Special Edition. COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech. READ MORE During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review our updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free. 12/14/2020 - COVID-19 Vaccine Administration. CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once it is available. READ MORE Providers that participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient. Providers who have questions about billing or reimbursement of vaccine administration for patients covered by private insurance or Medicaid should contact the respective health plan or state Medicaid agency. People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. *Updated* Additionally, you can find information about a monoclonal antibody infusion for treating COVID-19. During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions the same way it covers and pays for COVID-19 vaccines (when furnished consistent with the EUA). 12/10/2020 - MLN Connects Special Edition 12/10. CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and Providers. READ MORE 12/10/2020 - MLN Connects 12/10/20. 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application: Deadline February 1. READ MORE For More Information, contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292; customers who are hearing impaired can dial 711 for a TRS Communications Assistant. COVID-19: Hospital Operations Toolkit. READ MORE ^^ Healthcare Operations Toolkit: Helps hospitals prepare to manage large numbers of patients during the COVID-19 pandemic For More Information: Telehealth Services: Bill Correctly. READ MORE Additional resources: ICD-10 MS-DRG Grouper V38.1 & 2021 ICD-10-PCS Code Files. READ MORE ^^ 21 procedure codes (ICD-10-PCS): CMS will implement new codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment For More Information: MLN Connects 12/9/20 Special Edition. In Case You Missed It: CMS Announces Guidance for Medicare Coverage of COVID-19 Antibody Treatment. READ MORE 12/4/2020 - MLN Matters R10505CP dated 12/4/20 "Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List." CR# 12071, Implementation Date 1/4/2021. READ MORE ^^ For CY 2021, CMS is finalizing the proposal to add several Healthcare Common Procedure Coding System (HCPCS) codes to the list of telehealth services on a permanent basis. CMS is also finalizing the proposal to add additional HCPCS codes to the list of telehealth services on a temporary basis until the end of the calendar year in which the Public Health Emergency (PHE) for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or COVID-19 ends or December 31, 2021. ^^ Section 1834(m)(2)(B) of the Act establishes the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001, through December 31, 2002, at $20. For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is $27.02 (The beneficiary is responsible for any unmet deductible amount and Medicare coinsurance). MLN Matters R105404CP dated 12/4/20 "CY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule." CR# 12063, Implementation Date 1/4/2021. READ MORE 12/3/2020 - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/3/20). Pages 120 - 128 Drugs and Vaccines under Part B, Questions 5 - 16 regarding monoclonal antibody products to treat COVID-19 and what Medicare will pay. 12/3/2020 - MLN Connects 12/3/20. Events for Providers. Physician Fee Schedule Final Rule: Understanding 4 Key Topics Call (Thursday, December 10, 1:30 to 3 pm ET). Register for this Medicare Learning Network event. READ MORE ^^ Extending telehealth and licensing flexibilities beyond the public health emergency During this call, CMS experts briefly cover provisions from the final rule and address your questions. We encourage you to review the final rule (PDF) prior to the call. Target Audience: Medicare Part B Fee-for-Service clinicians; office managers and administrators; state and national associations that represent health care providers; and other stakeholders. 12/2/2020 - MLN Connects 12/2/20 - On December 2, CMS finalized policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. READ MORE 12/1/2020 - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/1/20). READ MORE 12/1/2020 - MLN Connects 12/1/20 Special Edition. Professional Scope of Practice and Supervision. READ MORE >>>Click here to read past updates, MLN Newsletters, Webinar recordings, etc. |
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3/25/2020 | CMS - Provider Reimbursement Board | Provider Reimbursement Board, created to adjudicate Medicare Part A payment disputes of Institutional Providers, is issuing alerts - Temporary COVID-19 Adjustments to PRRB Processes. READ MORE | ||||||||||||||||||||||
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5/19/2020 | Central Ohio Patient Account Managers (COPAM) |
OHA (Ohio Hospital Association) presentation 5/19/2020 w ODM (Ohio Department of Medicaid) clarification. 1.) When should hospitals use the Q3014 vs the telehealth E&Ms like 99211-99215 with modifiers and condition codes for outpatient hospital dept telehealth visits? A: provider may submit a claim for an E&M and for a telehealth originating site fee if they: i. Provided no other service to the presenting patient; or a. The patient presents to an office location and staff initiate the telehealth visit with a practitioner who is offsite. Providers are encouraged to review ODM’s COVID-19 Emergency Telehealth Guidance web page for possible examples and clarification on how to bill. READ MORE |
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12/29/2020 | Cigna |
UPDATE - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until January 21, 2021. The cost-share waiver for COVID-19 related treatment is in place until February 15, 2021. Other interim accommodations (e.g., for credentialing and authorizations) are extended through March 31, 2021, as outlined on this page. READ MORE 12/21/2020 - As the first COVID-19 vaccines are being distributed across the country, we are committed to ensuring that Cigna commercial and Medicare customers receive the COVID-19 vaccine with no out-of-pocket costs and according to the federal and state priority grouping. Providers receive timely information and reasonable reimbursement consistent with CMS rates for administering EUA-approved COVID-19 vaccines and treatments. READ MORE 12/7/2020 - Cigna Medical Coverage Policy 0557 effective 11/18/2020. COVID-19: In Vitro Diagnostic Testing. READ MORE NOTE - Effective November 1, 2020, Cigna is denying COVID-19 claims when billed only with diagnosis code Z11.59 (asymptomatic screening). In vitro testing (i.e., molecular, antigen, antibody) is considered not diagnostic and not medically necessary when performed for screening purposes in the general population, including but not limited to the following indications: |
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4/3/2020 | Colorado Medicaid | DXC Technology (DXC), the Department's fiscal agent, continues to be fully functional during this time of the COVID-19 state of emergency. Providers are strongly encouraged to utilize all electronic options for claims submissions including claims with attachments. All attachments can be sent via the Provider Web Portal. For assistance on sending attachments, voids or adjustments, contact the Provider Services Call Center at 1-844-235-2387. READ MORE | ||||||||||||||||||||||
12/30/2020 | Excellus Blue Cross Blue Shield |
UPDATE - Update to Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies – Diagnosis Code B97.29. READ MORE Claims for medically appropriate COVID-19 testing must be submitted with one of the following CPT® codes U0001, U0002, U0003, U0004, 0202U, 87635, 86328 86769, 86413, 0225U, 87636, 87637, 87811, 0240U, 0241U, and/or 87428 and billed with a diagnosis of U07.1, Z03.818, and/or Z20.828 will be reimbursed. Laboratories may bill G2023 and G2024 for the purpose of specimen collection at a skilled nursing facility or for homebound patients with a diagnosis of U07.1, Z03.818, and/or Z20.828 and it will be reimbursed during public health emergency. For specimen collection purposes, when HCPCS code C9803 is billed with diagnosis code U07.1, Z03.818, and/or Z20.828, it will be reimbursed during public health emergency. 12/23/2020 - Excellus BCBS Updates on COVID-19 (Coronavirus). READ MORE 12/11/2020 - COVID-19 Reinstating Reimbursement of Preventive Visits via Telehealth. READ MORE 12/4/2020 - Extension of In-Network Outpatient Behavioral Health Services for Essential Workers During the COVID-19 State of Emergency. Audience: Behavioral Health Providers and Outpatient Facilities. READ MORE Under the extension, health plans are prohibited from imposing copayments, coinsurance, or deductibles for outpatient mental health visits rendered by in-network outpatient mental health service providers through January 26, 2021. However, collecting deductibles is permissible from members with coverage under a high-deductible health plan until the member has met the deductible amount. Excellus BlueCross BlueShield will continue to waive member cost-share through January 26, 2021 for in-network outpatient behavioral health services provided to our members with coverage under: ^^ Commercial insured This cost-share waiver does not apply to self-funded employer groups that have elected not to offer the waiver. It also does not pertain to Medicaid Managed Care or Child Health Plus members, as they already have no cost-share responsibility. 12/1/2020 - Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing and Supplies; Reimbursement Update Effective March 1, 2021. Audience: Physicians and Facilities. READ MORE |
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12/23/2020 | Federal Government | 2021 Federal Omnibus Appropriations Legislation. Extends the temporary suspension of Medicare Sequestration through March 31, 2021. The suspension was scheduled to end on December 31, 2020. READ MORE | ||||||||||||||||||||||
3/24/2020 | Fidelis Care |
Effective March 01, 2020, providers are responsible to ensure any copays, coinsurance, or deductible charges are waived for Fidelis Care members at the time of an office visit, urgent care visit, clinic, or emergency room visit when the purpose of that visit is testing for COVID-19. Claims with correct coding will be adjusted to reflect provider payments with $0 member liability upon processing. Updating claiming systems to be able to receive new codes by April 1, 2020. Will add Healthcare Common Procedure Coding System (HCPCS) codes to system. READ MORE |
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12/18/2020 | First Coast Service Options - JN A/B |
UPDATE - 2021 payment rates for COVID-19 vaccine and monoclonal administration. READ MORE 2021 payment rates for COVID-19 vaccine and monoclonal administration The Centers for Medicare & Medicaid Services (CMS) established national payment allowances for the administration of COVID-19 vaccines and monoclonal antibodies. These allowances will be geographically adjusted for many providers. 12/18/2020 UPDATE - 2020 payment rates for COVID-19 vaccine and monoclonal administration. READ MORE The Centers for Medicare & Medicaid Services (CMS) established national payment allowances for the administration of COVID-19 vaccines and monoclonal antibodies. These allowances will be geographically adjusted for many providers. If you received the national, unadjusted payment allowance, you can bring the claim to our attention for reopening to receive the geographically adjusted payment rate. When submitting your request, ensure the billed amount is equal to or higher than the rate to obtain the adjusted rate. For Part A claims, if you use Direct Data Entry for claims submission, you can resubmit your claim to obtain the geographically adjusted rate. For Part B claims, you can use the Secure Provider Online Tool (SPOT) or the Reopening Gateway. To reopen your claim in SPOT or the Reopening Gateway, select the reopening request type Billed Amount and ensure the correct billed amount is present on the line item. 12/7/2020 UPDATE - First Coast Processing Issues/Part B. Allowing Claims With "Z" Diagnosis Codes. READ MORE Resolution - Effective for claims processed on or after July 17, 2020, for dates of service on or after January 27, 2020, First Coast will no longer deny claims when submitted with diagnosis codes Z03.818 and Z11.59, as long as all other coverage requirements are met for claims processing. Status/date resolved - Beginning July 17, 2020, for dates of service on or after January 27, 2020, claims will no longer be denied when billed with diagnosis codes Z03.818 and Z11.59. Provider action - First Coast will adjust claims when brought to our attention. If you have a claim that denied due to the diagnosis code of Z03.818 or Z11.59 and want to request an adjustment, please contact customer service. |
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1/4/2021 | Food and Drug Administration (FDA) |
UPDATE - FDA Statement on Following the Authorized Dosing Schedules for COVID-19 Vaccines. We want to remind the public about the importance of receiving COVID-19 vaccines according to how they’ve been authorized by the FDA in order to safely receive the level of protection observed in the large randomized trials supporting their effectiveness. READ MORE We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19. These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19. 12/18/2020 - FDA issued an EUA for the second vaccine for prevention of COVID-19 caused by SARS-CoV-2. The emergency use authorization allows the Moderna COFID-19 Vaccine to be distributed in the US for use in individuals 18 years of age and older. READ MORE 12/15/2020 - COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech. During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review our updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free. COVID-19 Update - FDA Authorizes Antigen Test as 1st Over-the-Counter Fully At-Home Diagnostic Test for COVID-19. READ MORE 12/9/2020 - FDA authorized LabCorp's Pixel COVID-19 Test Home Collection Kit for use by any individual 18 years and older without prescription. READ MORE 12/1/2020 - The FDA has reissued the August 23, 2020 emergency use authorization (EUA) for the emergency use of COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19. The Letter of Authorization has been revised to add the Mount Sinai COVID-19 ELISA IgG Antibody Test as an acceptable test to be used for the purpose of qualifying high and low titer COVID-19 convalescent plasma in the manufacture of COVID-19 convalescent plasma. READ MORE Further, the FDA has updated the guidance, Notifying CDRH of a Permanent Discontinuance or Interruption in Manufacturing of a Device Under Section 506J of the FD&C Act During the COVID-19 Public Health Emergency. The update is intended to further assist manufacturers in providing the FDA with timely and informative notifications about changes in the production of certain medical devices that could help the FDA prevent or mitigate shortages of such devices during the COVID-19 public health emergency. |
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12/29/2020 | Department of Health & Human Services (HHS) |
UPDATE - COVID-19 Claims Reimbursement Program Update for the Uninsured. More than $2.3B has been paid and over 170,000 health care providers have enrolled in the program to date.* (as of 12/4/2020). READ MORE 10/27/2020 - The Provider Relief Fund supports healthcare providers in the battle against the COVID-19 pandemic. Through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act (PPPCHE), the federal government has allocated $175 billion in payments to be distributed through the Provider Relief Fund (PRF). READ MORE Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenue due to COVID-19. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions. New funding is available. Applications for the Phase 3 General Distribution are now being accepted through November 6, 2020. Providers are encouraged to apply as soon as possible to expedite the calculation and distribution of payments. All recipients of Provider Relief Fund payments must sign an attestation within 90 days of the payment to confirm its receipt.
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12/10/2020 | HHS OIG (Office of Inspector General) |
UPDATE - FAQs–Application of OIG's Administrative Enforcement Authorities to Arrangements Directly Connected to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency. READ MORE
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12/14/2020 | Highmark |
UPDATE - Extended/Open Authorizations for professional and facility providers. 12/11/2020 - Telehealth and Virtual Visit. READ MORE 11/2/2020 - REMINDER: OUT-OF-AREA BLUE PLAN PROVIDERS REQUIRED TO OBTAIN PRIOR AUTHORIZATION FOR OUTPATIENT SERVICES. READ MORE |
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3/6/2020 |
Horizon |
Effective March 6, 2020: ◦ Waiving prior authorizations for a visit to a primary care physician, urgent care center, or emergency room for evaluation of upper respiratory symptoms, fever, shortness of breath or other conditions that may represent COVID-19. |
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1/7/2021 | HRSA - Health Resources & Services Administration |
UPDATE - HRSA eNews January 7, 2021. Claims Reimbursement: Testing, Treatment and Vaccine Administration for Those Without Health Care Coverage. READ MORE 12/17/2020 - HRSA eNews 12/17/2020. HHS Increases and Begins Distributing Over $24 Billion in Phase 3 COVID-19 Provider Relief Funding December 16 READ MORE 12/17/2020 UPDATE - HRSA enews 12/17. HRSA Funds Additional Rural Health Clinics to Expand COVID-19 Testing. READ MORE 12/15/2020 - UPDATE - COVID-19 Claims Payment Guidelines for the Uninsured Program. READ MORE 12/3/2020 - COVID-19 Claims Payment Guidelines for the Uninsured Program. Question - Will the HRSA COVID-19 Uninsured Program provide claims reimbursement for monoclonal antibody therapy? Answer - The HRSA COVID-19 Uninsured Program will align claims reimbursement for monoclonal antibody therapy with the CMS guidance issued on November 10, 2020. Per CMS’s Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction, “During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions the same way it covers and pays for COVID-19 vaccines (when furnished consistent with the EUA).” View information regarding coding and pricing. https://www.cms.gov/files/document/covid-medicare-monoclonal-antibody-infusion-program-instruction.pdf
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12/23/2020 | Humana |
UPDATE - COVID-19 Vaccine FAQs 12/23/20. READ MORE How is Humana handling cost share for the vaccine? For Humana members, all FDA-authorized COVID-19 vaccines will be covered at no additional cost during the public health emergency. Coverage applies no matter where the Humana patient gets the vaccine -- including at both in-network and out-of-network providers. It also covers instances in which two vaccine doses are required. For Medicare Advantage (MA) members specifically, the Centers for Medicare & Medicaid Services determined that coverage for COVID-19 vaccines administered to MA plan members during 2020 and 2021 will be provided through the Original Medicare program. This includes charges for the vaccine and its administration. All claims should be submitted to the Medicare Administrative Contractors. Humana will deny any vaccine product or administration claims received for Medicare Advantage members. For Commercial and Medicaid members, the federal government is coordinating with the states to supply all vaccine products to providers. It is not necessary for a provider to submit a vaccine product code for a state-supplied vaccine. Humana will not reimburse for a state-supplied vaccine product, however the administration of a state-supplied What codes are reported for the COVID-19 vaccine? Providers should report charges for the vaccine product and its administration according to the Current Procedural Terminology (CPT®) coding standards established by the American Medical Association (AMA). Providers should report the code appropriate for the manufacturer-specific vaccine and dose administered. The AMA has created the codes listed in the chart below for reporting the COVID-19 vaccine. See the AMA’s website for more information on COVID-19 vaccine coding. If the AMA creates more CPT codes for additional COVID-19 vaccines, we will update this FAQ.
10/16/2020 - Humana is reinstating authorization requirements for COVID-19 related diagnoses for Medicare Advantage and commercial plans. Medicaid and commercial plans will continue to follow state regulations and existing state executive orders as applicable. READ MORE We are providing advanced notice so you can prepare for this change. Availity and telephonic authorization tools will continue to provide an approval upon submission of a COVID-19 related authorization request or notification through Oct. 23, 2020, and no process changes are required through that date. We will reinstate authorization requirements on COVID-19 diagnoses for Medicare Advantage and commercial plans for authorizations requested on or after Oct. 24, 2020. Please note: Humana continues to waive out-of-pocket costs related to COVID-19 testing. Additionally, Humana will waive out-of-pocket costs related to treatment for confirmed cases of COVID-19. These cost share waivers apply to all of our Medicare Advantage, Medicaid and fully-insured commercial members. Finally, there are no prior authorization requirements related to COVID-19 testing. |
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8/11/2020 | Illinois Medicaid |
Provider Alert - Repricing Hospital Outpatient Claims Billed with COVID-19 Diagnosis and Procedure Codes. READ MORE |
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4/22/2020 | Independence Blue Cross |
Payer is expanding temporary suspension of prior authorization for acute in-network inpatient admissions from the emergency department to include all diagnoses (including COVID-19) and for in-network transfers and transportation between facilities. The change, which is for fully insured members, takes effect immediately and will remain in effect until June 4, 2020. READ MORE |
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3/27/2020 | Kaiser Permanente | Proactively extending the use of telehealth appointments via video and phone where appropriate. Not requiring members to pay any costs related to COVID-19 screening or testing when referred by a Kaiser Permanente doctor. READ MORE | ||||||||||||||||||||||
5/8/2020 | Medicaid - Ohio |
This Bulletin pertains to all health plan issuers, including insurance companies, health insuring corporations, MEWAs, non-federal governmental health plans, and other entities transacting the business of insurance in the State of Ohio, or that are subject to the jurisdiction of the Superintendent of Insurance (collectively, Insurers), that reimburse the costs of health care services under a health benefit plan in Ohio. Testing and treatment for COVID-19 diagnoses are provided by select hospitals in the State. If the hospital is an out-of-network hospital for an insured, emergency medical conditions (i.e., COVID-19) testing and treatment for an insured must be covered with cost-sharing at in-network rates and without preauthorization. Insurers must provide benefits for these emergency services equal to the greatest amount for contracted in-network providers, out-of-network providers, or the amount paid by Medicare without balance billing the patient. READ MORE |
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1/11/2021 | Medi-Cal |
UPDATE - Update to Billing Policy for Infectious Agent Antigen Detection. READ MORE An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. The updated provider manual pages reflecting this change will be released in a future Medi-Cal Update. 1/6/2021 - COVID-19 Vaccine Administration: Real-Time RTIP Pharmacy Claims Can Be Submitted. READ MORE Medi-Cal requests pharmacy providers to remain aware of the below highlights as they begin submission. Clarification on system changes, reimbursement, and timelines has been added. The Food and Drug Administration (FDA) has provided Emergency Use Authorization (EUA) for two vaccine manufacturers: Pfizer-BioNTech and Moderna. As other vaccine manufacturers are approved by the FDA, additional billing instructions will be issued. DHCS will reimburse the associated COVID-19 vaccine administration fee at the Medicare allowable rate for all claim types, including pharmacy. ** When billed appropriately, providers will be reimbursed $16.94 for the first dose and $28.39 for the second dose (regardless of manufacturer). 1/4/2021 - Medi-Cal List of Contract Drugs: COVID-19 Vaccines Pfizer-BioNTech and Moderna Added. READ MORE A summary of drug that has been added is shown below. For additional information, click on the link to the manual section and scroll to the page indicated or use the find feature to search for the particular drug. - Added Drug(s)/Effective Date - December 11, 2020, and December 18, 2020 12/22/2020 - COVID-19 Vaccine Administration - Initial and Upcoming Policy. READ MORE DHCS will follow California’s COVID-19 vaccination plan, which was approved by the California Department of Public Health (CDPH). Consistent with the approach being taken by Medicare through Medicare Advantage Plans, DHCS will carve out the COVID-19 vaccine from Medi-Cal managed care health plans and will reimburse providers under the fee-for-service delivery system for both medical and pharmacy claims. This approach will ease program administration, eliminate challenges with out-of-network provider reimbursements, and keep vaccine administration fee rates consistent for providers regardless of delivery system. COVID-19 Vaccine Administration: COVID-19 Uninsured Group – Vaccine Reimbursement. READ MORE The COVID-19 Uninsured Group program provides temporary, no cost diagnostic testing, testing-related services, hospitalization and other treatment and vaccination services, including all medically necessary care, which includes associated office, clinic, or emergency room visits related to COVID-19. This program is available to uninsured and underinsured individuals determined eligible by a QP based on preliminary applicant information. Providers should refer to the COVID-19 Uninsured Group’s Frequently Asked Questions for more information. 12/14/2020 - New Benefit for COVID-19 Detection. READ MORE 12/11/2020 - COVID-19 Uninsured Group Program Retroactive Applications. READ MORE 12/8/2020 - Rates are Updated for CPT COVID-19 Testing Codes 87636, 87637, 87811.
The codes above are exempt from the 10% payment reductions in Welfare and Institutions (W&I) Code section 14105.192, as described in Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. 12/4/2020 - New COVID-19 Testing Codes 87636, 87637 and 87811 are Medi-Cal Benefits. READ MORE Two of the newly approved codes, 87636 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)] and influenza virus types A and B, multiplex amplified probe technique) and 87637 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)], influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique), allow a single test to simultaneously detect the novel coronavirus, and a combination of common viral infectious agents, including influenza A/B and respiratory syncytial virus. Also approved is a new category I CPT code 87811 (infectious agent antigen detection by immunoassay with direct optical [ie visual] observation; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)]). An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. The updated manual pages reflecting this change will be released in a future Medi-Cal Update.
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3/6/2020 | Medi-Cal Managed Care Health Plans | Cover all medically necessary emergency care without prior authorization, whether that care is provided by an in-network or out-of-network provider. READ MORE | ||||||||||||||||||||||
12/23/2020 | Medical Mutual of Ohio |
UPDATE - Effective Nov. 18, 2020, Medical Mutual temporarily suspended skilled nursing facility (SNF) prior authorizations through Jan. 31, 2021, for all hospitals. We did this to help make bed space available for COVID-19 patients. This applies to our commercial and Medicare Advantage lines of business. Prior authorization remains in place for Long Term Acute Care and Inpatient Rehabilitation facilities. Also, Medical Mutual is allowing the expanded telehealth services through Dec. 31, 2020, at which time we will begin to follow Ohio telehealth regulations effective Jan. 1, 2021. 12/17/2020 - You will be able to get the vaccine from in-network or out-of-network providers or locations during the national public health emergency declared by the U.S. Department of Health and Human Services. READ MORE 11/18/2020 - Effective Nov. 18, 2020, Medical Mutual is temporarily suspending skilled nursing facility (SNF) prior authorizations through Dec. 31, 2020, for all hospitals. |
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4/6/2020 | Michigan Medicaid |
The Michigan Department of Health and Human Services (MDHHS) has suspended the ability to scan paper claims received by U.S. postal mail. Providers can submit HIPAA 837P,837I or 837D electronic claims. If you currently do not have the ability to send electronic claims, please contact your Quadax Account Executive. READ MORE |
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7/27/2020 |
MLO Medical Laboratory Observer |
UPDATE - MLO Infectious Disease News 7/27/2020. READ MORE 7/10/2020 - Disease/Infectious Disease - WHO: Aggressive Action Needed to Turn COVID-19 Around. READ MORE |
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6/8/2020 | Molina |
UPDATE - Molina Healthcare, Inc. (NYSE: MOH) announced that it will continue waiving all out-of-pocket costs associated with COVID-19 testing and treatment for its Medicare, Medicaid, and Marketplace members nationwide through December 31, 2020. READ MORE |
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1/13/2021 | National Government Services (NGS) - J6 A/B, JK A/B |
UPDATE - NGS Upcoming Education for Providers. Let's Chat: COVID-19 Telehealth Services for Part B Providers. READ MORE 1/12/2021 - Medicare Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody. READ MORE ^^ COVID-19 vaccine shot administration 1/6/2021 - NGS Newsletter January 2021. For Part B Providers - PC-ACE V4.8.100 Workaround for COVID-19 Roster Billing. READ MORE Workaround - While utilizing the roster billing functionality within PC-ACE, users are encouraged to review their claims within PC-ACE and update the claim to the appropriate administration code to meet their needs. PC-ACE allows users to select and modify the code to meet their business needs. Long-Term Plan - Through collaboration with CMS, ABILITY will update PC-ACE functionality that will terminate the auto-population functionality of an administration code when a COVID-19 related vaccination code is utilized within roster billing functionality. To ensure accurate billing for COVID-19 related items, users will be responsible to select and choose the administration code for proper reimbursement. 12/14/2020 - NGS Newsletter December 2020. TPE reviews remain suspended due to the PHE related to COVID-19. READ MORE Telehealth Video: Medicare Coverage and Payment of Virtual Services 12/10/2020 - To ensure broad access to the coronavirus disease 2019 (COVID-19) vaccine, Medicare will cover FDA-approved or authorized vaccines as a preventive service at no cost to your patients. READ MORE 12/7/2020 - ANNUAL PARTICIPATION ENROLLMENT PERIOD EXTENDED TO JANUARY 31, 2021. READ MORE Per 100-04, of the Internet Only Manual (IOM), Chapter 1, Section 30.3.12, contractors shall furnish participating physician/supplier data to the Railroad Retirement Board no later than 3/2/2021. Per 100-06, of the IOM, Chapter 6, Section 390.2, contractors shall submit participation counts to the CMS’ Central Office via Contractor Reporting of Operational and Workload Data (CROWD) no later than 3/17/2021. |
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12/22/2020 | New York Medicaid |
UPDATE - The services in this guidance document are currently reimbursable by NYS Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) Plans. READ MORE * The fees are current as of December 9, 2020. Providers should periodically check their respective fee schedules in eMedNY for updates: https://www.emedny.org/ProviderManuals/index.aspx Tests with EUA: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergencyuse-authorizations#covid19ivd 12/10/2020 - New York State Medicaid Billing Guidance for COVID-19 Testing, Specimen Collection and Monoclonal Antibody Infusions. READ MORE 11/12/2020 - Emergency Use Authorization (EUA) through the FDA and in agreement with the level of complexity assigned by Wadsworth Lab. CHHA specimen collection for homebound patients who do not receive nursing services is eligible for reimbursement on or after 11/01/2020. Please see the chart below for details. READ MORE
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1/13/2021 | Noridian |
UPDATE - COVID-19 Mass Immunizer A/B Roster Billing Webinar. READ MORE 12/23/2021 - COVID-19 Mass Immunizer A/B Roster Billing Webinar. READ MORE This event includes: To sign up for this webinar, visit the Noridian Schedule of Events. 12/8/2020 - Your Source for All Noridian COVID-19 Information. Are you feeling overwhelmed with the amount of information you are receiving on COVID-19? We hope to help by providing all COVID-19 related information for Part A, Part B, or DME on a single web page for each payer. READ MORE 12/8/2020 - New and Expanded Flexibilities for RHCs & FQHCs during the COVID-19 PHE - Revised. READ MORE To provide as much support as possible to you and your patients during the COVID-19 PHE, both Congress and CMS have made several changes to the RHC and FQHC requirements and payments. These changes are for the duration of the COVID-19 PHE, and CMS will make other discretionary changes as necessary to make sure that your patients have access to the services they need during the pandemic. For more information, please see the RHC/FQHC COVID-19 FAQs at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. MLN Matters Number: SE20016 Revised
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3/26/2020 | North Carolina Medicaid | NC Medicaid and Health Choice providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020, NCTracks has reset your re-verification due date to Sept. 13, 2020. Prior- authorization is not required for COVID-19 testing. Humana Military will follow the Centers for Medicare & Medicaid Services (CMS) coding U0001 and U0002 HCPCS codes for billing. READ MORE | ||||||||||||||||||||||
1/13/2021 | Novitas Solutions - JH & JL |
UPDATE - COVID-19 Information 1/13/2021. 2021 COVID-19 monoclonal antibodies reimbursement. READ MORE 2021 COVID-19 vaccine reimbursement. The geographically adjusted payment allowances for the COVID-19 vaccine administration fees have been updated due to changes made by the Consolidated Appropriations Act, 2021. 1/6/2021 - Immunizations: COVID-19 roster billing collaborative webinar. READ MORE 12/28/2020 - Novitas Provider Enrollment Hotline for Temporary Enrollments. These are all of the supplier types who do not need to separately enroll to bill for COVID-19 vaccine administrations: Institutional: Hospital; Hospital outpatient department; Skilled nursing facility (includes Parts A and B); Critical access hospital; End-stage renal disease facility; Home health agency; Hospice; Comprehensive outpatient rehabilitation facility; Federally qualified health center; Rural health clinic; and Indian health services facility. Non-Institutional: Physician; Non-physician; Clinic/group practice; Pharmacy (enrolled as Part B); and Mass immunizer (roster bill only). If you are not on the above list, you can temporarily enroll to bill for COVID-19 vaccine administrations via the hotline. If you’re calling to initiate temporary billing privileges, you will receive the approval or rejection decision during the call, followed by a decision letter. Please ensure you have all necessary information available at the time of the call: For a list of eligible provider types, please see the CMS Enrollment for administering COVID-19 vaccine shots webpage. 12/21/2020 - Provider specialty: COVID-19 vaccine and monoclonal antibodies. This is a central location for all COVID-19 vaccine billing and monoclonal antibody infusion information, including links to related CMS resources and references. READ MORE Categories include - Billing/Coding, Mass Immunizers/Roster Billers, Reimbursement, Enrollment, Incentives/Quality Reporting, and Resources. These services include information on the COVID-19 vaccine, monoclonal antibodies, and their administration. General information regarding the Medicare program overall can be found using the topics down your left navigation bar. Please subscribe to our mailing lists to stay current with Medicare. 12/21/2020 UPDATE - COVID-19 vaccine and monoclonal antibody billing for Part B providers. This article will assist Medicare Part B providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. READ MORE How to bill for COVID-19 vaccines and monoclonal antibodies To bill single claims for COVID-19 vaccines and monoclonal antibodies, follow the instructions below. For roster billing and centralized billing reference the Medicare billing for COVID-19 vaccine shot administration page. When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free. If the patient is enrolled in a Medicare Advantage plan, submit your COVID-19 claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021. *Providers should not bill for the product if they received it for free* 10/13/2020 - UPDATE - Provider News on CMS' Amended Repayment Process for the Accelerated & Advance Repayments. READ MORE ** Other Notable Facts
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5/28/2020 | Ohio Bureau of Workers' Compensation |
Ohio Governor Mike DeWine announced the Ohio Bureau of Workers' Compensation (BWC) is deferring the due date for employers to pay their June, July, and August premium installments until Sept.1. READ MORE |
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12/7/2020 | Ohio Department of Health |
UPDATE - ANTIGEN TESTING UPDATE. Governor DeWine discussed the Ohio Department of Health aligning with the Center of Disease Control and Prevention’s (CDC) current case definition. READ MORE On December 8, the department will begin including antigen tests without an epidemiological link in the total case count. This will result in a one-day spike in reported cases from pending positive antigen cases. “After understanding more about the antigen testing, the CDC changed their definition. Our epidemiologists have alerted us that they are no longer able to keep up with the manual verification process of antigen testing because there is so much COVID-19 spread in Ohio,” said Governor DeWine. “Antigen tests have become a bigger part of our overall picture of understanding COVID-19, and it’s important to capture that information.” |
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11/4/2020 | Ohio Hospital Association |
UPDATE - Governor Mike DeWine signed Executive Order 2020-38D, which authorizes the Ohio Department of Medicaid to temporarily and substantially increase hospital-specific cost coverage add-ons, or CCAs. READ MORE ODM filed an Emergency Rule to implement this rate increase for services provided on or after November 1st, and on or before December 31st. Hold on Submitting Claims - Due to the quick nature of this executive order and emergency rule, the Medicaid managed care organizations will not be ready to implement these rate changes by Nov. 1. Therefore, we recommend holding claims for at least seven to 10 days to allow the MCOs time to update their systems with the new rates. We anticipate Medicaid fee-for-service to be ready to process claims with the new rates on Nov. 1. |
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9/24/2020 | Ohio Medicaid |
UPDATE - COVID-19 News Update: Governor DeWine announced that Ohio's Responsible Restart guidelines for higher education will now include a recommendation that all residential colleges and universities regularly test a sample population of asymptomatic students. READ MORE "Some schools are already doing this, and screening asymptomatic students really gives school leaders a good idea about virus spread on their campuses," said Governor DeWine. "Our expectation is that colleges and universities will screen at least 3 percent of their at-risk population on a regular basis." |
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8/6/2020 | Oscar |
NEW - COVID-19 Updates. Here are some of the steps we have taken to help providers and members. READ MORE - We are waiving the cost of diagnostic COVID-19 tests, related respiratory labs, and any visits associated with that test for both in-network and out-of-network facilities. Diagnostic testing included PCR and antigen tests used to inform patient treatment for COVID-19 or related complications, including serology testing for multi systemic inflammatory syndrome in children. Most non-diagnostic tests, including serology testing, testing for return to work, and public health surveillance testing, are not covered. - We are waiving the cost of treatment related to COVID-19 delivered by in-network providers through at least September 30, 2020 for those testing positive. Prior authorization is required for all out-of-network care, including COVID-19 treatment, except for emergency care and COVID-19 testing (see above). - We have expanded our telemedicine coverage policies in many states, including waiving the cost of any medically necessary care (related and unrelated to COVID-19, depending on the state) COVID-19 care delivered through telemedicine for our providers. - We are supporting members with resources such as a risk assessment survey, testing site locator and answers to their most common questions at hioscar.com/covid19. |
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3/30/2020 | Palmetto GBA |
UPDATE - Retroactive to March 1, 2020, for those impacted by COVID-19, Medicare Fee-For-Service operations will implement the following policies and procedures for all claims, not just for the COVID-19 diagnoses: Additional Documentation Requests that have already been issued, Medicare contractors will release the claims for payment and not issue claim denials. Any claims auto-denied for non-response of an ADR from March 1, 2020, until March 26, 2020, will have the denial reversed and allow payment if an appeal has not been filed. If an appeal has been filed, normal appeals processes will be followed. As of March 26, 2020, future ADRs will not be sent until further notice from CMS. READ MORE 3/18/2020 - At this time, there will be regular processing of claims and issuing of payments and same level of support and service. READ MORE |
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9/10/2020 | Palmetto GBA, CGS |
UPDATE - Claim Payment Issues Log. Resolved - Telehealth Procedure Codes and Skilled Nursing Facility Consolidated Billing edits. Issue - During the COVID-19 Public Health Emergency CPT codes 99441, 99442 and 99443, are not excluded from File 1 (Part A Stay – Physician Services) on the Skilled Nursing Facility Consolidated Billing (SNF CB) Part B file. As these three codes have now been added to the list of covered codes under the telehealth waiver during the COVID-19 PHE, they would also qualify for SNF CB exclusion and, thus, would be separately billable under Part B when furnished to a SNF’s Part A resident. Status 7/29/20 - Part B Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443, with dates of service on or after March 1, 2020, until notified that changes made for the PHE are to be discontinued. If you have already received payment from the SNF for these services, that payment should be returned to the SNF once your claims have been reprocessed. Status 9/10/20 - Resolved: Adjustments have been completed. READ MORE 3/20/2020 Temporary Provisional Medicare Billing Privileges - Allows physicians and non-physician practitioners to initiate temporary provisional Medicare billing privileges via telephone and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver. READ MORE |
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12/23/2020 | Palmetto GBA - JJ A/B, JM A/B |
UPDATE - CMS COVID-19 Vaccine Toolkits. READ MORE This toolkit includes information on: ^^ Enrollment for Administering COVID-19 Vaccine Shots CMS makes periodic updates to these toolkits as new information becomes available. Refer to them often to answer your questions, reducing the need to contact the Provider Contact Center. Claims Payment Issues Log posted 12/16/20. READ MORE —Issue: COVID-19 Tests: HCPCS U0003 and U0004 Some claims submitted with HCPCS codes U0003 and U0004 are denying incorrectly for required diagnosis coverage when submitted with dates of service on or after October 1, 2020. Provider Action: No provider action is necessary. Once system editing has been updated this claim payment issue will be updated and Palmetto GBA will proceed with adjusting affected claims. —Identified Issue: 11/10/20 12/23/2020 - Jurisdiction JM Part B Medicare Enrollment for Administering COVID-19 Vaccine Shots and/or Monoclonal Antibody Infusion Therapy Webinar. READ MORE 12/16/2020 - UPDATE - COVID-19 Laboratory Test Pricing. READ MORE The following list includes Medicare payment amounts for COVID-19 tests. This list includes national pricing established by CMS and Jurisdiction J and M Palmetto GBA contractor-priced codes. New codes with allowances in red. HCPCS Code Allowance 12/16/2020 - UPDATE - Palmetto Claims Payment Issues Log. COVID-19 Antibody Testing. READ MORE Update 12/16/2020 - System editing has been updated. Issue - Some claims submitted with CPT code 86769 are denying incorrectly for required diagnosis coverage when submitted with dates of service on or after April 10, 2020. Issue Identified - 11/24/2020. Current Status - Open on 11/25/2020. Provider Action - no provider action is necessary. Once system editing has been updated this claim payment issue will be updated and Palmetto GBA will adjust affected claims. UPDATE 12/16/2020 Claims Payment Issues Log posted 12/16/20. READ MORE Issue: COVID-19 Tests: HCPCS U0003 and U0004. Issue Updated 12/16/20 - System edition has been updated. Issue Updated 11/17/20 - The dates of service affected by this issue have been updated to include dates of service on or after July 1, 2020. Some claims submitted with HCPCS codes U0003 and U0004 are denying incorrectly for required diagnosis coverage when submitted with dates of service on or after October 1, 2020. Provider Action: No provider action is necessary. Once system editing has been updated this claim payment issue will be updated and Palmetto GBA will proceed with adjusting affected claims. Identified Issue: 11/10/20 Issue Status: Open. 12/15/2020 - UPDATE - CMS COVID-19 Vaccine Toolkits. Have questions about COVID-19 vaccines? Check out the CMS COVID-19 Vaccine Toolkits external link . CMS has developed these toolkits to provide you with up-to-date information about COVID-19 vaccines. READ MORE This toolkit includes information on: CMS makes periodic updates to these toolkits as new information becomes available. Refer to them often to answer your questions, reducing the need to contact the Provider Contact Center. |
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6/10/2020 | Regence BCBS Utah |
UPDATE - To support people and communities facing unprecedented challenges, Regence health plans announced an extension of coverage for coronavirus (COVID-19) treatment without any out-of-pocket costs for fully insured members through December 31, 2020. This extends the previously announced coverage period through June 30, 2020. READ MORE 3/24/2020 - Claims can be submitted with CPT 87635 for DOS on and after 3/1/2020. READ MORE |
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12/30/2020 | Select Health SC/First Choice |
UPDATE - COVID-19 Testing. First Choice will cover all medically necessary services required to facilitate testing and treatment of COVID-19 for its eligible members, in accordance with federal and state guidance. No prior authorization is required for COVID-19 testing. READ MORE Coronavirus testing codes follow:
12/30/2020 - Public Health Emergency (PHE) Extended. As an important reminder, on Friday, October 2, 2020, U.S. Department of Health and Human Services Secretary Alex Azar renewed his declaration of a PHE due to the coronavirus pandemic. The renewal is effective October 23, when the previous 90-day renewal would have expired, and extends the PHE through January 20, 2021. READ MORE 6/15/2020 - In accordance with guidance issued by South Carolina Department of Health and Human Services (SCDHHS), in the Medicaid bulletin dated April 16, 2020 Select Health will reimburse for well-child visits delivered via telehealth and/or telemedicine during the COVID-19 pandemic. READ MORE 3/30/2020 - No prior authorization is required for COVID-19 testing. Testing codes to use are U0001 and U0002. First Choice recommends that providers follow CDC, CMS, and State-specific guidelines with regard to COVID-19 evaluation, testing, diagnosis, treatment, and reporting. READ MORE 3/19/2020 - Effective for dates of service on and after 3/15/20 SCDHHS is expanding coverage for Telephonic and Telehealth services. SCDHHS will begin accepting claims for these services beginning 4/1/20. Codes to use for these services can be found on the website. READ MORE |
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12/31/2020 | South Carolina Medicaid |
UPDATE - Coronavirus Disease 2019 (COVID-19) Testing. In response to circumstances surrounding COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing additional testing resources available to healthcare personnel within South Carolina Healthy Connections Medicaid-enrolled nursing facilities beginning Jan. 1, 2021. READ MORE 12/23/2020 - COVID-19 Vaccination Administration Coverage. The South Carolina Department of Health and Human Services (SCDHHS) will reimburse for COVID-19 vaccine administration, without patient cost-sharing, when provided to Healthy Connections Medicaid members in a manner consistent with recommendations of the Advisory Committee on Immunization Practices (ACIP). READ MORE The initial phase of vaccine distribution is outside of the Vaccines for Children (VFC) program, so providers do not need to be enrolled in the VFC program to administer a COVID-19 vaccine to children enrolled in Healthy Connections Medicaid. Since providers will not incur a cost for the vaccine itself, providers will only be reimbursed for the administration of the vaccine. The following guidelines apply to both FFS members and those enrolled in an MCO. Providers who generally submit claims using the CMS-1500 or 837P claim type will submit claims for COVID-19 vaccine administration using the appropriate current procedural terminology (CPT) code. SCDHHS will adopt the billing codes, reimbursement rates and effective dates published by the Centers for Medicare and Medicaid Services (CMS) for Medicare Part B coverage, which are available on CMS’ website 10/27/2020 - Provider Alert. U.S. Department of Health and Human Services Announces Expanded Pool of Providers Eligible for Additional Provider Relief Funds. READ MORE Providers who render services in the following areas are eligible to apply for provider relief funding regardless of whether they accept Medicaid or Medicare: Behavioral Health Providers; Allopathic & Osteopathic Physicians; Dental Providers; Assisted Living Facilities; Chiropractors; Nursing Service and Related Providers; Hospice Providers; Respiratory, Developmental, Rehabilitative and Restorative Service Providers; Emergency Medical Service Providers; Hospital Units; Residential Treatment Facilities; Laboratories; Ambulatory Health Care Facilities; Eye and Vision Services Providers; Physician Assistants & Advanced Practice Nursing Providers; Nursing & Custodial Care Facilities; Podiatric Medicine & Surgery Service Providers. Phase 3 applicants, including the expanded pool of providers listed above, must submit their application before 11:59 p.m. on Nov. 6, 2020, to be considered for payment. All recipients of provider relief payments will be required to attest to receiving the Phase 3 General Distribution payment and accept HHS’ associated terms and conditions.
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4/28/2020 | SummaCare |
UPDATE - Coverage of telehealth services extended through July 26, 2020. Also allowing early refills of prescriptions through July 26, 2020. SummaCare is temporarily suspending a 2% sequestration reduction in claims reimbursements to providers in fee-for-service arrangements in Medicare Advantage plans. The suspension aligns with the CARES Act legislation requiring all health plans to suspend the -2% sequestration payment adjustment in claims with dates of service from May 1, 2020 through December 31, 2020. READ MORE 3/26/2020 - Waiving any co-pays and deductibles related to provider-ordered testing of COVID-19 for our Medicare Advantage, Individual and Commercial members regardless of where the test is ordered and performed. Self-insured plans will determine how their coverage will apply. Will pay 100% Medicare rates for COVID-19 testing regardless of provider affiliation. Will accept CPT code 87635 (effective 03/13/2020) or HCPCS Level II U0002 (effective 2-4-20) for the COVID-19 testing. There are no special modifiers at this time. |
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12/30/2020 | Texas Medicaid |
UPDATE - New ICD-10 COVID-19 Diagnosis Code Updates Effective January 1, 2021. The updates to the ICD diagnosis codes will be included in the All Patient Refined-Diagnosis Related Groups (APR-DRG) software Version 38.1 update, scheduled to be released on December 29, 2020. 12/23/2020 - COVID-19 Vaccine Information. READ MORE Reimbursement Rate Updates for Procedure Codes 87636, 87637 and 87811 Effective 10/6/2020. READ MORE Reimbursement Rate Updates for Procedure Codes 0011A and 0012A Effective 12/18/2020. READ MORE Reimbursement Rate Updates for Procedure Codes 86328, 86769 and 87426 Effective 1/1/2021. READ MORE Reimbursement Rate Updates for Procedure Codes 86328, 86769, and 87426 Effective January 1, 2020. READ MORE Reimbursement Rate Updates for Procedure Code 86413 Effective September 8, 2020. READ MORE 12/16/2020 - Reimbursement Rate Updates for Procedure Codes 0001A and 0002A Effective December 11, 2020. READ MORE 12/16/2020 - Reimbursement Rate Updates for Procedure Codes 0001A and 0002A Effective December 11, 2020. READ MORE 12/15/2020 - COVID-19 Update to Telehealth Guidance on CLASS Professional and Specialized Therapies - December 14. READ MORE 12/15/2020 - Multiple Medicaid COVID-19 Flexibilities Extended Through January 21, 2021, or Through January 31, 2021. READ MORE 12/14/2020 - COVID-19 Emergency Rules for ICF Providers Extended. READ MORE 12/14/2020 - COVID-19 Vaccine Administration Procedure Codes 0001A and 0002A Are Now Benefits. READ MORE 12/8/2020 - Emergency Rules for NF Providers Extended. READ MORE CSHCN COVID-19 Telehealth and Telemedicine Extensions through December 31, 2020. Client Signature Requirement Waived on CSHCN Documentation of Receipt Form through December 31, 2020. To help ensure continuity of care during the COVID-19 (coronavirus) response, the requirement to obtain the client or guardian signature on the Children with Special Health Care Needs (CSHCN) Services Program Documentation of Receipt Form is waived through December 31, 2020. For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413. Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services Extended Through December 31, 2020. Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. This is an update to the article titled “More Updates to ‘Further Updates to Date-of-Service Extension for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services,’” which was posted on this website on July 31, 2020. Healthy Texas Women and Family Planning Program COVID-19 related flexibilities have been extended through December 31, 2020. 12/4/2020 - Claims for Telemedicine and Telehealth Services for HTW Plus. READ MORE The HTW Plus telemedicine and telehealth services will be effective for dates of service from September 1, 2020, through December 31, 2020. Telemedicine and telehealth flexibilities only apply to a specific procedure codes - check the chart on the web site. To indicate use of the telemedicine or telehealth modality and that remote delivery occurred, providers should use the 95 modifier when submitting claims. The telemedicine or telehealth services must also meet applicable state statutory and rule scope-of-practice requirements. 12/3/2020 - 90-Day Prior Authorization Extensions to End December 31, 2020. Note: Providers currently have an option to request prior authorization time periods other than the 90-day extension. 12/1/2020 - HHSC Has Updated Reporting Guidance for Long-Term Care Providers – Point-of-Care Antigen Testing (PL 20-46). READ MORE
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11/10/2020 | Tricare East |
UPDATE - Tricare Provider News Issue 4 2020. COVID-19 News: Serology testing - Telemedicine policy updates - As telemedicine continues to play an important role in healthcare, TRICARE has updated its policy on the coverage and expansion of services, costs and other benefits. May 19, 2020 updated temporary benefits include: • Audio-only healthcare visits are now covered TRICARE will now waive cost-shares, copayments and deductible (if applicable) for covered telemedicine services from a military provider or TRICARE network provider. This waiver applies to all covered in-network telemedicine services, not just the services related to COVID-19. For more information and entire list of all updates, visit COVID-19 Telemedicine coverage.
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12/22/2020 | Tricare West |
UPDATE - DME Reimbursement per the CARES Act - Update. READ MORE 12/18/2020 - COVID-19 Clinical Trials. READ MORE Locating Clinical Trials - to be eligible for this Tricare benefit, clinical trials must be NIAID-sponsored. Covered Services: * * * Phase I, Phase II, Phase III and Phase IV COVID-19 clinical trials sponsored by NIAID for the prevention, screening, early detection, and treatment of COVID-19 and its associated aftereffects (e.g., cardiac and pulmonary complications). * * * Medical care and testing required to determine clinical trial eligibility and as a result of participation. Covered services include: inpatient care, outpatient care; diagnostic and laboratory services; and rehabilitation and home health services. 12/18/2020 - TRICARE coverage of COVID-19 clinical trials. READ MORE 11/24/2020 - Recent COVID-19 and TRICARE policy updates: investigational drugs, long-term care reimbursement, skilled nursing facility stays. READ MORE 11/19/2020 - Tricare West Provider Resources for COVID-19 updated on 11/19/2020. Find up to date information regarding benefits, provider education and online resources.
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1/5/2021 | UnitedHealthcare |
UPDATE - Select Prior Authorization Suspensions in Effect Nationally Dec. 18, 2020 – Jan. 8, 2021. READ MORE After Jan. 8, 2021, we may retrospectively review select services rendered during this time period. Admission notification is still required during this time, in alignment with the current protocol to support you in arranging post-admission care or other support services, if needed. In most cases, notification of inpatient admission is provided to UnitedHealthcare by the hospital or facility through Link or an EDI 278N transmission that requires no intervention on the part of your staff. 12/30/2020 - COVID-19 Information Updates. Suspended prior authorization period. COVID-19 - Extensions of Temporary Cost Share Waivers. READ MORE Medicare Advantage: Cost sharing (copay, coinsurance and deductible) will be waived for in-network and out-of-network COVID-19 treatment, including inpatient and outpatient treatment, from Feb. 4, 2020 through Jan. 31, 2021. The cost share waivers were previously set to expire on Dec. 31, 2020. COVID-19 Reminder on New Telehealth Policies. READ MORE Medicare Advantage: We will continue to follow current CMS guidelines in allowing the current CMS Telehealth List, including the expanded CMS code list for telehealth services and billing requirements. 12/17/2020 - COVID-19 Vaccine Guidance. Medicare Advantage health plans: Charges for COVID-19 vaccine administration for all Medicare beneficiaries should be billed to the Center for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). READ MORE 12/4/2020 - COVID-19 Monoclonal Antibody Study. READ MORE |
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9/28/2020 | UMR | COVID-19 Vaccine Update: You will have $0 cost-share - - Once FDA-authorized COVID-19 vaccines are publicly available, and during the public health emergency, you will be able to get it at $0 cost-share, no matter where you get the vaccine (in- and out-of-network providers), including when two doses are required. After the public health emergency ends, the vaccine will be covered under the plan just like other preventive vaccines. READ MORE | ||||||||||||||||||||||
9/28/2020 | Washington Medicaid |
UPDATE - Physical Health Providers/COVID-19 Resources - Apple Health Medicaid Clinical Policy and Billing Facts for COVID-19 (updated 9/23/20) READ MORE The Health Care Authority revised the Facts sheet and the following changes were made:
4/22/2020 - Retroactive to dates of service on and after February 29, 2020, ground and air ambulance providers are eligible to receive enhanced rates for transports related to COVID-19. Possible rate enhancements are available when transporting a suspected or confirmed case of COVID-19 or when performing interfacility transfers to clear beds for COVID-19 capacity. Providers must include modifier CR For COVID-19 related transports that have already been billed to HCA prior to this notice and did not include the CR modifier, providers may rebill to receive the enhanced rate. READ MORE 3/31/2020 - This page offers billing guidance for Providers COVID-19 related telemedicine, prior authorization requirements, and provider enrollment FAQs. READ MORE |
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8/1/2020 | WellCare |
UPDATE - We intend to cover COVID-19 testing and screening services for Medicare members and are waiving all associated member cost share amounts for COVID-19 testing and screening. READ MORE |
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3/19/2020 | Wellmark | Wellmark will be waiving copays, coinsurance and deductibles for virtual visits with dates of service from March 16 to June 16, 2020. Wellmark will pay the allowed amount for telehealth services in full. Services that are not a covered benefit, not medically necessary, experimental or investigational are excluded from the member’s copay or other cost-shares that are being waived. This is only applicable to in-network providers. More information on testing and which codes to use for testing to come. READ MORE | ||||||||||||||||||||||
3/23/2020 | Wisconsin Physicians Service (WPS) |
UPDATE - Due to COVID-19 impacts, WPS reports they are suspending Provider Enrollment revalidations at this time. They will not deactivate billing privileges and will notify Providers who were set to revalidate when they can do so. READ MORE |
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11/12/2020 | WPS Government Health Administrators - J5 A/B, J8 A/B |
UPDATE - MCS Claims Processing Alerts. READ MORE Description/Claims Coding Impact - Codes 99441, 99442 and 99443, for dates of service 03/01/2020 and after, were added to the list of telehealth codes coverable under the waiver during the COVID-19 PHE. These codes should bypass the Skilled Nursing Facility (SNF) Consolidated Billing (CB) edits. Proposed Resolution/Fix/Action Required - The system was updated on 11/02/2020 to bypass the SNFCB edits for the codes 99441, 99442 and 99442 for dates of service 03/01/2020 and after. Adjustments have been initiated on the affected claims. No provider action is needed. Status - Open
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