COVID-19 Payer Information

COVID-19 Public Health Emergency Extended by Federal Government. READ MORE

Medical Clinical Policy Bulletins - Policy 0982 revised 1/26/22 "Remdesivir (Veklury)." READ MORE

Are there any out of pocket costs for Aetna members that receive a COVID-19 vaccine? READ MORE 

Are there any out of pocket costs for Aetna members who go to an in or out of network pharmacy or provider for their vaccine? READ MORE 

Which COVID-19 vaccinations will Aetna cover? READ MORE 

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UPDATE - The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT^®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes new product and administration codes assigned to the Pfizer-BioNTech COVID-19 vaccine for children 6 months to under 5 years of age. READ MORE

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UPDATE - COVID-19 information (February 2022 update). READ MORE 

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UPDATE - Reimbursement of COVID-19 Vaccine Counseling for All Ages. READ MORE 
Effective March 15, 2022, for both Medicaid and CoverKids members of all ages, TennCare’s MCOs will reimburse providers for COVID-19 vaccine counseling whether the vaccine counseling occurs in conjunction with a preventive health visit(e.g. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) or annual adult physical examination), in conjunction with an office visit when another service was provided (e.g. office visit to address diagnosed illness(es), new issues, and/or refills), or when COVID-19 vaccine counseling is the sole reason for the office visit.

3/16/2022 -Timeline for the Expiration of the Remaining COVID-19 Hospital Administrative Flexibilities. READ MORE 

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UPDATE  - An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health with a date of service on or after Oct. 18, 2021.

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UPDATE - Response to COVID-19 state of emergency (January 2022) Amerigroup Community Care appreciates your dedication and commitment to our members and all Maryland residents.  READ MORE 

UPDATE - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 

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UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and fully insured commercial members discharging from hospitals in the state of Oregon through Oct. 24, 2021. Please provide notification of admission within 24 hours to allow us to track our members’ progress and provide assistance with discharge planning. You will receive an approval when you submit the notification. This suspension applies to participating/in-network providers only.

UPDATE - Medicaid CoverKids member FAQ: How to identify and how to bill vaccines. READ MORE 

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UPDATE - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 
Beginning January 1, 2022, Medicare Advantage Organizations (MAOs) and Medicare-Medicaid Plans (MMPs) are responsible for adjudicating claims for COVID-19 vaccines and their administration and for COVID-19 monoclonal antibodies and their administration.

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UPDATE - Payment for COVID-19 testing services and vaccine administration on or after January 1, 2022. READ MORE 
Please be advised that, while awaiting further guidance from the DMHC regarding SB510, Anthem Blue Cross (Anthem) will process Commercial claims for COVID-19 testing or vaccine administration incurred on or after January 1, 2022, regardless of risk type. Once we receive additional DMHC guidance, and update the payment systems, the claims payments will be reconciled if necessary.

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UPDATE - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 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 and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

4/1/2022 - COVID-19 Vaccine - Adverse Reactions. READ MORE 
Anthem Blue Cross and Blue Shield (Anthem) is aware that some of our members may have experienced an adverse physical reaction to the COVID-19 vaccine. Beginning October 29, 2021, Anthem expanded coverage for those members under-going treatment related to this diagnosis. If you submit a claim for services related to an adverse physical reaction to the COVID-19 vaccine, it is important that you use a CS modifier to identify these services so that Anthem can correctly process the claim.

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UPDATE - COVID-19 Update 4/25/22. We recently updated information about codes for telehealth and telemedicine care. READ MORE 

4/8/2022 - Rebounding from the Pandemic. Information about our efforts to assist and support our providers along with claims resources available. READ MORE 

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UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing: professional (MAC - Material adverse change).
READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 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 and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, until further notice, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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. Self-insured plan sponsors may opt out of this program.

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UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing-Professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing-Professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing: professional (MAC - Material adverse change).
READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing - professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, unless a longer period is required by law, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 

>>>Click here to read past updates

UPDATE - COVID-19 Update 4/20/22. We recently updated information about codes for telehealth and telemedicine care. READ MORE 
What codes would be appropriate to consider for telehealth, telemedicine or a telephonic visit? Based on standard coding guidelines from the AMA and HCPCS, office visit (99201-99215) telehealth claims will require Place of Service (POS) code “02” or “10” and either modifier “95” or “GT”. For Medicare Advantage telehealth claims, please follow original Medicare coding guidance.

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UPDATE - COVID-19 News 5/1/22. Evaluation and management services for COVID testing-Professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 
Effective from March 19, 2020, through July 15, 2022, 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 covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans. 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.

>>>Click here to read past updates

UPDATE - The U.S. Food and Drug Administration (FDA) on May 5, 2022, limited the authorized use of the Janssen COVID-19 vaccine to the following individuals: Those who are 18 or older and for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate; or, Those 18 or older who elect to receive the Janssen COVID-19 vaccine because they would otherwise not receive a COVID-19 vaccine.
READ MORE

3/23/2022 - LTACH and SNF Streamlined Admission Process for COVID Patients Ending March 31, 2022. READ MORE 
Effective April 1, 2022, we are resuming our standard admission process for long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) for all BCBS Alabama members. We are not extending the streamlined admission process for LTACHs and SNFs for Blue Cross members with a specified COVID-19 diagnosis beyond March 31, 2022.

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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

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UPDATE - COVID-19 Update. Here is a rundown of the anticipated status of those COVID-19-related benefits and measures as of October 1, 2021. READ MORE

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UPDATE - Attached link provides how to complete a claims form to be reimbursed for COVID over the counter tests. READ MORE 

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Blue Cross Blue Shield
Florida

UPDATE - COVID-19 Provider Billing Guidelines as of May 2022. READ MORE 

3/29/2022 - The Federal Public Health Emergency has been extended through April 16, 2022. READ MORE

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UPDATE - Effective immediately, Blue Cross and Blue Shield of Illinois (BCBSIL) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until Feb. 28, 2022. READ MORE

UPDATE - Updates regarding COVID-19 Vaccines and Coverage. 
READ MORE 

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UPDATE - U0005 - Reimbursable for dates of service on or after January 1, 2021 when billed with U0003 or U0004. READ MORE 

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UPDATE - BCBS of Michigan will waive all copays, deductibles, and coinsurance for the administration of COVID-19 vaccines to commercial members. READ MORE

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UPDATE - COVID-19 extensions are being extended through September 30, 2022. READ MORE 
Please be advised of the following: Temporarily suspending the requirement for a NE license if they are in good standing and free from disciplinary action in the state(s) where they are licensed. This includes those who are properly and lawfully licensed to perform the 19 listed job types, Providers with inactive or expired licenses formerly licensed in the state of NE who want to renew a credential after its expiration date or go from an inactive to active status will not be subject to continuing competency requirements, and Temporarily suspend requirements for issuing licenses for physicians, nurses, and pharmacy related professions to be processed electronically prior to receipt of license fee, pending test scores, pending national criminal history (pending provider licenses).

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UPDATE - Blue Cross has updated the standard non-RVU fee schedule for COVID-19 testing as follows in accordance with the member’s benefit plan for all lines of business. READ MORE 

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UPDATE - Clarification for COVID-19 Vaccine and Monoclonal Antibody Treatment Reimbursement for Commercial and Medicare Advantage Lines of Business. READ MORE 

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UPDATE - In April of 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a policy to ensure that out-of-network providers would not balance bill members for COVID-19 related services. READ MORE 
The policy stated if the provider was seeing a patient in a narrow network that they were not participating with, but the provider had a PPO contract with us, they would be paid at their PPO rate for the services rendered. Due to the passing of the No Surprises Act, COVID-19 related claims that are classified as Surprise Billing or Emergency claims will be paid at the QPA rate, not the PPO rate. 

3/10/2022 - BCBS NC is extending its expanded reimbursement telehealth policy. It will remain in place through September 30, 2022. READ MORE 
The telehealth policy was originally expanded effective March 2020 and covers doctor visits by video or phone the same as face-to-face visits. The policy applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including the State Health Plan. Members of the Federal Employee Program have telehealth covered at parity with in-person visits until further notice. The extended policy does not apply to Blue Cross NC members getting care from out-of-state providers. Providers may continue to use the virtual platform of their choosing for telehealth services.

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UPDATE - Not Covered: Testing for surveillance reasons is not eligible for coverage. READ MORE 

Including:
• Return to Work
• School requirements
• Travel requirements
• Recreational requirements

If testing a member for surveillance reasons, unless they have symptoms or have a known or suspected exposure to COVID-19, claims for such testing are not eligible for reimbursement and should not be submitted.

 >>>Click here to read past updates

UPDATE - COVID-19 Vaccine Informational Code Q0221 Benefit for Medicaid. READ MORE 

What is new: For dates of service on or after February 24 2022, the Centers for Medicare and Medicaid Services (CMS) added procedure code Q0221 as an informational code for the AstraZeneca’s Evusheld COVID-19 vaccine as benefits of Medicaid for adults and pediatric individuals (12 years of age and older with weight at least 40 kg). Vaccine procedure code Q0221 is informational only, while the vaccine is distributed to the provider free of charge.

Reimbursement:  We won't reimburse for AstraZeneca’s Evusheld COVID-19 vaccine that providers received for free. Providers should not charge members for the vaccine. We will reimburse for the administration of the vaccine. Other medically necessary treatments for COVID-19 will be covered consistent with the terms of the member's benefit plan. You can also reference the CMS Medicaid toolkit for more details.

5/6/2022 - COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid. READ MORE 

COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE 

4/13/2022 - COVID-19: New ICD-10 Diagnosis Codes Updates for Texas Medicaid Effective 04/01/2022. READ MORE

4/1/2022 - COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

COVID-19: Rural Health Clinics (RHC) and Telehealth/Telemedicine – Texas Medicaid. READ MORE

COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid. READ MORE

COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE 

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UPDATE - IPA/Medical Groups Financially Responsible for COVID-19 Testing Costs for HMO Commercial Plan Members, Effective 8/1/2021. READ MORE

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UPDATE - CareFirst Provider Newsletter April 2022: CMS Adds Place of Service 10. READ MORE 

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UPDATE - Ohio Medicaid & MyCare Providers. Effective 6/1/22 - Post-Acute Care Prior Authorization Resumption. READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/22. Effective 4/1/22 - COVID-19: Vaccination Program with Booster. READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/2022. COVID-19: Temporary Payment Policy for Immunizations Update. READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/22. COVID-19: Vaccination Pediatric Counseling Visit Coding Guidance. READ MORE 

4/25/2022 - COVID-19 Update 4/25/22 for Ohio Marketplace Providers, RE: COVID-19 OTC At-Home Testing Billing Guidance. READ MORE 

 >>>Click here to read past updates

Centene's Medicaid, Medicare Advantage, and Marketplace members can access COVID-19 vaccines at no cost as they become available to them in accordance with state and federal (CMS) requirements and timelines. 
READ MORE 

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UPDATE - New ICD-10 Code for Post-COVID Conditions, following the 2019 Novel Coronavirus (COVID_19). Effective 10/1/2021. READ MORE 
As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) has implemented an additional code into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting:

•  Post COVID-19 condition, unspecified (U09.9)
  This new code became effective October 1, 2021 to identify conditions following acute COVID-19. The code should be used for patients with a history of probable or confirmed SARS CoV-2 infection who are identified with a post-COVID condition. In addition, assign code(s) for specific conditions and/or symptoms identified. Full addenda information regarding this new code, along with other codes and code titles is available.

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5/6/2022

UPDATE - CGS Medicare Claims Processing Log. Issue - Some COVID codes were set up incorrectly. Claims were denied in error for referring physician, or the physician was not eligible to bill the service. Also, some claims applied deductible and co-insurance incorrectly. READ MORE

• Provider Type Impacted - Physicians, Lab
• Claim Coding Impact - CPT codes 86408, 86409, 86413, 87426, 87811 and 0226U
• MAC Action - The codes were updated
• Provider Action - None Proposed
• Resolution - A mass adjustment will be done for the claims that were processed incorrectly.
• Status - Resolved
• Date Resolved - 5/6/2022
• Date Reported - 5/3/2022

4/6/2022 - COVID-19 News 4/6/22. On April 4, The Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. READ MORE 

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UPDATE - MLN Connects 5/26/22. COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose. READ MORE 
On May 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization (PDF) to authorize the use of a single booster pediatric dose (orange cap) for all patients 5–11 years old. CMS issued a new code, effective May 17, 2022, for the vaccine administration.

5/12/2022 - MLN Connects 5/12/22. Clinical Laboratory Fee Schedule 2023 Preliminary Gapfill Rates: Submit Comments by July 11. READ MORE

5/5/2022 - MLN Connects 5/5/22. COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers. READ MORE 

MLN Matters MM12634 4/14/22 "Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General Updates." READ MORE 

4/14/2022 - MLN Connects 4/14/22. COVID-19: New Codes for Moderna Vaccine Booster Doses. READ MORE 

4/7/2022 - MLN Connects 4/7/22 Special Edition. CMS Returning to Certain Pre-COVID-19 Policies in Long-term Care and Other Facilities. READ MORE 
CMS is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 public health emergency (PHE). These temporary emergency waivers were designed to provide facilities with the flexibilities needed to respond to the COVID-19 pandemic.

4/7/2022 - MLN Connects 4/7/22. Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers. Regulatory changes for mental health visits in RHCs and FQHCs; and billing information for mental health visits done via telecommunications. READ MORE 

4/7/2022 - MLN Matters 4/7/2022 R11343OTN - System Limitation Update for Centralized Flu Billers (CFB), Pneumococcal and Covid-19 Vaccinations. READ MORE 

4/6/2022 - MLN Connects/Special Edition 4/6/22. Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost. READ MORE 
On April 6, CMS announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine, and there is no applicable copayment, coinsurance, or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.

4/4/2022 - MLN Connects/Special Edition 4/4/22. Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests.
READ MORE 
On April 4, the Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to 8 tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.

>>>Click here for past updates, MLN Newsletters, Webinar recordings, etc.

UPDATE - Consistent with the new end of the PHE period, Cigna has extended cost-share waivers for COVID-19 diagnostic testing and related office visits through July 14, 2022. Customer cost-share will be waived for COVID-19 related virtual care services through July 14, 2022. READ MORE 

4/11/2022 - Cigna Policy Updates March 2022. READ MORE 

>>>Click here to read past updates.

Add-on procedure code U0005 will be added to the laboratory fee schedule and priced at $25.00. The add-on code U0005 was created to be billed in combination with procedure codes U0003 or U0004 only when providers meet the specific criteria outlined by CMS. READ MORE

UPDATE - Provider News 4/27/22. Preauthorization Updates Effective August 1, 2022, for All Lines of Business Requiring Preauthorization. We would like to share updates regarding preauthorization under our Utilization Management (UM) Program. READ MORE 

4/18/2022 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. Please check back regularly. READ MORE 

• The Federal Public Health Emergency has been extended to 7/15/2022. This governs COVID-related telehealth services and testing/visits, out-of-network vaccine coverage, and the DRG reimbursement increase.
• The NYS Emergency Regulation on Telehealth, which governed COVID-19 and non-COVID-19-related telehealth services, expired on June 4, 2021. The Health Plan made a business decision to continue waiving member cost-share for in-network telehealth services for fully insured members* through 12/31/2021. For dates of service on or after 1/1/2022, please collect the appropriate member cost share for in-network telehealth services provided to fully insured members.
• The NYS Emergency Regulation on Testing/Visits has been extended to 6/13/2022. This governs the cost-share waiver for testing, diagnosis, and office/emergency room visits, and telehealth when the purpose is to diagnose COVID-19.
• The NY State of Emergency (NYSOE) expired on June 24, 2021. The Health Plan made a business decision to continue waiving member cost-share for COVID-19 treatment for fully insured members* through 12/31/2021. For dates of service on or after 1/1/2022, please collect the appropriate member cost share for COVID-19 treatment provided to our fully insured members.

4/13/2022 - COVID-19 Update 4/13/22. Vaccine Update/Vaccine Counseling Billing Information. READ MORE 

4/1/2022 - Connections Newsletter April 2022. New Telehealth Indicator Available.
READ MORE 
We are pleased to let you know that we have made it easier for our members and potential members to identify physicians who offer telehealth services. This feature is available via our website and is visible currently for Commercial and Medicare Advantage lines of business. 

>>>Click here to read past updates

UPDATE - First Coast Claims Processing Issue for Part A Providers - reported 5/10/2022. Inpatient claims with diagnosis codes Z28.310, Z28.311, or Z28.39 returned incorrectly with reason code 34931. READ MORE 

5/6/2022 - Fee Schedule News 5/6/22. COVID-19: Allowances for Laboratory Test Codes.
READ MORE 

5/2/2022 - First Coast Billing News for Part B Providers - reported 5/2/22. Billing the Taxonomy Code. Are you submitting claims for COVID-19 testing, vaccine or monoclonal antibody (mAb) infusion administration and experiencing issues with your claims processing under the incorrect PTAN? READ MORE 

4/19/2022 - COVID-19 Billing News 4/19/22. COVID-19 vaccine and monoclonal antibody billing for Part B providers. READ MORE 

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UPDATE - FDA Roundup 5/20/22. On May 17, the FDA published the refreshed Know Your Treatment Options for COVID-19 Consumer Update with the latest information on COVID therapies. The FDA has approved two drug treatments for COVID-19 and has authorized others for emergency use during this public health emergency. READ MORE 

5/17/2022 - FDA Roundup 5/17/22. On May 15, the FDA issued an Emergency Use Authorization (EUA) for the Laboratory Corporation of America (Labcorp) Pixel by Labcorp COVID-19+Flu+RSV Test Home Collection Kit for use with the Labcorp Seasonal Respiratory Virus RT-PCR DTC Test. READ MORE 

5/17/2022 - COVID-19 Update 5/17/22. The U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine, authorizing the use of a single booster dose for administration to individuals 5 through 11 years of age at least five months after completion of a primary series with the Pfizer-BioNTech COVID-19 Vaccine. READ MORE 

5/16/2022 - COVID-19 Update 5/16/22. FDA Authorizes First COVID-19 Test Available without a Prescription That Also Detects Flu and RSV.
READ MORE 

5/10/2022 - FDA Roundup 5/10/22.  The FDA approved a new indication for Olumiant (baricitinib) for the treatment of COVID-19 in hospitalized adults requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). READ MORE 

5/6/2022 - FDA Roundup 5/6/22. Through the American Rescue Plan Act of 2021, Congress provided temporary funding for the FDA to develop the capacity to sequence SARS-CoV-2 RNA from wastewater samples and to conduct a sampling and sequencing project through 2022. READ MORE 

4/15/2022 - FDA Roundup 4/15/22. On April 14, the FDA issued an emergency use authorization (EUA) to InspectIR Systems for their InspectIR COVID-19 Breathalyzer test. READ MORE 
The InspectIR COVID-19 Breathalyzer test is the first COVID-19 diagnostic test that detects chemical compounds in breath samples associated with SARS-CoV-2 infection. The authorization for the InspectIR COVID-19 Breathalyzer test is an example of the FDA’s continued commitment to support the development of innovative, appropriately accurate and reliable diagnostic tests that increase testing options for COVID-19.

On April 13, the FDA and the Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response issued a statement that the shelf-life of bamlanivimab and/or etesevimab is being evaluated, and an update regarding shelf-life extension is planned for early May 2022. READ MORE 

4/8/2022 - On April 7, the FDA authorized an extension for the shelf life of the refrigerated Janssen COVID-19 Vaccine, allowing the product to be stored at 2-8 degrees Celsius for 11 months. READ MORE 

4/5/2022 - FDA Roundup 4/5/22. The FDA announced sotrovimab is no longer authorized to treat COVID-19 in any U.S. region due to increases in the proportion of COVID-19 cases caused by the Omicron BA.2 sub-variant. READ MORE 
The Centers for Disease Control and Prevention (CDC) Nowcast data estimates that the proportion of COVID-19 cases caused by the Omicron BA.2 variant is above 50% in all Department of Health and Human Services (HHS) U.S. regions. Data included in the health care provider fact sheet shows the authorized dose of sotrovimab is unlikely to be effective against the BA.2 sub-variant.

4/1/2022 - FDA Roundup 4/1/22. The FDA published the FDA Voices: “Give Your Community a Boost: Combatting Misinformation Through Communication and Research,” by RADM Richardae Araojo, Pharm.D., M.S., Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity. READ MORE 

4/1/2022 - On March 31, the FDA revised its guidance, Emergency Use Authorization for Vaccines to Prevent COVID-19. The revised guidance updates recommendations for the clinical data to support effectiveness of a COVID-19 vaccine that has been modified to target a particular SARS-CoV-2 variant of concern. READ MORE 

4/1/2022 - On March 30, the FDA updated the list of Health and Human Services U.S. regions where sotrovimab is not authorized. This update is based on the Centers for Disease Control and Prevention (CDC) Nowcast data estimates from March 29 that the proportion of COVID-19 cases caused by the Omicron BA.2 variant is above 50% in these three regions.
READ MORE 

>>>Click here to read past updates

UPDATE - Provider Relief Fund Phase 4. READ MORE 

8/18/2021 - COVID-19 Vaccine - Third Dose. READ MORE 
Effective August 12, 2021: The Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine has been approved by the FDA to allow an additional third dose in certain immunocompromised people. The current reimbursement rate for the administration of the vaccine is $40 per dose. The appropriate codes, descriptions, and reimbursement rates are listed in the chart below.

READ MORE

UPDATE - HHS News 5/19/22. Statement from HHS Secretary Xavier Becerra on FDA and CDC Expanding Eligibility for Pfizer-BioNTech COVID-19 Vaccine Boosters for Ages 5-11. READ MORE 

5/12/2022 - HHS News 5/12/22. Statement from HHS Secretary Xavier Becerra on the One Million American Lives Lost to COVID-19. READ MORE

4/21/2022 - HHS Announces $90 Million to Support New Data-Driven Approaches for Health Centers to Identify and Reduce Health Disparities. READ MORE 

4/15/2022 - HHS Announces $226.5 Million to Launch Community Health Worker Training Program. READ MORE 

4/12/2022 - Renewal of De​​termination That A Public Health Emergency Exists. READ MORE

4/4/2022 - HHS News 4/4/22. Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests. READ MORE 

>>>Click here to read past updates

Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Monoclonal Antibody Bamlanivimab. READ MORE

>>>Click here to read past updates

UPDATE - Special eBulletin 4/8/22 for Professional and Facility Providers. Beginning April 11, 2022, Highmark is introducing a new Interactive Voice Response (IVR) for Inpatient Planned Authorizations to expedite and enhance authorization requests. READ MORE 

>>>Click here to read past updates

Horizon
Blue Cross Blue Shield
New Jersey

UPDATE - Certain Telemedicine Claims to be Adjusted. A recent claim audit revealed that some claims for telemedicine services performed and processed between February 3, 2022, and March 2, 2022, did not apply appropriate member cost-sharing amounts that were reinstated effective February 3, 2022. READ MORE 

4/8/2022 - Horizon Special eBulletin for Providers 4/8/22. NEW! Interactive Voice Response for Inpatient Planned Authorizations. READ MORE 
Beginning April 11, 2022, Highmark is introducing a new Interactive Voice Response (IVR) for Inpatient Planned Authorizations to expedite and enhance authorization requests. The IVR is meant for authorization status for Inpatient Planned requests only. All other authorization types and authorization inquiries will be transferred to a Customer Support Representative.

As stated in our Medicare Sequestration Reductions Delayed Through March 2022 eBulletin, Highmark will pass along to providers the current amount that claims are being reduced for sequestration to Medicare Advantage claims with dates of service through March 31, 2022. After that, there will be a staggered reapplication with full sequestration effective July 1, 2022. The reductions will affect all Highmark Medicare Advantage HMO and PPO claim payments after determining any applicable Medicare secondary payment adjustments.

>>>Click here to read past updates

UPDATE - Provider Relief Fund Reporting Requirements and Auditing.  READ MORE 
Reporting on Your Use of Funds - Providers who accepted PRF payment(s) agreed to the Terms and Conditions of the program which included a requirement to report on the use of the funds. Reporting Periods are associated with the date a payment(s) were received. Reporting is an important process in understanding how the program had an impact nationwide. Providers who do not submit a completed report are considered non-compliant with the Terms and Conditions.

5/19/2022 - HRSA eNews 5/19/22. HRSA Convenes First-Ever National Conference on Telehealth. Earlier this week, HRSA convened the first-ever national conference on telehealth, which drew a registered audience of nearly 4,000. READ MORE 

5/1/2022 - HRSA News 5/1/2022. COVID-19 Provider Relief Fund - Request to Report Late Due to Extenuating Circumstances. READ MORE 

4/21/2022 - National Telehealth Conference May 16-17. READ MORE 
HHS’s Health Resources and Services Administration (HRSA) and Telehealth.HHS.gov are pleased to host a National Telehealth Conference bringing together public and private sector leaders to discuss telehealth best practices and lessons learned during the COVID-19 pandemic.

4/13/2022 - HHS Distributing $1.75 Billion in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic. READ MORE 

4/7/2022 - HRSA eNews 4/7/22. Request to Report Late Due to Extenuating Circumstances. READ MORE 
Providers can now submit a Request to Report Late Due to Extenuating Circumstances Form HRSA Exit Disclaimer for Reporting Period 1 (RP1). All requests for RP1 must be submitted by Friday, April 22, 2022 at 11:59 p.m. ET.

4/6/2022 - COVID-19 Update. The Uninsured Program stopped accepting claims due to a lack of sufficient funds. READ MORE 
Confirmation of receipt of your claim submission does not mean the claim will be paid. No claims submitted after March 22, 2022 at 11:59 p.m. ET for testing or treatment will be processed for adjudication/payment. No claims submitted after April 5, 2022 at 11:59 p.m. ET for vaccine administration will be processed for adjudication/payment. HRSA anticipates that claims submitted by the deadline may take longer than the typical 30 business day timeframe to process as HRSA works to adjudicate and pay claims subject to their eligibility.

>>>Click here to read past updates

5/11/2022

UPDATE - What is Humana doing to comply with the federal at-home, over-the-counter COVID-19 test kit requirements? READ MORE 

4/27/2022 - An important message regarding Humana’s COVID-19 response. READ MORE 

4/13/2022 - An important message regarding Humana’s COVID-19 response. READ MORE 

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs) and long-term acute care (LTAC) with a date of service on or after Oct. 12, 2021.

a. This return to our standard authorization policy applies to participating/in-network providers.

b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs) and long-term acute care (LTAC) with a date of service on or after Oct. 12, 2021.

a. This return to our standard authorization policy applies to participating/in-network providers.

b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
March 2, 2022 Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) and long-term acute care (LTAC) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Arizona for dates of service on or after March 7, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 10, 2022 Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Arkansas for dates of service on or after Feb. 14, 2022.

 >>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Jan. 5, 2022

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage members discharging from hospitals in the state of Colorado through Jan. 23, 2022. Humana is also suspending authorization requirements for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health for commercial fully insured members discharging from hospitals in the state of Colorado through at least Jan. 23, 2022

 >>>Click here to read past updates

An important message regarding Humana’s COVID-19 response. READ MORE
ADMINISTRATIVE UPDATE
Jan. 12, 2022 

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Delaware through Jan. 23, 2022. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.

An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE
Sept. 22, 2021
As we continue to monitor the status of COVID-19 cases and review procedure data, Humana is implementing changes to authorization requirements in Florida.
Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) and long-term acute care (LTAC) for Medicare Advantage, Medicaid and commercial members discharging from hospitals in the state of Florida with a date of service on or after Oct. 1, 2021. Medicaid will continue to follow state mandates as published by
the Agency for Health Care Administration (AHCA).

a. This return to our standard authorization policy applies to participating/in-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE: An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Aug. 4, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) and long-term acute care (LTAC) for participating providers for Medicare Advantage, Medicaid and commercial members for the entire state of Florida through Aug. 31, 2021. Medicaid will continue to follow state mandates as published by the Agency for Health Care Administration (AHCA).

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 1, 2021
Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Georgia with a date of service on or after Oct. 1, 2021. Also, for commercial fully insured members, Humana is reinstating authorization requirements for inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC), home health as well as participating acute inpatient hospitalizations and scheduled surgeries (performed in Georgia hospitals).

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Dec. 1, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in Kootenai County in the state of Idaho through Dec. 12, 2021. 

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term acute care (LTAC) for Medicare Advantage and commercial fully insured members discharging from hospitals in all counties—except SNFs in Kootenai County—in the state of Idaho for dates of service on or after Dec. 6, 2021.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE - Sept. 15, 2021
Humana is implementing changes to authorization requirements in the following states:
 Illinois – Clinton, Jersey, Madison, Monroe and St. Claire counties
 Missouri

Humana is reinstating authorization requirements for the Medicare Advantage and commercial lines of business for skilled nursing facilities (SNFs) with a date of service on or after Sept. 20, 2021.

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022 Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Indiana for dates of service on or after Feb. 21, 2022.

>>>Click here to read past updates

An important message regarding Humana’s COVID-19 response. 
READ MORE

ADMINISTRATIVE UPDATE
Jan. 12, 2022  

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Kansas through Jan. 30, 2022. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in Boyd, Fayette and Madison counties in the state of Kentucky through Feb. 27, 2022. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning. Medicaid will continue to follow state mandates as published by the Kentucky Cabinet for Health and Family Services. 

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Kentucky—except SNFs in Boyd, Fayette and Madison counties—for dates of service on or after Feb. 21, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health with a date of service on or after Oct. 18, 2021.

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

Humana Claims Payment Policy. READ MORE 
Subject: COVID-19 Vaccine
Published date: 12/23/2020
Policy number: CP2020004
Revision date: 09/10/2021
Related policies: COVID-19 Related Coding

Humana Claims Payment Policy. READ MORE 
Subject: COVID-19 Related Coding
Application: Medicare Advantage, Commercial and Medicaid Products
Published date: 07/2020
Policy number: CP2020001
Revision date: 09/2021
Related policies: COVID-19 Vaccine; Original Medicare Payment for Some COVID-19 Treatments; Telehealth and Other Virtual Services During the COVID-19 PHE.

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Michigan for dates of service on or after Feb. 21, 2022. 

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Nov. 3, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs)for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Minnesota through Nov. 21, 2021. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health with a date of service on or after Oct. 18, 2021.

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE - Sept. 15, 2021
Humana is implementing changes to authorization requirements in the following states:
 Illinois – Clinton, Jersey, Madison, Monroe and St. Claire counties
 Missouri

Humana is reinstating authorization requirements for the Medicare Advantage and commercial lines of business for skilled nursing facilities (SNFs) with a date of service on or after Sept. 20, 2021.

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Dec 8, 2021
Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Montana for dates of service on or after Dec. 13, 2021.
a. This return to our standard authorization policy applies to participating/in-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing time frames; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of New Mexico for dates of service on or after Feb. 21, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE  

ADMINISTRATIVE UPDATE Dec. 23, 2020
Thank you for your continued participation with Humana and the exceptional service you provide to our Dental Members.

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE 
Feb. 23, 2022 Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of North Carolina for dates of service on or after Feb. 28, 2022.

Humana is also reinstating authorization requirements for inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health for Medicare Advantage and commercial fully insured members for facilities in Beaufort, Bertie, Chowan, Dare, Duplin, Edgecombe, Halifax, Hertford, Martin, Northampton and Pitt counties in the state of North Carolina for dates of service on or after Feb. 28, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Ohio for dates of service on or after Feb. 21, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 16, 2022

Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Oklahoma for dates of service on or after Feb. 21, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and fully insured commercial members discharging from hospitals in the state of Oregon through Oct. 24, 2021.

Please provide notification of admission within 24 hours to allow us to track our members’ progress and provide assistance with discharge planning. You will receive an approval when you submit the notification. This suspension applies to participating/in-network providers only.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs) and long-term acute care (LTAC) with a date of service on or after Oct. 12, 2021.

a. This return to our standard authorization policy applies to participating/in-network providers.

b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Oct. 6, 2021
Humana is reinstating authorization requirements for the Medicare Advantage and commercial fully insured lines of business for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care (LTAC) and home health with a date of service on or after Oct. 18, 2021.

a. This return to our standard authorization policy applies to participating/in-network and nonparticipating/out-of-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

ADMINISTRATIVE UPDATE
Feb. 23, 2022 Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Utah for dates of service on or after Feb. 28, 2022.

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE 

>>>Click here to read past updates

UPDATE - An important message regarding Humana’s COVID-19 response. READ MORE

ADMINISTRATIVE UPDATE
Nov. 3, 2021

Humana is suspending authorization requirements for skilled nursing facilities (SNFs)for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of West Virginia through Nov. 21, 2021. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.

Humana is reinstating authorization requirements for long-term acute care (LTAC) for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of West Virginia for dates of service on or after Nov. 15, 2021.

>>>Click here to read past updates

An important message regarding Humana’s COVID-19 response. 
READ MORE 

ADMINISTRATIVE UPDATE
Sept. 22, 2021
Humana is reinstating authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members discharging from hospitals in the state of Wisconsin with a date of service on or after Oct. 2, 2021.

a. This return to our standard authorization policy applies to participating/in-network providers.
b. You will need to submit supporting documentation for your authorization and can expect responses to be provided in normal processing timeframes; please plan accordingly.

>>>Click here to read past updates

UPDATE - COVID-19 Update 3/31/22. Prior authorizations for acute care resume. This article was revised on March 31, 2022, to update the coverage position. READ MORE 

>>>Click here to read past updates

UPDATE - Indiana Health Coverage Programs Bulletin BT202152 7/1/2021: IHCP Rescinds Certain COVID-19 Policy Changes. READ MORE 

>>>Click here to read past updates

UPDATE - Second Booster Dose for Select COVID-19 Boosters Now a Benefit. READ MORE 
Effective for dates of service (DOS) on or after March 29, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine, to allow for use of a second booster dose, to be administered at least four months after initial booster dose, to the following groups for each respective vaccine. 

5/4/2022 - Rebilling Period Provided for Telehealth Claims Denied Using TOB 02. READ MORE 

4/22/2022 - Sotrovimab No Longer Authorized to Treat COVID-19. Providers must not submit claims for the administration of Sotrovimab for dates of service on or after April 5, 2022, as they will be denied. READ MORE 

4/15/2022 - FQHC, RHC and Tribal FQHC Providers May Now Submit Claims for COVID-19 Vaccine Administration. READ MORE 

4/14/2022 - Coming Soon: Second Booster Dose for Select COVID-19 Vaccines. READ MORE 

4/7/2022 - Postpartum Care Expansion for Medi-Cal and MCAP Beneficiaries (republished 4/7/22). READ MORE 

>>>Click here to read past updates

UPDATE - News Bulletin March 2022: Reimbursement Policies - Effective April 1, 2022, Medical Mutual is revising the Telemedicine Reimbursement Policy (Policy Number RP-202001). READ MORE

>>>Click here to read past updates

UPDATE - Molina OH Provider Bulletin/December 2021. Post-acute Authorization Requirements (for Medicare network providers). 
READ MORE

>>>Click here to read past updates

UPDATE - NGS News 3/31/22. Just a reminder: The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of this Act, a suspension on the sequestration was put in place due to the PHE. The sequestration was suspended through 3/31/2022. READ MORE 
Effective 4/1/2022, the 1% sequestration payment adjustment will be applied for claims with dates of services 4/1/2022–6/30/2022. Of note, the sequestration payment adjustment will revert to the 2% rate for claims with dates of services as of 7/1/2022. This will bring the total sequestration rate to 2%, which was the rate in effect prior to the PHE.

>>>Click here to read past updates

UPDATE - NIH News Post: NIH-funded screening study builds case for frequent COVID-19 antigen testing - Rapid antigen tests perform on par with lab tests when used every three days. READ MORE 

>>>Click here to read past updates

UPDATE - New York State (NYS) Medicaid Billing Guidance for COVID-19 Testing, Specimen Collection and Monoclonal Antibody Infusions (updated 12/13/21). READ MORE 

New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage. READ MORE 

>>>Click here to read past updates

UPDATE - Noridian Updates 5/20/22. Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels (A57340) Retirement - Effective June 1, 2022. READ MORE 

5/11/2022 - Noridian Updates 5/11/22. Mental Health Visits via Telecommunications for RHCs & FQHCs - Revised. READ MORE 

5/5/2022 - Noridian News 5/5/22. READ MORE 
Mental Health Visits via  Telecommunications for RHCs & FQHCs - Revised. MLN Matters Number: SE22001 Revised.
Article Release Date: May 5, 2022

Note: CMS revised this Article to show that RHCs must include modifier CG on claims for mental health visits via telecommunications. This change is in dark red font on page 2. All other information is the same.

4/14/2022 - Noridian News: COVID-19 - New Codes for Moderna Vaccine Booster Doses. READ MORE 
On March 29, 2022, the FDA amended the Moderna COVID-19 vaccine emergency use authorization (PDF) This link will take you to an external website., including new packaging for vaccine boosters (blue cap).CMS issued new codes, effective March 29, 2022, for the vaccine booster (91309) and administration (0094a).

4/4/2022 - Telehealth Place of Service Code. Effective for date of service on or after January 1, 2022, the Center for Medicare and Medicaid Services (CMS) allowed the new telehealth place of service (POS) code 10 - telehealth provided in patient’s home. The telehealth POS change was implemented on April 4, 2022. READ MORE 

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UPDATE - Novitas News: Over-the-counter (OTC) COVID-19 tests. READ MORE 
Starting April 4, and through the end of the COVID-19 public health emergency (PHE), Medicare covers and pays for OTC COVID-19 tests at no cost to people with Medicare Part B, including those with Medicare Advantage (MA) plans.

4/12/2022 - Novitas News 4/12/22. Roster Billing for Part B Providers. READ MORE
We have created standard roster billing forms for the COVID-19, monoclonal antibody, influenza, and pneumococcal services, along with examples of the modified CMS-1500. The CMS-1500 claim form serves as the cover document for the roster bill. Use of these forms should simplify roster billing, and since most paper claims received are scanned using optical character recognition (OCR) technology, use of the standard roster form should expedite claims processing. The roster billing form allows you to report five patients per page. It is acceptable to submit up to 20 single-sided pages per CMS-1500 claim form for a total of 100 beneficiaries.

4/1/2022 - COVID-19 News 4/1/22. Billing Veklury (remdesivir) antiviral medication in outpatient settings. READ MORE 

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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 

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UPDATE - Ohio Department of Medicaid. COVID-19 Vaccine Administration Billing Guidelines. Update 6/25/2021 includes: Added home infusions, additional monoclonal antibody treatments, and vaccine add-on for home administration. READ MORE

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UPDATE - Important Reminder: Medicare FFS Claims Payment Adjustment (Sequestration) Resumes. READ MORE

Providers are reminded the Payment Adjustment (Sequestration) will be reinstated beginning April 1, 2022. The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims in the following way:

** No payment adjustment May 1, 2020, through March 31, 2022
** 1 percent payment adjustment April 1 – June 30, 2022
** 2 percent payment adjustment beginning July 1, 2022

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Premera BC COVID-19 Updates as of 4/14/22. READ MORE 

Providence Health Plan members can receive COVID-19 vaccines at no cost.  READ MORE 

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UPDATE - COVID-19 Update for Providers 5/9/22. READ MORE 

CMS sequestration: The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service (FFS) claims as follows: There is a 1% payment adjustment for dates of service from April 1 through June 30, 2022; the 2% payment adjustment will apply for dates of service on or after July 1, 2022. We will apply these payment adjustments to our Medicare Advantage claims.

COVID-19 testing: Access to COVID-19 testing is a critical component of public health and safety, enabling our members to navigate the pandemic. View answers to frequently asked questions about over-the-counter (OTC) rapid test coverage for commercial members and Medicare Advantage members. View our COVID-19 Testing FAQ for information about coverage for tests.

4/19/2022 - COVID-19 Update 4/19/22 for Providers. READ MORE 

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UPDATE - Coronavirus Disease 2019 (COVID-19) Third Dose of Vaccine Administration Coverage. READ MORE 

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UPDATE - Provider Bulletin 5/18/22. COVID-19 Temporary Policy Updates: Nurse Aide Training and Competency Evaluation and Paid Feeding Assistant Programs. READ MORE 
During the initial response to the coronavirus disease 2019 (COVID-19) pandemic, the South Carolina Department of Health and Human Services (SCDHHS) announced dozens of temporary policy changes designed to ensure ongoing access to care for Healthy Connections Medicaid members. The majority of these policy changes were issued using emergency authorities derived from the federal public health emergency (PHE) and were issued for the duration of the PHE.

4/29/2022 - Provider Bulletin: Update on Telehealth Flexibilities Issued During the COVID-19 Public Health Emergency. READ MORE 
During the initial response to the coronavirus disease 2019 (COVID-19) pandemic, the South Carolina Department of Health and Human Services (SCDHHS) announced dozens of temporary policy changes designed to ensure ongoing access to care for Healthy Connections Medicaid members and children enrolled in the Individuals with Disabilities Education Act Part C program, which is commonly known as BabyNet. The majority of these policy changes were issued using emergency authorities derived from the federal public health emergency (PHE) and were issued for the duration of the federal PHE. These policy changes included a heavy emphasis on building upon SCDHHS’ existing telehealth benefit. New telehealth flexibilities were extended for a wide variety of services where early evidence demonstrated a service may be able to be performed with an efficacy and quality of care comparable to the service provided in a face-to-face format.

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UPDATE - Moderna COVID-19 Vaccine Booster Dose Update. On May 13, 2022, the Texas Health and Human Services Commission (HHSC) added formulary coverage for a new booster dose-only formulation of the Moderna COVID-19 vaccine for individuals 18 years of age or older. This formulation is authorized under the emergency use authorization (EUA). READ MORE 

Pfizer-BioNTech COVID-19 Vaccine Booster Dose for Children Update. READ MORE 
On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine as follows:

• Authorization of a single booster dose for individuals 5 years through 11 years of age at least 5 months after completion of the primary series with the Pfizer-BioNTech COVID-19 vaccine.
• The Texas Health and Human Services Commission allows for pharmacy benefit coverage of the Pfizer-BioNTech COVID-19 vaccine in compliance with the expanded use authorized by the FDA.
  

5/12/2022 - COVID-19 Drug Veklury (Remdesivir) Update 5/12/22. Beginning April 25, 2022, Veklury (J0248) is an approved benefit for Medicaid and Children’s Health Insurance Program (CHIP) clients 28 days or older when used in an outpatient setting. READ MORE 

5/11/2022 - Some COVID-19 Procedure Codes Now Benefits for Pharmacists and Pharmacies Effective 5/1/2022. READ MORE 

5/10/2022 - 2022 Hurricane Season Emergency Preparedness with COVID-19. Long-term care (LTC) providers in Texas are reminded to review their emergency preparedness and response plans before Atlantic hurricane season begins, which runs June 1 to November 30. LTC providers should make updates, if necessary. READ MORE 

4/27/2022 - Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE. READ MORE 

Effective April 1, 2022, COVID-19 convalescent plasma procedure code C9507 is a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for dates of service on or after December 28, 2021. READ MORE 

Telephone (Audio-only) Delivery of Some Medicaid and HTW Plus Substance Use Services Ending. Effective May 31, 2022, the Texas Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for behavioral health services described below. The following flexibility will no longer be allowed for dates of service beginning June 1, 2022. READ MORE 

4/26/2022 - CMS Publishes Revised CLIA Requirements About COVID-19 Test Reporting. The Centers for Medicare and Medicaid Services has issued revised QSO-21-10-CLIA. READ MORE

4/13/2022 - CMS to End COVID-19 Waivers for NFs, ICF/IIDs, Inpatient Hospices on May 7 or June 6, 2022 (QSO-22-15-NH & NLTC & LSC). READ MORE 
The Centers for Medicare & Medicaid Services has issued QSO-22-15-NH & NLTC & LSC. The memo will end COVID-19 emergency declaration blanket waivers for nursing facilities, skilled nursing facilities, ICF/IIDs, and inpatient hospices in two phases:
^^ 30 days from April 7, 2022
^^ 60 days from April 7, 2022

4/8/2022 - COVID-19 ICF Mitigation, Response Rule Revised Effective April 6. HHSC Long-term Care Regulation has published a revised Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Mitigation and Response Emergency Rule. It is effective April 6, 2022. READ MORE 

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UPDATE - Provider News 4/1/22. COVID-19 Test to Treat Initiative.
READ MORE 
While vaccination continues to provide the best protection against COVID-19, therapies are now available to help treat eligible people who do get sick. The Biden-Harris Administration has invested in a medicine cabinet of COVID-19 treatments, which includes two oral antiviral pills – Pfizer’s Paxlovid and Merck’s Lagevrio (molnupiravir) – that can help prevent severe illness and hospitalization when taken within five days of first COVID-19 symptoms. 

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UPDATE - COVID-19 Update 5/17/22 - Boosters and Billing Reminders. READ MORE 
We are now officially in the third year of the COVID-19 pandemic and continue to learn and shift our day-to-day operations to meet continuously evolving health care needs. Please take a moment to review the latest COVID-19 vaccine coverage and billing guidelines.

4/1/2022 - Provider News 4/1/22. One-Stop Test to Treat for COVID-19 Now Available. When your office is unable to schedule patient visits, we encourage you to inform your TRICARE patients about using One-Stop Test to Treat locations for COVID-19 testing and oral antiviral treatment. READ MORE 

Provider Newsletter April 2022. COVID-19 Updates. TRICARE continues to follow Centers for Disease Control and Prevention (CDC) guidelines on COVID-19 testing, treatment and vaccines. In this ever-changing environment, be sure to visit cdc.gov, tricare-west.com and tricare.mil for up-to-date information. READ MORE 

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UPDATE - COVID-19 Vaccines and Vaccine Administration (Updates 1/19/22). The cost of FDA-authorized COVID-19 vaccine serums will initially be paid for by the U.S. government. READ MORE 

COVID-19 Testing and Cost Share Guidance (Updated 1/19/22). Member Coverage and Cost Share. READ MORE 

COVID-19 Telehealth (Updates 1/19/22). Member Coverage and Cost Share: UnitedHealthcare Medicare Advantage will continue to extend its temporary cost share waiver (copay, coinsurance or deductible) for certain telehealth services, as described below. READ MORE 

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UPDATE - Provider Alert 3/24/22. HRSA COVID-19 Uninsured Program funding ending - other funding opportunities available. READ MORE 

Due to lack of funds, the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program will stop accepting claims on the following schedule:
^ Testing claims: March 22, 2022, at 8:59 P.M. (Pacific)
^ Treatment claims: March 22, 2022, at 8:59 P.M. (Pacific)
^ Vaccine administration claims: April 5, 2022, at 8:59 P.M. (Pacific)

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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. 
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Wellmark BCBS will cover COVID-19 vaccinations with no member cost-sharing payments, deeming it a preventive service under the ACA. READ MORE 

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UPDATE - COVID-19 Laboratory Test HCPCS Code U0005 and CERT Reviews (updated 4/18/22). The Comprehensive Error Rate Testing (CERT) contractor may conduct reviews on COVID-19 laboratory tests. READ MORE 

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