COVID-19 Payer Information - Archives

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HHS -
US Department of Health & Human
Services

6/29/2022 - HHS News 6/29/22. Biden-Harris Administration secures 105 million doses of Pfizer’s latest COVID-19 vaccine for fall vaccination campaign. READ MORE 

6/18/2022 - HHS News 6/18/22. Statement from HHS Secretary Xavier Becerra on COVID-19 Vaccines for Children 6 months through 5 Years Old. READ MORE 

6/13/2022 - HHS Issues Guidance on HIPAA and Audio-Only Telehealth. READ MORE 

6/3/2022 - HHS News 6/3/22. The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.
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5/19/2022 - 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 

3/22/2022 - HHS News 3/22/22. The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), today announced more than $413 million in Provider Relief Fund (PRF) payments to more than 3,600 providers across the country. READ MORE 

3/21/2022 - HHS News 3/21/22. The U.S. Department of Health and Human Services (HHS) recognized the one-year anniversary of the Health Resources and Services Administration’s (HRSA) Health Center COVID-19 Vaccine Program, which received funding from President Biden’s American Rescue Plan and has provided COVID-19 vaccines directly to thousands of HRSA-supported health center sites nationwide. READ MORE 

3/8/2022 - Fact Sheet 3/8/22. As part of President Biden’s National COVID-19 Preparedness Plan to help America move forward safely, the Biden-Harris Administration is launching a nationwide Test to Treat Initiative this week so Americans can rapidly access needed COVID-19 treatments. READ MORE 

2/24/2022 - HHS News Release 2/24/22. HHS Distributing $560 Million in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic. READ MORE 

2/14/2022 - HHS News Release 2/14/22. HHS Awards Nearly $55 Million to Increase Virtual Health Care Access and Quality Through Community Health Centers. Awards will enhance telehealth, digital patient tools, and health information technology to support underserved communities. READ MORE 

2/10/2022 - HHS News 2/10/22. Part of the Biden-Harris Administration’s commitment to ensuring Americans who get sick with COVID-19 have access to treatments that work, the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra is announcing that the federal government has purchased 600,000 treatment courses of a new monoclonal antibody treatment that data shows works against the Omicron variant. READ MORE 

1/25/2022 - HHS News Release 1/25/22. The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 7,600 providers across the country this week. READ MORE 

1/14/2022 - Renewal of De​​termination That A Public Health Emergency Exists. READ MORE 

1/10/2022 - HHS News Release 1/10/22. Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. READ MORE 

1/5/2021 - HHS News Release 1/5/22. Following actions by the Centers for Disease Control and Prevention and the Food and Drug Administration to expand Pfizer COVID-19 booster shots to 12 to 15 year-olds, HHS Secretary Xavier Becerra issued this statement. READ MORE

12/29/2021 - HHS News Release 12/29/21. Two New Over-the-Counter At-Home COVID-19 Tests Brought to the US Market Quickly by Biden-Harris Administration. READ MORE

12/23/2021 - HHS News Release 12/23/21. HHS Announces Availability of Nearly $48 Million to Increase the Public Health Workforce in Rural and Tribal Communities. READ MORE 

12/22/2021 - HHS News Release 12/22/21. New Guidance to Boost Accessibility and Equity in COVID-19 Vaccine Programs. READ MORE 

12/18/2021 - HHS News Release 12/8/21. HHS Awards $82 Million in American Rescue Plan Funding to Expand Home Visiting Assistance for Families Affected by the COVID-19 Pandemic. READ MORE 

12/14/2021 - HHS News Release 12/14/21. HHS Is Releasing $9 Billion in Provider Relief Fund Payments to Support Health Care Providers Affected by the COVID-19 Pandemic. READ MORE 

11/23/2021 - HHS Announces $35 Million for Telehealth in the Title X Family Planning Program. READ MORE 

11/23/2021 - Biden-Harris Administration Begins Distributing American Rescue Plan Rural Funding to Support Providers Impacted by Pandemic. READ MORE 

10/25/2021 - New HHS Actions Add to Biden Administration Efforts to Increase Access to Easy-to-Use Over-the-Counter COVID-19 Tests. READ MORE 

10/22/2021 - HHS Invests over $560 million to Bolster Product Manufacturing to Increase Supply, Availability of COVID-19 Tests. READ MORE 

10/15/2021 - Renewal of Determination that A Public Health Emergency Exists - posted 10/15/2021. READ MORE 

9/30/2021 - Provider Relief Fund Reporting Requirements and Auditing. Announcing 60-Day Grace Period – Reporting Period 1. READ MORE 

9/24/2021 - The Health and Human Services Secretary Xavier Becerra issued the following statement on the significance of booster doses of the Pfizer-BioNTech COVID-19 vaccine reaching millions of eligible people across the country.
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9/22/2021 - HHS Announces Funding for Public Health IT Workforce Development Program. READ MORE 

9/10/2021 - HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding. READ MORE 

8/30/2021 - Biden-Harris Administration Releases Medicaid and CHIP Guidance Targeting Vaccination and Testing for COVID-19. READ MORE

8/27/2021 - Resumption in Use and Distribution of Bamlanivimab/Etesevimab in Certain States. READ MORE

7/27/2021 - As part of its response to the COVID-19 pandemic, the Biden-Harris Administration is providing $121 million to support the work of trusted community-based efforts to increase vaccinations in underserved communities. READ MORE 

7/26/2021 - Today, as we commemorate the 31st anniversary of the Americans with Disabilities Act (ADA), the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) are jointly publishing guidance on how "long COVID" can be a disability under the ADA, Section 504 of the Rehabilitation Act, and Section 1557 of the Affordable Care Act. The guidance is on the HHS website. READ MORE 

7/21/2021 - US renews 'public health emergency' declaration. READ MORE 

7/13/2021 - HHS Provides $398 Million to Small Rural Hospitals for COVID-19 Testing and Mitigation. READ MORE 

6/29/2021 - American Rescue Plan Lowers Health Insurance Costs for Americans Who May Have Lost Their Job. Consumers should Visit HealthCare.gov Beginning July 1 to see if they Qualify for New Financial Help. READ MORE 

6/14/2021 - Thanks to the American Rescue Plan, the US Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) awarded $125 million to support 14 nonprofit private or public organizations to reach underserved communities in all 50 states plus the District of Columbia, Puerto Rico, Guam and the Freely Associated States to develop and support a community-based workforce that will engage in locally tailored efforts to build vaccine confidence and bolster COVID-19 vaccinations in underserved communities. READ MORE 

6/11/2021 - The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA) is releasing revised reporting requirements for recipients of Provider Relief Fund (PRF) payments. READ MORE

6/9/2021 - HHS Secretary Xavier Becerra to Insurers & Providers: COVID-19 Vaccines and Testing Must be Free for Patients. READ MORE 

5/25/2021 - HHS to Dedicate $4.8 Billion from American Rescue Plan to COVID-19 Testing for the Uninsured. READ MORE 

5/20/2021 - HHS Announces $14.2 Million from American Rescue Plan to Expand Pediatric Mental Health Care Access. READ MORE

5/11/2021 - HHS Awards $40 Million in American Rescue Plan Funding to Support Emergency Home Visiting Assistance for Families Affected by the COVID-19 Pandemic. READ MORE  

5/4/2021 - HHS Announces Nearly $1 Billion from American Rescue Plan for Rural COVID-19 Response. READ MORE 

5/4/2021 - HHS Announces $250 Million from American Rescue Plan to Develop and Support a Community-Based Workforce to Increase COVID-19 Vaccinations in Underserved Communities. READ MORE 

5/4/2021 - FACT SHEET: President Biden to Announce Goal to Administer at Least One Vaccine Shot to 70% of the U.S. Adult Population by July 4th. READ MORE 

5/3/2021 - HHS Launches New Reimbursement Program for COVID-19 Vaccine Administration Fees not Covered by Insurance. READ MORE 

4/29/2021 - HHS Awards Over $32 Million in American Rescue Plan Funding to Expand COVID-19 Training and Support for Health Centers. READ MORE 

4/27/2021 Thanks to the American Rescue Plan, today the U.S. Department of Health and Human Services (HHS) is announcing the availability of $1 billion for Health Resources and Services Administration (HRSA)-Health Center Program funded health centers to support major construction and renovation projects across the country.  READ MORE 

4/19/2021 - HHS Announces Nearly $150 Million from American Rescue Plan to Support Community-Based Health Care Providers with COVID-19 Response. READ MORE 

4/15/2021 - Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance. READ MORE 

4/2/2021 - HHS Secretary Xavier Becerra Announces Expansion of COVID-19 Vaccine Program to All Community Health Centers Across the Country. READ MORE 

3/12/2021 - Biden Administration Takes Action Through HHS to Increase Number of Vaccinators. READ MORE 

3/11/2021 - Biden Administration to Expand COVID-19 Vaccine Program to 950 Community Health Centers. READ MORE 

2/17/2021 - Biden Administration Announces Actions to Expand COVID-19 Testing. READ MORE 

2/3/2021 - COVID-19 Claims Reimbursement Program Update for the Uninsured. READ MORE 

1/28/2021 - HHS Announces Marketplace Special Enrollment Period for COVID-19 Public Health Emergency. READ MORE 

12/29/2020 - 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 

12/10/2020 - FAQs–Application of OIG's Administrative Enforcement Authorities to Arrangements Directly Connected to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency. 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

10/20/2020 - To meet the Trump Administration's Operation Warp Speed (OWS) goals, the U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD ) today announced agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term care facilities (LTCF) nationwide with no out-of-pocket costs.
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10/12/2020 - To meet Operation Warp Speed goals, HHS and DoD announced an agreement with AstraZeneca for late-stage development and large-scale manufacturing of the company's COVID-19 investigational product AZD7442, a cocktail of two monoclonal antibodies, that may help treat or prevent infection with SARS-CoV-2, the coronavirus that causes COVID-19.
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10/6/2020 - NIH RADx initiative advances six new COVID-19 testing technologies. READ MORE

10/2/2020 - Renewal of Determination That A Public Health Emergency Exists. READ MORE

10/2/2020 - October 1, 2020 the US Department of Health and Human Services (HHS) , through the Health Resources and Services Administration (HRSA), is announcing $20 billion in new funding for providers on the frontlines of the coronavirus pandemic.  READ MORE

9/28/2020 - The Trump Administration detailed the national distribution plan for the Abbott BinaxNow Ag Card rapid test to assist Governors' efforts to continue to safely reopen their states. READ MORE

9/1/2020 - The Federal Communications Commission (FCC), U.S. Department of Health and Human Services (HHS), and U.S. Department of Agriculture (USDA) today announced that they have signed a Memorandum of Understanding to work together on the Rural Telehealth Initiative, a joint effort to collaborate and share information to address health disparities, resolve service provider challenges, and promote broadband services and technology to rural areas in America. READ MORE

9/1/2020 - The National Institutes of Health has launched a study to track the prevalence and impact of SARS-CoV-2 infection among approximately 16,000 pregnant women in seven low-and middle-income countries. READ MORE

8/24/2020 - HHS News on Plasma Donation Guidelines. READ MORE

8/24/2020 - Provider Relief Fund News. UPDATE: The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020.  READ MORE

8/20/2020 - The Defense Production Act (DPA) application to priority rated orders for contracts with Becton Dickinson (BD) and Quidel Corporation through September. READ MORE

8/17/2020 - Provider Relief Fund Update. The application deadline for Phase 2 General Distribution funding is August 28, 2020.  READ MORE

8/14/2020 - Relief Funds to Certain Children's Hospitals. READ MORE

8/14/2020 - COVID-19 Vaccine Distribution.  READ MORE

8/12/2020 - CARES Act Provider Relief Fund - Reminder: The application deadline for Phase 2 General Distribution funding is August 28, 2020.  READ MORE

8/12/2020 - HHS and Department of Defense (DoD) today announced an agreement with Moderna, Inc. to manufacture and deliver 100 million doses of the company’s COVID-19 vaccine candidate. READ MORE

8/10/2020 - HHS Releases July through December COVID-19 State Testing Plans. READ MORE

8/7/2020 - HHS Announces Allocations of CARES Act for Nursing Homes. READ MORE

8/5/2020 - HHS, DoD Collaborate with Johnson & Johnson to Produce Millions of COVID-19 Investigational Vaccine Doses.
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7/31/2020 - CARES Act Provider Relief Fund: Key Facts for Providers. READ MORE

7/31/2020 - The U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD) today announced agreements with Sanofi and GlaxoSmithKline (GSK) to support advanced development including clinical trials and large-scale manufacturing of 100 million doses of a COVID-19 investigational adjuvanted vaccine. READ MORE

7/28/2020 - DOE, HHS and VA Announce COVID-19 Insights Partnership. READ MORE

7/23/2020 - Public Health Emergency News from HHS: Renewal of Determination That A Public Health Emergency Exists. 
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7/22/2020 - US Government Engages Pfizer to Produce Millions of Doses of COVID-19 Vaccine. READ MORE

7/17/2020 - HHS, through the HRSA, to begin distributing $10 Billion in additional funding to Hospitals in High Impact COVID-19 areas next week. READ MORE

7/10/2020 - HHS Announces Over $4 Billion in Additional Relief Payments to Healthcare Providers Impacted by the COVID19 Pandemic. READ MORE

UPDATE - HHS Releases May and June 2020 COVID-19 State Testing Plans. READ MORE

7/8/2020 HHS Launches 'Surge' COVID-19 Testing in Hotspot Jurisdictions of Florida, Louisiana and Texas. READ MORE

7/7/2020 - HHS published a table regarding what is provided for Coverage, Types of Testing Covered, Cost Share, and Pricing for Group Health Plans and Health Insurance Coverage for Non-emergent Care and Emergency Care.  READ MORE

6/30/2020 - HHS, DOD (Department of Defense) Collaborate with Novavax to Produce Millions of COVID-19 Investigational Vaccine Doses in Commercial-Scale Manufacturing Demonstration Projects. READ MORE

6/30/2020 - HHS Extends COVID_19 Testing Public-Private Partnership. READ MORE

6/30/2020 - CARES Act Provider Relief Fund. READ MORE

6/29/2020 - Trump Administration Secures New Supplies of Remdesivir for the US. READ MORE

6/26/2020 - Texas Community-Based Testing Sites Extension. READ MORE

6/18/2020 - HHS Awards $107.2 Million to Grow and Train the Health Workforce. READ MORE

6/18/2020 - CARES Act Provider Relief Fund: HHS expects to distribute $15 billion to eligible Medicaid and CHIP providers through the Provider Relief Fund. READ MORE

6/12/2020 - HHS Enhanced Provider Relief Fund update:  On Monday, June 8, 2020, HHS sent communications to all hospitals asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020.  READ MORE

6/9/2020 - Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance. READ MORE

6/9/2020 - HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals and Medicaid & CHIP Providers. READ MORE

6/4/2020 - HHS Announces New Laboratory Data Reporting Guidance for COVID-19 Testing. READ MORE

6/2/2020 - Indian Health Service COVID-19 Update. READ MORE

6/2/2020 - HHS Provides an Additional $250 Million to Help US Health Care Systems Respond to COVID-19. READ MORE

6/2/2020 - Reminder/CARES Act Provider Relief Fund. Providers must act by June 3, 2020 to receive additional Provider Relief Fund General Distribution payments. READ MORE

5/28/2020 - HHS Awards $15 Million to Combat the COVID-19 Pandemic in Rural Tribal Communities. READ MORE

5/22/2020 - HHS Announces $500 Million Distribution to Tribal Hospitals, Clinics and Urban Health Centers. Today, the Department of Health and Human Services (HHS) announced $500 million in payments from the Provider Relief Fund to the Indian Health Service (IHS) and tribal hospitals, clinics, and urban health centers to support the tribal response to COVID-19. READ MORE

5/22/2020 - HHS Announces 45-Day Compliance Deadline Extension for Providers. READ MORE

5/22/2020 - HHS Announces Nearly $4.9 Billion Distribution to Nursing Facilities impacted by COVID-19. READ MORE

5/22/2020 - Press Release. Trump Admin Announces Changes to Medicare Advantage and Part D to Provider Better Coverage and Increase Access for Medicare Beneficiaries. READ MORE

5/21/2020 - Operation Warp Speed Accelerates AstraZeneca COVID-19 Vaccine. READ MORE

5/20/2020 - Providers Must Act by June 3, 2020 to Receive Additional Relief Fund General Distribution Payment. READ MORE

5/15/2020 - Operation Warp Speed (OWS) is the administration's national program to accelerate the development, manufacturing, and distribution of COVID-19 vaccine, therapeutics, and diagnostics (medical countermeasures). The objective is to have a vaccine for Americans by January 2021. READ MORE

5/13/2020 - HHS awards $15 million to support telehealth providers during the COVID-19 pandemic. READ MORE

5/7/2020 - HHS Awards More than Half Billion Dollars Across the Nation to Expand COVID-19 Testing. READ MORE

5/7/2020 - The Department of Health and Human Services has extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. READ MORE

5/5/2020 - The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued additional guidance explaining that even during the current COVID-19 public health emergency, covered health care providers are still required to obtain a valid HIPAA authorization from each patient whose PHI will be accessible to the media before the media is given access to that PHI. READ MORE

5/1/2020 - HHS is distributing $12 billion to 395 hospitals, accounting for 71% of hospitals who provided inpatient care for 100 or more COVID-19 patients through April 10, 2020, $2 billion of which will be distributed to these hospitals based on their Medicare and Medicaid disproportionate share and uncompensated care payments. READ MORE

4/28/2020 - Provider Relief Fund Payments: Additional Relief. The Department of Health and Human Services (HHS) has begun the distribution of an additional $20 billion of the $50 billion general distribution to Medicare facilities and providers impacted by COVID-19, augmenting the $30 billion that was allocated earlier this month. READ MORE

4/27/2020 - SAMHSA Awards Grants Expanding Community-Based Behavioral Health Services, Strengthens COVID-19 Response. READ MORE

4/27/2020 - CARES Act Provider Relief Fund: $50 billion of the Provider Relief Fund is allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' 2018 net patient revenue. (The funds do not need to be repaid if certain terms and conditions are met). The initial $30 billion was distributed between April 10 and April 17, and the remaining $20 billion was distributed Friday, April 24, 2020.  READ MORE

4/22/2020 - HHS Awards Nearly $165 Million to Combat the COVID-19 Pandemic in Rural Communities. READ MORE

4/16/2020 - CARES Act Provider Relief Fund is $100 billion in relief funds, and initial $30 billion is being distributed to hospitals and other healthcare providers on the front lines of the coronavirus response. READ MORE

4/15/2020 - The U.S. Department of Health and Human Services (HHS) awarded $90 million for Ryan White HIV/AIDS Program recipients across the country to prevent, prepare for, and respond to coronavirus disease 2019 (COVID-19). READ MORE

4/13/2020 - News Release: The U.S. Department of Health and Human Services (HHS) will collaborate with multiple non-government organizations on the development of convalescent plasma and hyperimmune globulin immunotherapies. These treatments would use antibodies against SARS-CoV-2 from COVID-19 survivors and are intended to stimulate the immune systems of people currently ill from the virus. READ MORE

4/10/2020 - CARES Act Provider Relief Fund - support to healthcare providers fighting the COVID-19 pandemic. $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. READ MORE

Highmark

3/29/2022 - Highmark Special eBulletin 3/29/2022. Medicare Sequestration Reductions. READ MORE 

3/28/2022 - Highmark Special eBulletin 3/28/22. Updates to Reimbursement Policy 064: Government Supplied Vaccinations and Antibody Treatments. READ MORE 

8/23/2021 - COVID-19 Update 8/23/21. Inpatient Hospital Care/Member Coverage. READ MORE 

8/4/2021 - COVID-19 Update on Member Coverage of Telehealth. READ MORE 

7/1/2021 - Special eBulletin 7/1/21. Delivering Telehealth Services to Highmark Members After 6/30/21. READ MORE

5/21/2021 - The following codes may be used when collecting specimens for the diagnostic purposes of COVID-19.
READ MORE 

4/15/2021 - EXTENDED THROUGH DECEMBER 2021: MEDICARE SEQUESTRATION TEMPORARY PAYMENT INCREASE.
READ MORE 

4/13/2021 - INPATIENT HOSPITAL CARE - Highmark members who receive inpatient hospital care for COVID-19 from an in-network facility will not incur any deductibles, co-insurance and co-pays, effective for dates of service from February 1, 2020 through June 30, 2021. READ MORE 

3/16/2021 - Highmark members will receive the COVID-19 vaccine free of charge. READ MORE 

3/5/2021 - During the Public Health Emergency (PHE), the federal government will pay for the cost of the COVID-19 vaccine for all individuals and throughout 2021 for Medicare Advantage members regardless of when the PHE ends. READ MORE 

2/17/2021 - COVID-19 News: The purpose of this policy to provide direction on procedure codes The Plan will not separately reimburse - U0005. READ MORE

2/3/2021 - COVID-19 Claims Reimbursement Program Update for the Uninsured. READ MORE 

12/14/2020 - Extended/Open Authorizations for professional and facility providers. READ MORE

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 

10/7/2020 - Highmark (Temporary) Telemedicine Code List. READ MORE 

7/28/2020 - COVID-19 Telehealth and Virtual Visits update. READ MORE 

7/1/2020 - Updates to Highmark's Reimbursement of Telemedicine Services. READ MORE 

6/25/2020 - Special eBulletin updated 6/25/2020 - Return to Work Testing. READ MORE  

6/25/2020 - COVID-19 and Annual Wellness Visits for Medicare Advantage patients. READ MORE 

6/23/2020 - Return to Work Testing for COVID-19. READ MORE 

6/9/2020 - COVID-19 Timely Filing Policy. READ MORE 

5/29/2020 - COVID-19 Specimen-only collection. READ MORE 

5/22/2020 - Telemedicine and Virtual Visits. READ MORE 

5/20/2020 - Inpatient Hospital Care for COVID-19 Treatment. READ MORE 

5/20/2020 - COVID-19 Associated Services. READ MORE 

5/19/2020 - All Highmark member cost-sharing (deductibles, coinsurance and copayments) for outpatient virtual visits will be waived for dates of service from March 13 through June 13, 2020 regardless of medical diagnosis. READ MORE 

5/13/2020 - The payer is currently experiencing an issue where providers trying to submit claims for certain services are receiving an error that denies the claim upfront.  READ MORE 

5/13/2020 - Inpatient Hospital Care for COVID-19 Treatment.  READ MORE 

5/6/2020 - Effective May 7, 2020, Highmark will resume a modified quarterly validation process as required by CMS and administered by Atlas. READ MORE 

5/6/2020 - PLACE OF SERVICE CHANGES FOR AUTHORIZED SERVICES.  READ MORE 

5/1/2020 - For professional and facility providers: For Medicare Advantage claims with dates of service from May 1, 2020 through December 31, 2020, Highmark will pass along to providers the current amount that claims are being reduced for sequestration.  READ MORE 

4/28/2020 - Highmark is making it a priority to connect people with nearby community benefit organizations (CBOs) that can address their needs during this time by implementing “Aunt Bertha” an electronic social service resource directory and referral tool to connect individuals and families with the programs that can serve them. READ MORE 

4/28/2020 - Please be advised that any temporary modifications or provisions to telemedicine policies and procedures are for dates of service from March 13 through June 13, 2020 unless otherwise noted. Should this change at any time, this information will be updated accordingly.  READ MORE 

4/20/2020 - Highmark is expanding their telemedicine medical and reimbursement policies for a limited time to permit and pay for more telehealth providers, services and modalities. For guidance specific to Home Health, please see the Home Health Frequently Asked Questions.  READ MORE 

4/20/2020 - Virtual Visits: All Highmark member cost-sharing (deductibles, coinsurance and copayments) for outpatient virtual visits will be waived for dates of service from March 13 through June 13, 2020 regardless of medical diagnosis. READ MORE 

4/20/2020 - Telemedicine Services: All Highmark member cost-sharing (deductibles, coinsurance and copayments) for covered services provided by our national vendors (American Well, Doctor On Demand, Teladoc and Bright Heart Health) will also be waived for dates of service from March 13 through June 13, 2020 regardless of medical diagnosis. READ MORE 

4/14/2020 - Members who receive inpatient hospital care with a confirmed diagnosis (after positive COVID-19 test) from an in-network facility will not incur any deductibles, co-insurance and co-pays, effective retroactively for dates of service from February 1 through May 31, 2020. READ MORE 

4/14/2020 - Outpatient Visits: Highmark will waive the member cost share for office visits (including telehealth), urgent care visits, Emergency Department visits, and for any items or services provided during the visit when the visit results in a COVID-19 test being ordered or administered. If visit does not result in COVID-19 testing, standard cost sharing will apply as well as member's benefit plan.  READ MORE 

4/13/2020 - CHANGES TO REIMBURSEMENT POLICY 041 (SERVICES THAT ARE NOT SEPARATELY REIMBURSABLE).  READ MORE 

4/9/2020 - Due to the COVID-19 public health emergency, Highmark is modifying their timely filing policy temporarily for claim submissions from participating providers. All in-network providers will have 365 days to submit claims with dates of service beginning February 1, 2020, through June 30, 2020.  READ MORE 

4/7/2020 - MEDICAL POLICY CHANGES TO ADDRESS EASY ACCESS TO NECESSARY SUPPLIES DURING COVID-19 OUTBREAK.  READ MORE 

4/6/2020 - EXPEDITED CREDENTIALING OF PROVIDERS DUE TO COVID-19: To ensure our members have timely access to care during the COVID-19 Public Health Emergency (PHE), Highmark is temporarily relaxing its credentialing requirements in line with federal guidelines.  READ MORE 

4/3/2020 - CODING/BILLING/REIMBURSEMENT. READ MORE 

4/3/2020 - Prior Authorizations for applicable services, with a few exceptions, will still follow current Utilization Management standards. READ MORE 

4/2/2020 - Highmark has announced that members who require in-network, inpatient hospital care for COVID-19 will not incur any deductibles, co-insurance and co-pays, effective immediately. This applies through May 31, 2020 for members with group employer coverage (self-funded groups may elect to opt into the program), as well as ACA and Medicare members. 
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4/2/2020 - Highmark will reimburse each telemedicine code at the contracted rate or Highmark established Fee Schedule for these services. Highmark's Telehealth Reimbursement Policy is currently being updated.  READ MORE 

4/1/2020 - If the member is referred for testing, Highmark will waive the member cost share for the COVID-19 test and in-person visit (if the visit results in the COVID-19 diagnostic test being ordered or administered). READ MORE 

Horizon
Blue Cross Blue Shield

New Jersey

5/4/2022 - 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 

3/29/2022 - Horizon Special eBulletin for Providers 3/29/22. Medicare Sequestration Reductions. READ MORE 

3/28/2022 - Horizon Special eBulletin for Providers 3/28/22. Updates to Reimbursement Policy 064: Government Supplied Vaccinations and Antibody Treatments. READ MORE

8/26/2021- COVID-19 Pharmacy Claims for Vaccinations. READ MORE 

7/30/2021 - Reminder: Select one method for COVID-19 and Influenza Testing. READ MORE

7/30/2021 - Antibody testing: FDA and CDC do not recommend use to determine immunity. READ MORE

6/30/2021 - Pre-admission testing reimbursement policy changes. READ MORE 

5/10/2021 - Horizon BCBS New Jersey 5/10/2021 - BCBSNE will commit to extending the approval dates for an already approved Pre-Authorization (PA) due to the continued precautions with coronavirus through June 30, 2021. READ MORE 

1/1/2021 - Effective January 1, 2021 and throughout the period of public health emergency, Horizon BCBSNJ shall consider an additional add-on payment (U0005) for COVID-19 diagnostic testing run on high throughput technology, when billed with procedure code U0003 or U0004, and when following conditions are met. READ MORE

3/6/2020 - 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. ◦ Waiving prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. ◦ Waiving prior authorization for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay.  Horizon will cover the full cost of the COVID-19 test. ◦ Horizon members will have no cost, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection.  READ MORE

HRSA -
Health Resources & Services Administration

6/30/2022 - Provider Relief Fund - Reporting Requirements. Providers Who Were Required to Report in Reporting Periods 1 and/or 2. Providers who received one or more payments totaling greater than $10,000 in the aggregate during a Payment Received Period must report on use of funds in each applicable Reporting Period. READ MORE 

6/16/2022 - Provider Relief Fund: Key Dates. READ MORE 

6/2/2022 - HRSA eNews 6/2/22. Building a Village: Community Linkages for COVID-19 Vaccines and Beyond. Next month, the U.S. Food and Drug Administration (FDA) will consider issuing an Emergency Use Authorization for a COVID-19 vaccine for young children. Please join us for a special town hall event on Thursday, June 9, 3-4:30 p.m. ET. READ MORE 

6/1/2022 - Provider Relief Fund Reporting Requirements and Auditing: Request to Report Late Due to Extenuating Circumstances. READ MORE 

5/25/2022 - Provider Relief Fund Reporting Requirements and Auditing.  READ MORE 

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 

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 

4/6/2022 - COVID-19 Update. The Uninsured Program stopped accepting claims due to a lack of sufficient funds. READ MORE 

3/24/2022 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. READ MORE 

3/17/2022 - HRSA eNews 3/17/22. Provider Relief Fund Reporting Period 2. READ MORE 

3/16/2022 - HRSA COVID-19 Claims Reimbursement to Health Care Providers for the Uninsured - Important Update Regarding Submission of Claims. READ MORE 

3/15/2022 - HRSA News. Provider Relief Fund Reporting Requirements and Auditing. Reporting Period 2 Is Open.
READ MORE 

3/7/2022 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of March 7, 2022, more than $19.5 Billion has been paid and over 361,000 health care providers have enrolled in the program to date. READ MORE 

3/1/2022 - HRSA COVID-19 News. Dispensing fees for FDA-licensed or authorized outpatient antiviral drugs for treatment of COVID-19 are now reimbursable under the HRSA COVID-19 Uninsured Program. The HRSA COVID-19 Uninsured Program will reimburse providers for dispensing fees for FDA-licensed or authorized outpatient antiviral drugs for patients with a confirmed diagnosis of COVID-19. READ MORE 

2/9/2022 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of February 9, 2022, more than $17.9 Billion has been paid and over 352,000 health care providers have enrolled in the program to date. READ MORE 

2/3/2022 - HRSA eNews 2/3/22. HRSA Takes Action to Fight the Pandemic, Improve Health Outcomes, and Promote Health Equity. HRSA continues to improve health outcomes in underserved communities, promote health equity, and support the health workforce. READ MORE 

1/20/2022 - HRSA News 1/20/22. The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), today announced $103 million in awards to improve the retention of health care workers and help respond to the nation’s critical staffing needs by reducing burnout and promoting mental health and wellness among the health care workforce. READ MORE 

1/20/2022 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of January 20, 2022, more than $17.0 Billion has been paid and over 344,000 health care providers have enrolled in the program to date. READ MORE 

1/19/2022 - Provider Relief Fund Reporting Requirements and Auditing. Reporting Period 2 Is Open. READ MORE 

1/6/2022 - HRSA eNews 1/6/22. HHS Announces Availability of Nearly $48 Million to Increase the Public Health Workforce in Rural and Tribal Communities. READ MORE 

12/23/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of December 23, 2021, more than $15.7 Billion has been paid and over 336,000 health care providers have enrolled in the program to date. READ MORE 

12/14/2021 - HRSA News Release 12/14/21. HHS Is Releasing $9 Billion in Provider Relief Fund Payments to Support Health Care Providers Affected by the COVID-19 Pandemic. READ MORE 

12/8/2021 - HRSA News Release 12/8/21. HHS Awards $82 Million in American Rescue Plan Funding to Expand Home Visiting Assistance for Families Affected by the COVID-19 Pandemic. READ MORE 

12/7/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of December 7, 2021, more than $14.3 Billion has been paid and over 330,000 health care providers have enrolled in the program to date. READ MORE 

12/2/2021 - HRSA News Release 12/2/21. President Biden announced new actions to combat COVID-19 as the United States heads into the winter months and with the emergence of a new variant, Omicron. READ MORE 

11/23/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of November 23, 2021, more than $13.5 Billion has been paid and over 326,000 health care providers have enrolled in the program to date. READ MORE 

11/10/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of November 10, 2021, more than $12.7 Billion has been paid and over 321,000 health care providers have enrolled in the program to date. READ MORE 

10/27/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of October 27, 2021, more than $12.2 Billion has been paid and over 315,000 health care providers have enrolled in the program to date. READ MORE 

10/12/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of October 12, 2021, more than $11.6 Billion has been paid and over 309,000 health care providers have enrolled in the program to date. READ MORE 

10/6/2021 - Providers - $25.5 billion in Provider Relief Fund & American Rescue Plan Rural Funding is now available. The application is now open for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments. READ MORE 

9/30/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of September 30, 2021, more than $11.2 Billion has been paid and over 304,000 health care providers have enrolled in the program to date. READ MORE 

9/16/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of September 16, 2021, more than $10.7 Billion has been paid and over 297,000 health care providers have enrolled in the program to date. READ MORE 

9/16/2021 - HRSA eNews 9/16/21. HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding. Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29. READ MORE

9/9/2021 - Biden-Harris Administration Awards Over $5 Million to Expand Services at HRSA's Health Center Program School-Based Service Sites. READ MORE 

9/3/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. READ MORE 

9/2/2021 - HRSA eNews 9/2/21 - recent reorganization of HRSA.READ MORE 

8/20/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of August 20, 2021, more than $9.7 Billion has been paid and over 289,000 health care providers have enrolled in the program to date. READ MORE 

8/5/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. As of August 5, 2021, more than $9.3 Billion has been paid and over 284,000 health care providers have enrolled in the program to date. READ MORE 

7/22/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. READ MORE 

7/15/2021 - HRSA eNews 7/15/21. Provider Relief Fund (PRF) Reporting Portal Technical Assistance. READ MORE 

7/6/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. READ MORE 

7/1/2021 - HRSA eNews 7/1/21. Now OPEN: PRF Reporting Portal. The Provider Relief Fund (PRF) Reporting Portal is now open. READ MORE 

6/17/2021 - HRSA Press Release 6/17/21. HRSA Announces Coverage of Over Five Million Claims for COVID-19 Vaccinations for Uninsured Individuals. READ MORE 

6/3/2021 - HRSA eNews 6/3/21: HHS to Dedicate $4.8 Billion from American Rescue Plan to COVID-19 Testing for the Uninsured. READ MORE 

5/20/2021 - More Than 10 Million COVID-19 Vaccine Doses Administered by Community Health Centers. READ MORE 

5/19/2021 - HRSA COVID-19 Coverage Assistance Fund. READ MORE 

5/6/2021 - HRSA eNews 5/6/21. READ MORE 

5/6/2021 - HRSA eNews 5/6/21. READ MORE 

4/15/2021 - HRSA eNews April 15, 2021: New CDC COVID-19 Vaccination Provider Trainings Available. READ MORE 

4/15/2021 - HRSA eNews April 15, 2021: Emerging Stronger After COVID-19: Priorities for Health System Transformation. READ MORE 

4/5/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of April 5, 2021, more than $5 Billion has been paid and over 227,000 health care providers have enrolled in the program to date. READ MORE

4/1/2021 - HRSA eNews 4/1/21. $6 Billion Investment in Community Health Centers to Expand Access to Vaccines in Underserved Communities. READ MORE 

3/18/2021 - HRSA eNews 3/18/21. HRSA COVID-19 Uninsured Program Increases Vaccine Administration Rates. READ MORE 

3/8/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. READ MORE

2/18/2021 - HRSA eNews 2/18/21. Ensuring Equity in COVID-19 Vaccine Distribution. READ MORE 

2/15/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured.  READ MORE 

2/10/2021 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/ Facilities for Testing and Treatment of the Uninsured. READ MORE 

2/3/2021 - HRSA COVID-19 Claims Reimbursement for the Uninsured. READ MORE 

1/21/2021 - HRSA eNews January 21, 2021. HHS Invests $8 Million to Address Gaps in Rural Telehealth through the Telehealth Broadband Pilot. READ MORE 

1/7/2021 - 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. READ MORE

11/5/2020 - HRSA eNews 11/5/20. ** COVID-19 Provider Relief Fund 'Phase 3' General Distribution - Providers have until November 6 to initiate an application for funds. Apply Now. Interested applicants can view a recording of the October 15 Webcast HRSA Exit Disclaimer to learn important information about Phase 3, eligibility and the application process. READ MORE

10/15/2020 - HRSA eNews 10/15/2020. Safety net providers are encouraged to apply for the latest round of Provider Relief Fund (PRF) support. READ MORE

10/15/2020 - HRSA COVID-19 Claims Reimbursement to Health Care Providers/Facilities for Testing and Treatment of the Uninsured. As of September 10, 2020, more than $1 Billion has been paid and over 126,000 health care providers have enrolled in the program to date.  READ MORE

8/10/2020 - HRSA COVID-19 Uninsured Program - HRSA explanation on confirming no insurance.  READ MORE

7/16/2020 - HRSA eNews 7/16/2020. READ MORE

7/23/2020 - HRSA Uninsured Program - Updated Q & A.  READ MORE

7/21/2020 - CARES Act Provider Relief Fund Update: The application deadline for Medicaid, CHIP and dentists has been extended to August 3, 2020. READ MORE

7/9/2020 - HHS Awards More Than $21 Million to Support Health Centers' COVID-19 Response. READ MORE

7/7/2020 - HRSA COVID-19 Uninsured Program: More than $186 million in claims have been paid by the COVID-19 Uninsured Program. READ MORE

6/11/2020 - HHS awards $8 million to expand COVID-19 training and technical assistance for health centers. READ MORE

5/26/2020 - HRSA COVID-19 Uninsured Program: Frequently Asked Questions. READ MORE

5/20/2020 - $225 Million for COVID-19 Testing in Rural Communities. READ MORE

5/18/2020 - Uninsured Program Compliance. Payments received from the program are claims reimbursements and should be treated in the same manner as reimbursements received from commercial insurance, Medicaid, and/or Medicare, including in how revenue or losses are determined. READ MORE

5/15/2020 - Be aware that the HRSA COVID-19 Uninsured Program is using a unique version of Smart Edits, which is an EDI capability that detects electronic claims with potential errors. READ MORE

5/13/2020 - The HRSA COVID-19 Uninsured Program reimburses providers for COVID-19 testing or treatment of uninsured individuals; therefore, any money collected from an individual must be returned to the individual if the provider received funding for that patient through this program. This requirement is included in the Terms and Conditions that the provider signs in order to enroll in the program. READ MORE

5/11/2020 - COVID-19 Uninsured Program Resources for Providers. Please refer to the following resources created to assist providers with navigating this program: HRSA COVID-19 Uninsured Program Facts from the Webcasts 4/29/2020 and 4/30/2020; HRSA COVID-19 Uninsured Program Smart Edits Facts for Providers; HRSA COVID-19 Uninsured Program Smart Edits Reference Guide. READ MORE

5/7/2020 - The COVID-19 Uninsured Program: Providers may submit claims for individuals in the U.S without health care coverage for dates of service or admittance on or after February 4, 2020, for COVID-19 testing and testing-related visits for uninsured individuals, as well as treatment for uninsured individuals with a COVID-19 diagnosis. All claims will be subject to the same timely filing requirements required by Medicare. READ MORE

5/6/2020 - HRSA COVID-19 Uninsured Program: May 6, 2020 is the first day to begin submitting patient information and electronic claims for payment. READ MORE

4/28/2020 - COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured.  READ MORE

Humana

6/9/2022 - Medicare Sequestration Reminder. Suspension of Medicare sequestration. READ MORE 

6/1/2022 - An important message regarding Humana’s COVID-19 response: COVID-19 VACCINE FAQs. READ MORE 

5/11/2022 - 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 

3/16/2022 - An important message regarding Humana’s COVID-19 response. READ MORE 

3/9/2022 - An important message regarding Humana’s COVID-19 response. READ MORE 

3/2/2022 - An important message regarding Humana’s COVID-19 response: SNFs. READ MORE

2/2/2022 - CLAIMS PAYMENT POLICY: The 2019 novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes the disease known as coronavirus disease 2019 (COVID-19). READ MORE

1/19/2022 - An important message regarding Humana’s COVID-19 response. READ MORE

1/15/2022 - As announced by the US Department of Health & Human Services, as of January 15, 2022, all private insurance members are eligible to receive up to eight (8) at-home, OTC COVID-19 tests per month at no out-of-pocket cost. READ MORE 

1/12/2022 - Given the recent rise of COVID-19 infection rates in Arkansas, we must continue to remain vigilant and take necessary precautions for the safety of our community. READ MORE 

1/12/2022 - An important message regarding Humana’s COVID-19 response. READ MORE 

12/29/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

12/29/2021 - Humana COVID-19 Update 12/29/21. Question 7. How is Humana handling claims for the vaccines?  READ MORE 

12/16/2021 - ALERT: On December 16, 2021, the CDC updated their COVID-19 vaccine recommendation expressing a clinical preference for individuals to receive the mRNA COVID-19 vaccines (Pfizer and Moderna) over the Johnson & Johnson COVID-19 vaccine. READ MORE 

12/15/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

12/8/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

11/24/2021 - An important message regarding Humana’s COVID-19 response. READ MORE

11/17/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

11/10/2021 - An important message regarding Humana’s COVID-19 response. READ MORE

11/10/2021 - Submitting COVID-19 claims/COVID-19 Vaccine Coding (Updated November 9, 2021). READ MORE 

11/3/2021 - An important message regarding Humana’s COVID-19 response: COVID-19 VACCINE FAQs. READ MORE 

10/27/2021 - An important message regarding Humana’s COVID-19 response: COVID-19 VACCINE FAQs. READ MORE 

10/27/2021 - Claims Payment Policy - Subject: COVID-19 Vaccine Application: Medicare Advantage, Commercial and Medicaid Products. READ MORE

10/27/2021 - Claims Payment Policy - Subject: COVID-19 Related Coding Application: Medicare Advantage, Commercial and Medicaid Products. READ MORE 

10/20/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

10/13/2021 - Submitting COVID-19 claims - COVID-19 Vaccine Coding - Updated September 27, 2021. READ MORE 

10/13/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

9/29/2021 - An important message regarding Humana’s COVID-19 response: COVID-19 VACCINE FAQs (09/27/2021). READ MORE 

9/29/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

9/15/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

8/18/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

8/18/2021 - Provider Notification 8/09/2021, Illinois Executive Order 2021-15; (COVID-19 Executive Order NO. 84) Extension for Telehealth Coverage. READ MORE 

8/11/2021 - Humana COVID-19 Related Coding. READ MORE 

8/11/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

8/4/2021 - An important message regarding Humana’s COVID-19 response. READ MORE 

8/4/2021 - An important message regarding Humana’s COVID-19 response: COVID-19 VACCINE FAQs 07/22/2021. READ MORE 

8/4/2021 - Humana Claims Payment Policy: Subject: Telehealth and Other Virtual Services During the COVID-19 PHE. READ MORE 

6/30/2021 - Humana Illinois Medicare-Medicaid Plan Statewide Expansion. READ MORE 

6/30/2021 - Florida Medicaid/Long-Term Care (LTC): COVID-19 State of Emergency: Ending Temporary Flexibilities. READ MORE 

6/30/2021 - Florida Medicaid: COVID-19 State of Emergency: Ending Provisional Provider Enrollment. READ MORE 

5/5/2021 - As we continue to monitor the status of COVID-19 cases and review procedure data in Michigan, Humana is implementing changes to authorization requirements. READ MORE 

4/26/2021 - Following a thorough safety review, the FDA and CDC recommended that use of the Johnson & Johnson vaccine resume effective April 23, 2021. READ MORE 

4/26/2021 - Humana members, all FDA-authorized COVID-19 vaccines will be covered at no additional cost during the public health emergency. READ MORE

4/20/2021 - Humana Claims Payment Policy - COVID-19 Related Coding Revised 04/2021. READ MORE 

12/23/2020 - COVID-19 Vaccine FAQs 12/23/20. READ MORE 

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 

6/30/2020 - At-home and drive-thru COVID-19 testing available for eligible Humana medical plan members effective 6/30/2020. READ MORE

5/1/2020 - Effective May 1, 2020 Humana is waiving in-network primary care costs, not only for COVID-19 costs, but all primary care visits for the rest of 2020. READ MORE

5/5/2020 - Effective May 1, 2020, Humana is eliminating out-of-pocket costs for office visits so Medicare Advantage members can reconnect with their healthcare providers. READ MORE

5/1/2020 - Humana is encouraging members to use telehealth as their first option of care. Out of pocket costs for telehealth visits with participating in network providers will be waived for 90 days beginning March 6, 2020. READ MORE

3/29/2020 - Preauthorizations for care have been removed for Humana Medicare Advantage and employer-plan members who test positive for COVID-19. For Medicaid members refer to your state’s specific page at Humana.com/Medicaid. READ MORE

3/26/2020 - Lab providers should use the newly created HCPCS codes when billing for COVID-19 testing.  Member cost-share waivers for COVID-19-related testing have been expanded, which includes both the COVID-19 test and viral panels that rule out COVID-19; cost-share waivers now apply to laboratory testing, specimen collection and certain related services that result in the ordering or administration of the test, including, physician office or emergency department visits. READ MORE

Independence Blue Cross

6/1/2022 - New Telemedicine Reimbursement Rate Effective 6/1/22. Independence has updated its reimbursement rate for Telemedicine Services, effective June 1, 2022. READ MORE 

3/31/2022 - 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 

3/1/2022 - Telemedicine reimbursement rate update. Effective June 1, 2022, Independence will update its reimbursement rate for Telemedicine Services. READ MORE 

1/4/2022 - COVID-19 Update 1/4/22 - Vaccine Coverage and Reimbursement. READ MORE 

12/28/2021 - COVID-19 Update 12/28/21. Independence will cover member cost-share for Commercial and Medicare Advantage members who receive COVID-19 tests through urgent care providers. READ MORE 

12/21/2021 - COVID-19 Update 12/21/21. Prior Authorizations Suspended December 21, 2021. READ MORE 

3/16/2021 - Independence Blue Cross is waiving all cost-sharing for the administration of the COVID-19 vaccine to commercial group and individual members. For Medicare Advantage members, the cost of the COVID-19 vaccine and its administration will be covered by Medicare. READ MORE

4/3/2020 - The payer will waive member cost-sharing for in-network, inpatient, acute care treatment and Emergency Department visits when members are admitted to the hospital under these same conditions. These changes are effective March 30, 2020 and will extend through May 31, 2020. for COVID-19. This means members will pay no co-pay, co-insurance or deductible in this scenario. READ MORE

Indiana Medicaid

2/17/2021 - Effective 1/1/2021, U0005 completed within 2 calendar days from date of specimen collection (list separately in addition to either HCPCS code U0003 or U0004) as described by CMS-2020-01-R2. READ MORE 

Medi-Cal

6/28/2022 - Coming Soon: COVID-19 Vaccine for Children 6 Months and Up. Effective for dates of service on or after June 17, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorizations (EUA) for the Pfizer-BioNTech and Moderna COVID-19 vaccines. READ MORE 

6/23/2022 - Pfizer COVID-19 Vaccine Booster Dose Approved for Individuals 5 to 11 Years Old. Effective for dates of service on or after May 17, 2022, the Food and Drug Administration (FDA) 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. READ MORE 

6/22/2022 - 2022 COVID-19 Vaccine Administration FAQs Available. The Department of Health Care Services (DHCS) has published an additional FAQ regarding COVID-19 vaccine administration. READ MORE 

6/1/2022 - American Rescue Plan Act Postpartum Care Extension Program Has Replaced the PPCE. The Provisional Postpartum Care Extension (PPCE) program was suspended on March 31, 2022. The information originally published on July 31, 2020 in the Medi-Cal update titled “Provisional Postpartum Care Extension” has been retired. READ MORE 

5/23/2022 - Second Booster Dose for Select COVID-19 Boosters Now a Benefit. READ MORE 

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 

3/18/2022 - Vaccine Counseling Services are Reimbursable using E&M Office or Other Outpatient Visit CPT codes. READ MORE 

3/8/2022 - Postpartum Care Expansion (revised 3/8/22). READ MORE 

3/7/2022 - Bebtelovimab Administration added as New COVID-19 Monoclonal Antibody Benefit. READ MORE 

3/3/2022 - J0248 Established as Medi-Cal Benefit for Remdesivir to Treat COVID-19. READ MORE

2/24/2022 - Providers Holding Submissions of Claims for COVID-19 Vaccine Administration May Now Submit.
READ MORE 

2/8/2022 - Home Health Agency Providers May Be Reimbursed for COVID-19 Vaccine Administration.  READ MORE 

2/1/2022 - Pharmacy Providers to Bill Medi-Cal Rx for COVID-19 Vaccine Administration. READ MORE

2/1/2022 - Pfizer-BioNTech COVID-19 Vaccine Updates for Third Dose, Booster Dose and Shortening of its Time Requirements. READ MORE 

1/10/2022 - Reimbursement of COVID-19 Vaccine and Monoclonal Antibody Administration for Medical Providers. READ MORE 

12/15/2021 - Eligibility of Pfizer-BioNTech COVID-19 Booster Dose Expanded to 16 Years of Age and Older. READ MORE 

12/8/2021 - Postpartum Care Expansion. READ MORE 

11/23/2021 - Eligibility of COVID-19 Booster Doses Expanded to All Adults. READ MORE 

11/17/2021 - Reimbursement of COVID-19 Vaccine and Monoclonal Antibody Administration for Medical Providers (updated 11/17/21). READ MORE 

11/5/2021 - Pfizer-BioNTech COVID-19 Vaccine for Children 5 Through 11 Can Be Processed. READ MORE 

11/3/2021 - Pregnancy Eligibility During the COVID-19 PHE. READ MORE

10/29/2021 - Booster Dose for Pfizer-BioNTech COVID-19 Vaccine Can Be Processed. READ MORE

10/29/2021 - Booster Dose for Moderna COVID-19 Vaccine Can Be Processed. READ MORE

10/29/2021 - Booster Dose for Janssen COVID-19 Vaccine Can Be Processed. READ MORE

10/26/2021 - Heterologous (Mix and Match) COVID-19 Vaccine Booster Doses are Authorized. READ MORE 

10/26/2021 - Booster Dose for Pfizer-BioNTech COVID-19 Vaccine Can Be Processed. READ MORE

10/26/2021 - Coming Soon: Booster Dose for Janssen COVID-19 Vaccine is Authorized. READ MORE 

10/26/2021 - Booster Dose for Moderna COVID-19 Vaccine Can Be Processed. READ MORE 

10/25/2021 - Transportation, Treatment Covered for COVID-19 Uninsured Group, Restricted Scope. READ MORE 

10/21/2021 - COVID-19 Uninsured Group Program Off-Premise Flexibilities. READ MORE 

10/15/2021 - Extension of Grace Period Related to "Four Walls" Requirement for HIS/Tribal Facilities. READ MORE 

10/8/2021 - Coming Soon: Booster Dose for Pfizer-BioNTech COVID-19 Vaccine is Authorized for Certain Populations. READ MORE 

9/28/2021 - Erroneously Denied Claims for Vaccines Billed with or without SK & SL Modifiers. READ MORE 

9/21/2021 - Third dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Authorized. This article was updated on

9/21/2021 - To inform providers that the requisite system updates to process claims for the third dose have been implemented. Providers no longer need to hold claims. READ MORE 

9/21/2021 - Supplemental Rate for Administration of COVID-19 Vaccine in Home Setting. READ MORE 

9/3/2021 - Third dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Authorized. READ MORE 

8/30/2021 - COVID-19 Vaccination Administration Reimbursable for Ambulance Providers. READ MORE 

8/20/2021- Update Bulletin/General Medicine/August 2021. CLIA-Waived Status Available to Certified Providers for COVID-19 Codes. READ MORE 

7/14/2021 - Reimbursement of COVID-19 Vaccine and Monoclonal Antibody Administration for Medical Providers (Updates 7/14/21). READ MORE 

6/21/2021 - In-Person Signature Requirement for Delivered Medications. READ MORE

6/8/2021 - New Telehealth Code Added to EWC for FQHC/RHC Providers. READ MORE

6/7/2021 - Broadband Benefit for Medi-Cal Beneficiaries. READ MORE 

5/24/2021 - Effective Date Correction to Previous EPC Letter of Retroactive Rate Adjustment for COVID-19 Diagnosis Claims. READ MORE 

5/18/2021 - Temporary Increased COVID-19 DME Oxygen and Respiratory Rates. READ MORE 

5/14/2021 - COVID-19 Uninsured Group User Guide Now Available. A step-by-step user guide for the Coronavirus (COVID-19) Uninsured Group Web Application Web Portal is now available on the Medi-Cal Provider website. READ MORE 

5/12/2021 - New Age Restriction for Pfizer-BioNTech COVID-19 Vaccine. READ MORE 

5/5/2021 - New NDC for Moderna COVID-19 Vaccine. READ MORE 

4/16/2021 - Temporary Increased COVID-19 FSSA/NF-B Rates for Calendar Year 2021. The January 1, 2021, through December 31, 2021, (calendar year 2021), facility-specific reimbursement rates for Freestanding Adult Subacute Skilled Nursing Facility Level B (FSSA/NF-B) are established effective for dates of service on or after January 1, 2021.
READ MORE 

4/26/2021 - Current Direction on Claims Submission--To assist providers with claims submission for the administration of the COVID-19 vaccine, Medi-Cal has provided a summary of the most current direction that providers are being asked to follow. This table is updated as changes are made. READ MORE 

4/7/2021 - COVID-19 Drug Flexibilities Expiring. On March 23, 2020, the Department of Health Care Services (DHCS) received approval of a federal waiver allowing specific flexibilities related to the coronavirus disease 2019 (COVID-19) public health emergency. These flexibilities are set to end on April 20, 2021. READ MORE 

4/6/2021 - New COVID-19 HCPCS Codes for the Every Woman Counts Program. READ MORE 

3/30/2021 - Temporary Increased COVID-19 Freestanding Skilled Nursing Facility Level B Rates. READ MORE 

3/30/2021 - Limits Removed from ICD-10-CM Code U07.1 for Aid Code V2. Effective for dates of service on or after March 18, 2020, all policy for aid code V2 that limits services billed with ICD-10-CM diagnosis code U07.1 is removed.
READ MORE 

3/25/2021 - COVID-19 Testing: Billing Update for Medi-Cal COVID-19 Testing in Schools. READ MORE 

3/3/2021 - To assist providers with claims submission for the administration of the COVID-19 vaccine, Medi-Cal has provided a summary of the most current direction that providers are being asked to follow. This table is updated as changes are made. READ MORE 

1/19/2021 - Vaccine Administration - Current Direction on Claims Submission. READ MORE 

1/19/2021 - COVID-19 Vaccine Administration: Pharmacy Batch and Hard Copy Claims can be Submitted. READ MORE 

1/19/2021 - COVID-19 Vaccine Administration: Preparing to bill. READ MORE 

1/11/2021 - Update to Billing Policy for Infectious Agent Antigen Detection. READ MORE 

1/6/2021 - COVID-19 Vaccine Administration: Real-Time RTIP Pharmacy Claims Can Be Submitted. READ MORE 

1/4/2021 - Medi-Cal List of Contract Drugs: COVID-19 Vaccines Pfizer-BioNTech and Moderna Added. READ MORE

12/22/2020 - COVID-19 Vaccine Administration - Initial and Upcoming Policy. READ MORE 

12/22/2020 - COVID-19 Vaccine Administration: COVID-19 Uninsured Group – Vaccine Reimbursement. READ MORE

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.READ MORE 

12/4/2020 - New COVID-19 Testing Codes 87636, 87637 and 87811 are Medi-Cal Benefits.READ MORE

10/16/2020 - CPT Code 86413 Reimbursement Rate Update. READ MORE

10/5/2020 - Reimbursement Rates are updated for COVID-19 Testing. READ MORE

10/1/2020 - COVID-19 Uninsured Group Program Retroactive Applications. READ MORE

9/18/2020 - COVID-19 Quantitative Antibody Test Added as a Med-Cal Benefit. READ MORE

9/11/2020 - Your Medi-Cal and Cal MediConnect coverage for coronavirus. READ MORE

9/10/2020 - Effective for Dates of Service 8-10-20, CPTs 86408 and 86409 will now be paid by Medi-Cal. There are no restrictions by age or gender, but there is a limit of one per day per patient. These codes can be billed with any ICD-10 codes. Claims denied in error will be re-processed by Medi-Cal. READ MORE

8/28/2020 - Effective immediately, Qualified Providers (QPs) must use the new Coronavirus (COVID-19) Uninsured Group Application Portal to process applications for the COVID-19 Uninsured Group program. READ MORE

8/26/2020 - COVID-19 Uninsured Group Application Portal - Soft Launch. READ MORE

8/26/2020 - On August 28, 2020, a new Coronavirus (COVID-19) Uninsured Group Application Portal will be made available behind the Transactions area of the Medi-Cal website to process applications for the COVID-19 Uninsured Group program.
READ MORE

8/25/2020 - COVID-19 Frequently Asked Questions (FAQs) Section Now Available on the COVID-19 Medi-Cal Response page of the Medi-Cal Providers Website. READ MORE

8/21/2020 - Provider News: COVID-19 Uninsured Group Application Portal Will Be Implemented On August 28, 2020.
READ MORE

7/23/2020 - New policy changes to the Hospital Presumptive Eligibility Program. READ MORE

7/21/2020 - CCS Service Code Groupings Update for COVID-19 Services. READ MORE

6/17/2020 - Claims Submitted for Telehealth Services Erroneously Denying for RAD Code 0225. READ MORE

5/28/2020 - DHCS has agreed to reimburse the two serology testing codes (CPT codes 86769 and 86328) at 100% of the Medicare rate and to waive the extra AB 97 10% payment reduction. READ MORE

5/22/2020 - New Policy Changes to the Hospital Presumptive Eligibility Program. READ MORE

5/21/2020 - New COVID-19 Specimen Collection Rate. READ MORE

5/12/2020 - COVID-19 Specimen Collection is a new Medi-Cal Benefit. READ MORE

5/12/2020 - Additional Guidance on Presumptive Eligibility (PE) for COVID-19. READ MORE

5/4/2020 - Additional Guidance on Presumptive Eligibility (PE) for Coronavirus (COVID-19). READ MORE

5/1/2020 - COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications. READ MORE

4/29/2020 - Effective for dates of service on or after April 8, 2020, Aid Code V2 will allow individuals to seek all medically necessary care for COVID-19 diagnostic and testing related services, including all associated medical, outpatient, inpatient and pharmacy related services at no cost to them. READ MORE

4/29/2020 - Updated Billing Instructions for Certain COVID-19 Services - Eligibility for COVID-19 will use Aid Code V2 to determine eligibility for these limited benefits. READ MORE

4/24/2020 - Billing Instructions for Presumptive Eligibility (PE) for Coronavirus (COVID-19). The Department of Health Care Services (DHCS) implemented Presumptive Eligibility (PE) for Coronavirus (COVID-19) on April 8, 2020. READ MORE

4/22/2020 - New HCPCS codes for COVID-19 Diagnosis. Effective for dates of service on or after March 18, 2020, HCPCS codes U0003 (SARS Cov-2 COVID-19 Amp prob high throughput) and U0004 (COVID-19 lab test non-CDC high throughput) for the detection of SARS-COV-2 or the diagnosis of the virus that causes the coronavirus disease 2019 (COVID-19). READ MORE

4/17/2020 - Effective for dates of service on or after April 10, 2020, the American Medical Association (AMA) has released specific CPT® codes to report and track COVID-19 antibody testing. READ MORE

4/16/2020 - Emergency Medi-Cal Provider Enrollment. Effective March 23, 2020 retroactive to March 1, 2020: The applicant or provider must have treated a Medi-Cal beneficiary who has been affected by the current national COVID-19 public health emergency. Providers who successfully enroll using the procedures listed in the provider bulletin will be granted enrollment for only 60 days, retroactive to March 1, 2020. READ MORE

4/8/2020 - Effective for dates of service on or after March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) established Current Procedural Terminology (CPT®) code 87635 (SARS-COV-2 COVID-19 AMP PRB) for COVID-19 diagnostic testing services. When billing, providers may be reimbursed up to $51.31 for these services. In addition, this code is exempted from the 10 percent payment reductions in Welfare and Institutions Code (W&I Code) section. READ MORE

4/7/2020 - Effective for dates of service on or after March 1, 2020, HCPCS codes G2023 (specimen collect covid-19) and G2024 (spec coll snf/lab covid-19) are now Medi-Cal benefits. These codes are billable by clinical diagnostic laboratories. READ MORE

4/2/2020 - Supersedes March 27, 2020 version. For all Medi-Cal covered benefit categories covered in the State Plan, which are currently subject to Prior Authorization (PA), including but not limited to elective hospitalizations and/or procedures, durable medical equipment (DME), magnetic resonance imaging (MRI), hearing aids, laboratory services, speech/occupational/physical therapy services, nonemergency medical transportation, etc., DHCS is temporarily suspending PA requirements. READ MORE

3/27/2020 - The State Controller’s Office (SCO) will print and mail the paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary up to four (4) business days later than the warrant itself. READ MORE

3/19/2020 - Effective for dates of service on or after February 4, 2020, HCPCS code U0001 (2019-Novel Coronavirus [2019-nCoV diagnostic p]) and HCPCS code U0002 (COVID-19 lab test non-cdc) are new Medi-Cal benefits. READ MORE

3/17/2020 - Medical Supplies: Providers are instructed to incorporate the statement “Patient impacted by COVID-19.” within the Miscellaneous Information field on the Treatment Authorization Requests (TAR) or Service Authorization Requests (SAR) for medical supplies requiring an authorization. READ MORE

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

Michigan Medicaid

4/6/2020 - 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

Medical Mutual of Ohio

8/31/2021 - Effective Sept. 1, 2021, Medical Mutual temporarily is suspending skilled nursing facility (SNF) prior authorizations for all hospitals. This prior authorization suspension extends through at least Oct. 31, 2021, but we will reevaluate it as the situation evolves. READ MORE 

6/25/2021 - Effective May 12, 2021, high-tech imaging approvals through EviCore are changing back to the prior 45 day timeframe from the date of authorization. This had been extended to 180 days due to the COVID-19 pandemic. READ MORE 

3/8/2021 - Effective Nov. 18, 2020, Medical Mutual temporarily suspended skilled nursing facility (SNF) prior authorizations for all hospitals. This prior authorization suspension ends on Apr. 2, 2021. READ MORE 

1/18/2021 - Effective Nov. 18, 2020, Medical Mutual temporarily suspended skilled nursing facility (SNF) prior authorizations through Feb. 28, 2021, for all hospitals. READ MORE 

12/23/2020 - Effective Nov. 18, 2020, Medical Mutual temporarily suspended skilled nursing facility (SNF) prior authorizations through Jan. 31, 2021, for all hospitals.  READ MORE

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. READ MORE 

8/11/2020 - COVID-19 Frequently Asked Questions for Providers. READ MORE

8/3/2020 - COVID-19 Frequently Asked Questions for Providers (Updated 8/3/2020).  READ MORE

7/27/2020 - For our fully insured plans, Medical Mutual has extended the period during which cost sharing for all treatment related to COVID-19 will be waived to now go through Dec. 31, 2020. READ MORE

5/28/2020 - Medical Mutual has extended the period during which cost sharing for all treatment related to COVID-19 will be waived to now go through July 24, 2020 for our fully insured plans. Medications to treat COVID-19 on an inpatient basis would be covered at 100% with no member cost share, through July 24, 2020. READ MORE

4/10/2020 - Considering clinical guidance from the American Academy of Pediatrics, Medical Mutual will NOT cover pediatric preventive care (well child care) visits conducted via telehealth (telemedicine) These visits center around services that necessitate a face-to-face interaction, such as administering vaccines, checking height and weight, and performing vision and hearing screenings. READ MORE

4/10/2020 - The Ohio Bureau of Workers’ Compensation (BWC) has issued guidance stating that claims can be filed in cases where jobs pose a special hazard or risk which results in employees contracting COVID-19 directly from the work exposure. READ MORE

3/30/2020 - Will cover COVID-19 treatment with no cost sharing for fully insured plans through 5/31/20. Treatment includes hospitalizations and ambulance transfers. Will permanently cover FDA-approved medications and vaccines when available. This is effective retroactively to 3/13/20. Copays for testing are waived for members. Telehealth visits between a member and provider are covered. Waiving the requirement that telehealth visits must have a visual encounter. Also waiving requirement that an initial behavioral health visit be done in person before visits can be conducted via telehealth. READ MORE

Molina

12/1/2021 - Molina OH Provider Bulletin/December 2021. COVID-19 Update. Vaccine Administration Rate for Additional Dose (Information for all network providers). READ MORE

9/1/2021 - COVID-19 Authorization Update September 2021. Ohio is experiencing another surge in COVID-19 cases, hospitalization and Intensive Care Units (ICU) admissions across the state. READ MORE 

2/17/2021 - Effective 1/1/2021, only submitters of U0003 or U0004 that also include code U0005 will earn the higher payment of $100 per test. Submitters unable to support the additional code of U0005 high throughput tests will receive a lesser CMS payment of $75 per test. READ MORE

6/8/2020 - 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

4/2/2020 - Waiving all COVID-19-related out-of-pocket expenses for its Medicare, Medicaid, and Marketplace members nationwide, following up on its previous announcement last month about waiving all member costs associated with testing for the coronavirus, which causes COVID-19. 

3/24/2020 - Launched "Coronavirus Chatbot," a digital tool for members to assess COVID-19 risk factors and their own personal risk profile. 

3/18/2020 - Molina office-based employees and contractors in various states are temporarily transitioning to remote status. 

3/13/2020 - Molina Healthcare (“Molina”) announced it would waive member costs associated with testing for the coronavirus, which causes COVID-19. 

National Government Services (NGS) - J6 A/B, JK A/B

3/31/22 - NGS News: 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 

3/16/2022 - Place of Service 10 for Telehealth Services Not for Medicare Billing. National Government Services is receiving calls from providers to our call center in regard to the usage of the new Place of Service 10 code. READ MORE 

3/1/2022 - Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody.
READ MORE 

1/14/2022 - NGS News 1/21/22. Place of Service 10 for Telehealth Services Not for Medicare Billing. National Government Services is receiving calls from providers to our call center in regard to the usage of the new Place of Service 10 code. READ MORE 

1/14/2022 - NGS News 1/14/22 - Billing VEKLURY™ (remdesivir) Antiviral Medication in Outpatient Settings. READ MORE

12/23/2021 - NGS News 12/23/21. December 2021-January 2022 LCD and Billing and Coding Article Updates. Billing and Coding: Respiratory Pathogen Panel Testing (A58741). Due to the annual CPT/HCPCS code updates the long code description for 87428 has been changed. READ MORE 

11/18/2021 - NGS Medicare News 11/18/21. New Local Coverage Determination: Effective 12/1/2021, National Government Services will be instituting a new LCD for Respiratory Pathogen Panel Testing. READ MORE 

11/17/2021 - NGS Medicare News 11/17/21. Provider Enrollment - COVID-19 Waiver Update on Application Fee.
READ MORE 

11/4/2021 - NGS Medicare News 11/4/21. Clarification on the Proper Use of the CS Modifier. READ MORE 

7/22/2021 - NGS Alert for Part A Providers. Urgent News: Cost Sharing for COVID-19 Vaccine and Monoclonal Antibodies Claims. READ MORE 

6/14/2021 - News & Alerts: Billing Tips for COVID-19 Vaccine as a Mass Immunizer Roster Biller (Use the Taxonomy Code). READ MORE

5/27/2021 - NGS Upcoming Education for Providers | Thursday, May 27, 2021 | 11:30 AM - 12:30 PM EST. READ MORE

5/19/2021 - NGS Upcoming Education for Providers | Thursday, May 20, 2021 | 10am - 11am EST. READ MORE 

5/14/2021 - NGS Medicare Production Alerts. READ MORE 

5/13/2021 - NGS Upcoming Education for Providers | Thursday, May 13, 2021 | 11:30 AM - 12:30 PM EST. READ MORE

4/29/2021 - NGS Upcoming Education for Providers | Thursday, April 29, 2021 | 10am - 11am EDT.  READ MORE 

4/29/2021 - NEWS AND ALERTS MLN CONNECTS® FOR THURSDAY, APRIL 29, 2021. READ MORE

4/29/2021 - NEWS AND ALERTS  ACCELERATED AND ADVANCED REMIT REMINDERS: If you received an accelerated or advance payment, CMS will begin to recoup any outstanding balance from any payments due to you from your Medicare claims. READ MORE 

4/28/2021 - NGS News & Alerts 4/28/21. Accelerated and Advanced Payment Nettings/Offsets Across Organization Affiliations. READ MORE 

4/23/2021 - NGS Medicare Production Alerts. READ MORE 

4/15/2021 - NGS Upcoming Education for Providers | Thursday, April 15, 2021 | 1:00 PM - 2:00 PM EST.  READ MORE 

4/14/2021 - News and Alerts 4/8/21. Accelerated/Advanced Repayment Terms. READ MORE 

4/7/2021 - Checking the Status of Your Accelerated or Advanced Overpayment. READ MORE 

3/24/2021 - NGS Upcoming Education for Providers |Tuesday, March 30, 2021 | 10am - 11am EDT. READ MORE

3/18/2021 - NGS Upcoming Education for Providers | Thursday, March 18, 2021 |1:00 PM - 2:00 PM EST. READ MORE

2/25/2021 - Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody: If your patient is enrolled in a MA plan, you will need to submit your COVID-19 vaccine and/or monoclonal antibody infusion claims to Original Fee-For-Service Medicare. READ MORE 

2/18/2021 - COVID-19 Test Pricing and Frequency Limitation. READ MORE 

2/18/2021 - NGS Upcoming Education for Providers | Thursday, February 18, 2021 | 1:00 PM - 2:00 PM EST. READ MORE

2/16/2021 - Medicare Part A & B Billing for the COVID-19 Vaccine and Monoclonal Antibody. READ MORE

2/3/2021 - NGS Immunization Roster Billing Job Aid is now Available. READ MORE

2/3/2021 - NGS Education for Providers: COVID-19 Vaccine Administration and Billing for Part B Providers.

1/27/2021 - NGS MCR News/Alerts. Providers are reporting a frequent problem relevant to their patients who are covered by a MA Plan. READ MORE 

1/13/2021 - Medicare Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody. READ MORE

1/6/2021 - NGS Newsletter January 2021. For Part B Providers - PC-ACE V4.8.100 Workaround for COVID-19 Roster Billing. READ MORE

12/14/2020 - NGS Newsletter December 2020. TPE reviews remain suspended due to the PHE related to COVID-19.  
READ MORE 

12/14/2020 - Telehealth Video: Medicare Coverage and Payment of Virtual Services: CMS updated the Medicare Coverage and Payment of Virtual Services YouTube video that answers common questions about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency.

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 

12/4/2020 - NGS Upcoming Education for Providers. READ MORE 

11/3/2020 - NGS Upcoming Education for Providers. READ MORE 

11/2/2020 - NEW NGS + AUNT BERTHA AND USA.GOV WEBSITES NOW AVAILABLE. READ MORE 

10/30/2020 - Medicare Usage of CPT Code 99072. READ MORE 

10/14/2020 - NGS Provider Upcoming Education. READ MORE 

9/25/2020 - NGS Production Alerts. "Incorrect Denials for COVID-19 Claims." READ MORE 

9/16/2020 - NGS Provider Upcoming Education. READ MORE 

8/26/2020 NGS Part B Medical Review Newsletter/Sept. 2020. READ MORE   

8/25/2020 - Fee Schedule Adjustments Reminder for 99441-99443. READ MORE 

8/17/2020 - Cyber Alert - NGS wants to share the following alert from the HHS Office of Civil Rights Office issued Friday 8/14/20. READ MORE 

7/27/2020 - Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27, 2020. READ MORE 

7/21/2020 - NGS Portal/Production Notice - NGS Incorrect Denials of COVID-19 Claims. READ MORE 

6/24/2020 - Registered Dietitians and COVID-19 Allowances for Billing. READ MORE 

6/16/2020 - Changes in Guidance for E/M Telephone Services: We are informing providers of a recent revision in interpretation and guidance for use of CPT codes 99441-99443 for telephone E/M services. READ MORE 

6/9/2020 - NGS Alert on Proper Billing for Telehealth Service Claims. READ MORE 

6/2/2020 - Modifier CS and COVID-19 Billing. READ MORE 

5/22/2020 - NGS Telehealth Billing Facts for COVID-19 (updated 5/22/2020). READ MORE 

5/19/2020 - A time-based E/M service, during which > 50% of time is spent in counseling/ coordination of care, may be performed via telehealth. Counseling/coordination of care time will not come into play if Provider chooses to follow the 2021 E/M guidelines for office and other outpatient services that the AMA has posted. READ MORE 

5/14/2020 - Modifier CR as it Relates to Medicare Part B and COVID-19 Billing. READ MORE 

5/14/2020- During the COVID-19 PHE, the modifier 95 should be used when a real-time interaction between the provider at the distant site and the patient at an originating site occurs via an audio or an audio and video telecommunications system.
READ MORE 

4/26/2020 - News and Alerts/Production Alerts Issue.  READ MORE 

4/22/2020 - News and Alerts/Production Alerts for J6 & JK Providers. READ MORE 

4/22/2020 - Some electronic remittance advice files (ERAs, 835s) show accelerated payments as positive values in the PLB segment. They should be showing as a negative which indicates a payment. These do not impact the actual payments, just the ERA. NGS is currently working on a fix. READ MORE 

4/22/2020 - NGS is in the process of pausing TPE Medical Reviews. Unable to provide additional clarity on when or how TPE reviews will resume, but Payer will share information as it’s made available.  READ MORE 

4/15/2020 - Proper Billing for Telehealth Service Claims: CMS has received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE (Public Health Emergency) that will be rejected because they were improperly coded with two different POS codes on one claim (example 11-office, 02-telehealth). CMS-1500 paper claim form cannot contain more than one POS. READ MORE 

4/14/2020 - NGS Telehealth Billing Facts for COVID-19 Changes. READ MORE 

4/9/2020 - Message from the Medical Review Team. READ MORE 

4/3/2020 - April 2020 EDI Front-End Quarterly Release: Please be advised that while the CMS-mandated quarterly release for April 2020 will be installed the weekend of 4/5/2020, the code set updates included with this release will not be effective in the EDI Front-End processing system until Wednesday, 4/8/2020. EDI claims sent prior to 4/8/2020 that include any of the new or updated codes will reject in the EDI front-end. READ MORE 

4/1/2020 - CMS has expanded the Accelerated and Advance Payment Program for financial hardship relief for Medicare providers during the COVID-19 pandemic. If you have questions about the Accelerated and Advance Payment Program, you may call the NGS Hotline at (888) 802-3898 for assistance.  READ MORE 

National Institutes of Health (NIH)

6/22/2021 - NIH News Post: Immunity Generated from COVID-19 Vaccines Differs from an Infection. READ MORE

New York Medicaid

8/25/2021 - COVID-19 Billing Guidance for COVID-19 Vaccines. READ MORE 

7/2/2021 - NY Department of Health - Letter to Hospital & Nursing Home Administrators. READ MORE 

5/13/2021 - NOTE Practitioner and Ordered Ambulatory claims submitted prior to June 1, 2021 for dates of service on or after April 1, 2021 that were paid at $13.23 will be automatically reprocessed at the new $40.00 administration fee. Providers do not need to submit claim adjustments. READ MORE 

3/10/2021 - NYS Medicaid FFS Billing Instructions and Fees --CPT Code 0031A- Janssen - ADM SARSCOV2 VAC AD26 .5ML - Fee: 13.23- Effective for DOS on or after: 02/27/21. READ MORE 

2/17/2021 - In accordance with CMS, the fees for high throughput tests will be reduced to $75 effective 01/01/2021. READ MORE 

2/8/2021 - NY State Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines Authorized for Emergency Use. READ MORE 

1/1/8/2021 - New York State Medicaid Coverage Policy and Billing Guidelines for the Administration of COVID-19 Vaccines Authorized for Emergency Use. READ MORE 

12/22/2020 - The services in this guidance document are currently reimbursable by NYS Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) Plans. READ MORE

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. READ MORE 

5/19/2020 - 1.5% Across the Board (ATB) Medicaid Payment Reductions. READ MORE

5/1/2020 - Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency. READ MORE

4/20/2020 - Pursuant to section 1135(b)(1)(B) of the Social Security Act, CMS has allowed states to temporarily waive and/or suspend some of the requirements for providers who wish to temporarily enroll in fee-for-service (FFS) Medicaid for the purpose of assisting with the COVID-19 public health emergency. READ MORE

3/27/2020 - New York State Medicaid Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19). READ MORE

3/23/2020 - Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency. READ MORE

Noridian JE & JF

6/16/2022 - Billing and Coding: Pulmonary Rehabilitation Services - R5 - Effective 5/19/22. This coverage article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY). READ MORE 

5/26/2022 - COVID-19: New Administration Code 0074A for Pfizer Pediatric Vaccine Booster Dose. READ MORE 

5/20/2022 - 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

4/14/2022 - Noridian News: COVID-19 - New Codes for Moderna Vaccine Booster Doses.
READ MORE 

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 

3/17/2022 - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD Q0221. READ MORE 

2/9/2022 - COVID-19 Mass Immunizer A/B Roster Billing Webinar on 2/9/2022. The Noridian Provider Outreach and Education (POE) staff is hosting the COVID-19 Mass Immunizer A/B Roster Billing webinar on February 9, 2022 at 1 p.m. CT. READ MORE 

1/20/2022 - New & Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE - Revised 1/13/22 (MLN Matters SE20016 Revised). Note: CMS revised this article to add the 2022 payment rate for distant site telehealth services and information on RHC payment limits. You’ll find substantive content updates in dark red font (see pages 2, 3, 5, 6 and 7). All other information is the same. READ MORE

12/23/2021 - Noridian News 12/23/21. Medicare FFS Claims 2 Percent Payment Adjustment (Sequestration) Changes. READ MORE 

12/10/2021 - Addition of the QW Modifier to HCPCS Code 86328. MLN Matters MM12557 released 12/10/21, Effective 9/23/2020, Implementation Date 1/3/2022.CR 12557 information. READ MORE 

8/19/2021 - Help protect your patients from COVID-19. Medicare covers the COVID-19 vaccine administration.
READ MORE

8/17/2021 - COVID-19 Vaccines - the Additional Doses/ Coding and Payment. READ MORE 

8/5/2021 - Noridian Alert. HCPCS U0005 Services Underpaid - Resolved 8/5/2021. Provider/Supplier Type(s) Impacted: All providers. READ MORE

7/23/2021 - Noridian News 7/23/21. Travel Allowance for Specimen Collection Improper Place of Service (POS) Billing. READ MORE 

7/19/2021 - Noridian Alert. HCPCS U0005 Services Underpaid. READ MORE 

6/30/2021 - COVID-19 Lab Test Denials. READ MORE 

6/11/2021 - The Noridian Provider Outreach and Education (POE) staff is hosting the Telehealth Services webinar on July 13th at 3:00 p.m. CT. READ MORE

5/26/2021 - Noridian Update: Addition of the Shared System CWF to the Business Requirements for the HCPCS Codes U0002QW and 87635QW Mentioned in Change Request 11765. READ MORE

5/11/2021 - Noridian Alert. Denials for U0002QW and 87635QW. READ MORE 

4/28/2021 - MLN Matters Number: MM12269
Related CR Release Date: April 26, 2021
Related CR Transmittal Number: R10732OTN
Related Change Request (CR) Number: 12269
Effective Date: July 1, 2021
Implementation Date: July 6, 2021
READ MORE 

4/21/2021 - MLN Connects Special Edition - April 20, 2021 - COVID-19 Update: FDA Revoked the EUA for Bamlanivimab When Administered Alone. READ MORE 

4/6/2021 - COVID-19 Accelerated and Advance Payments (CAAP) Recoupment and Netting Hierarchy. READ MORE 

4/6/2021 - Noridian Alert. Claim Denial for HCPCS Code U0005 - DATE RESOLVED 4/1/21. READ MORE 

3/23/2021 - The Noridian Provider Outreach and Education (POE) staff hosted the Telehealth Services webinar on March 23, 2021 at 5:30 p.m. CT. READ MORE

3/18/2021 - Noridian Webinar: Accelerated and Advance Payment Program Updates |Thursday, March 18, 2021, 2-3 PM EDT. READ MORE

3/15/2021 - Claim Denial for HCPCS Code U0005 - RESOLVED 3/3/21. READ MORE 

3/3/2021 - Noridian Alert: Claim Denial for CPCS Code U0005. RESOLVED 3/3/21. Provider/Supplier Type(s) Impacted: Not Applicable. Reason Codes: Not Applicable. READ MORE 

3/2/2021 - Clinicians Ordering Oxygen and Oxygen Equipment - COVID-19 PHE Reference Guide. As a result of the COVID-19 PHE, CMS has issued waivers and flexibilities to assist Medicare beneficiaries in obtaining the services they need and allowing practitioners to utilize home oxygen therapy when they determine it is warranted. READ MORE

2/18/2021 - CMS Takes Further Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment. READ MORE 

2/17/2021 - COVID-19 Revised Clinician Codes Accepted with the CS Modifier. READ MORE

2/8/2021 - Noridian Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels - R11 - Effective January 01, 2021. READ MORE 

2/2/2021 - Noridian Telehealth Services Webinar 2/23/2021 at 3 p.m. CT. READ MORE 

1/27/2021 - COVID-19 Vaccine, Monoclonal Antibodies and Administration. READ MORE

1/13/2021 - COVID-19 Mass Immunizer A/B Roster Billing Webinar (1/20). READ MORE

12/23/2021 - COVID-19 Mass Immunizer A/B Roster Billing Webinar (1/7/21). READ MORE 

12/8/2020 - New and Expanded Flexibilities for RHCs & FQHCs during the COVID-19 PHE - Revised. READ MORE 

12/8/2020 - Your Source for All Noridian COVID-19 Information. READ MORE   

12/4/2020 - Physician Fee Schedule Final Rule: Understanding 4 Key Topics CMS Call. READ MORE 

11/17/2020 - COVID-19 Roster Billing with C-ACE. If you intend to administer the COVID-19 vaccines when they become available, or the new monoclonal antibody bamlanivimab, especially if you intend to roster bill these codes, please download and install the new release of PC-ACE. READ MORE 

11/4/2020 - Noridian Alert. Laboratory Services Denying as Non-Covered with Beneficiary Liability - RESOLVED 11/4/20. Provider/Supplier Type(s) Impacted: Not Applicable. Reason Codes: Not Applicable. READ MORE  

10/15/2020 - Accelerated and Advance Payment (AAP) Program Updates Webinars. READ MORE 

10/15/2020 - Noridian Alert: Laboratory Services Denying as Non-Covered with Beneficiary Liability. READ MORE 

9/3/2020 - COVID-19 Webinar - "Telehealth and Virtual Visits During COVID 19" on September 17, 2020. READ MORE

7/20/2020 - Medicare FFS Response to the PHE on the COVID-19 Revised. READ MORE 

7/2/2020 - COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services. READ MORE 

6/19/2020 - The Noridian Provider Outreach and Education (POE) staff is hosting additional sessions of the webinar, "Telehealth and Virtual Services - During COVID 19" on August 4, 2020.  READ MORE 

6/5/2020 - Webinar Notice - "Telehealth and Virtual Services during COVID-19" June 25, 2020 3:00-4:00 p.m. EDT. READ MORE 

5/2020 - Noridian Administrative Services advising of deductible and coinsurance amounts being applied in error when a CS modifier is present on Part A claims: Noridian is working on system updates and will be adjusting claims. No provider action required; Noridian will mass adjust claims. READ MORE 

5/15/2020 - Provider Enrollment COVID-19 Updates Webinars. The Noridian JE Provider Outreach and Education (POE) staff is hosting Provider Enrollment COVID-19 Updates webinars on 05/19/20 and 05/26/20 at 11:30 am PT.  READ MORE 

5/6/2020 - There was a Common Working File (CWF) “Dark” day on Friday, May 8, 2020 for the annual history archive process. 

4/30/2020 - CR 11765 informs you about the addition of the QW modifier to U0002 and 87365 for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after March 20, 2020.  READ MORE 

4/28/2020 - Claims Processing Error Part A: Claims submitted with modifier CS are applying deductible and coinsurance in error. Noridian is working on system updates and will be adjusting claims. READ MORE

4/7/2020 - New Accelerated/Advance Payment Request Form can be found on the Noridian COVID-19 web pages and on the Forms web page within the Overpayment and Recoupment section.  READ MORE 

3/31/2020 - To support our provider community, we have established a COVID-19 Hotline to help with COVID-19 related inquiries. The hotline number is 866-575-4067. Customer services representatives will be on the line to help from 8 a.m. - 6 p.m. CDT.  READ MORE 

3/23/2020 - 99 percent of Noridian employees are working-from-home. Each of their office locations is closed, and access to those is restricted to a handful of employees with an approved business need. Noridian states they will continue to perform their work with quality and care.  READ MORE 

Novitas Solutions -  JH & JL

4/19/2022 - Novitas News: Over-the-counter (OTC) COVID-19 tests. READ MORE 

4/12/2022 - Novitas News 4/12/22. Roster Billing for Part B Providers. READ MORE

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

3/11/2022 - COVID-19 monoclonal antibody (mAb): Revised emergency use authorization (EUA) for EVUSHELD. READ MORE 

2/11/2022 - Billing COVID-19 Convalescent Plasma in the Outpatient Setting. READ MORE 

2/11/2022 - Novitas Solutions News 2/24/22. COVID-19 monoclonal antibody (mAb): New product and administration codes for Bebtelovimab. READ MORE 

2/4/2022 - COVID-19 News 2/4/22. Billing for COVID-19 vaccine home administration.
READ MORE 

2/3/2022 - Novitas News 2/3/22. Multiple PTAN linked to single NPI claim issue. READ MORE 

1/27/2022 - Novitas News 1/27/22. COVID-19 Vaccine codes: Pfizer pre-diluted vaccine for patients ages 12+ & third dose for immunocompromised patients ages 5–11. READ MORE

1/7/2022 - Novitas Medicare News 1/7/22. COVID-19 vaccines and monoclonal antibodies (mAbs): New product and administration codes for EVUSHELD™ (tixagevimab co-packaged with cilgavimab). READ MORE 

11/5/2021 - Novitas Medicare News 11/5/21. COVID-19 vaccines and monoclonal antibodies (mAbs): New Pfizer vaccine for children and changes for Medicare Advantage plan claims. READ MORE 

8/18/2021 - COVID-19 Vaccines Additional Doses: Codes & Payment Information. READ MORE 

8/16/2021 - COVID-19 News. COVID-19 Vaccines Additional Doses: Codes & Payment. READ MORE 

7/12/2021 - LCDs and related billing/coding articles are now effective, which includes - Respiratory Pathogen Panel Testing (L38916), and Billing and Coding: Respiratory Pathogen Panel Testing (A58575). READ MORE 

5/21/2021 - Important Updates to the COVID-19 Vaccine and Monoclonal Antibody (mAb) Infusions. READ MORE

5/21/2021 - Travel Allowance for Collection of Specimens. READ MORE 

5/10/2021 - Novitas Claim Issues for Part B. CLIA waived codes 87635 & U0002. Reported 5/10/2021. READ MORE 

4/29/2021 - MLN Connects newsletter for Thursday, April 29, 2021: MLN Matters® Articles - Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636. READ MORE 

4/21/2021 - COVID-19 News. 2021 COVID-19 monoclonal antibodies reimbursement. READ MORE 

3/30/2021 - Provider Education Message: Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension. READ MORE

3/29/2021 - News 3/29/21. Roster billing for Part B providers. READ MORE 

2/24/2021 - COVID-19 Vaccine Reimbursement. READ MORE 

2/2/2021 - Webinar: Understanding COVID-19 Vaccine and Monoclonal Antibody Infusion Billing and Coding | February 11, 2021 for A & B Providers. READ MORE 

1/27/2021 - COVID-19 Vaccine and Monoclonal Antibody (mAb) Infusion Billing Alerts. READ MORE 

1/20/2021 - Webinar for A & B Providers: Understanding COVID-19 Vaccine and Monoclonal Antibody Infusion Billing and Coding (1/21/21). READ MORE

1/20/2021 - Novitas MCR News 1/19/21. Billing reminder: 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. Please carefully review the article for additional information. READ MORE 

1/13/2021 - COVID-19 Information: 2021 COVID-19 monoclonal antibodies reimbursement. READ MORE 

12/28/2020 - Novitas Provider Enrollment Hotline for Temporary Enrollments. READ MORE

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

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

10/13/2020 - UPDATE - Provider News on CMS' Amended Repayment Process for the Accelerated & Advance Repayments.
READ MORE 

9/14/2020 - Claims Issues Part B. Skilled Nursing Facility Consolidated Billing and COVID-19. READ MORE

9/14/2020 - Novitas Solutions Claim Issues for Part B. Skilled Nursing Facility (SNF) Consolidated Billing. READ MORE

8/12/2020 - COVID-19 Information. MM11870 - Telehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - Implementation. READ MORE

6/24/2020 - Hospitals: Submission of Medicare GME Affiliation Agreements during the COVID-19 PHE. READ MORE

6/24/2020 - Hospitals: Submission of Medicare GME Affiliation Agreements during the COVID-19 PHE.  READ MORE

5/1/2020 - In accordance with §3709 of the Coronavirus Aid, Relief and Economic Security (CARES) Act, signed on March 27, 2020, the 2% payment sequestration reduction applied to all bi-weekly PIP and Pass-Thru Payments has been suspended through December 31, 2020. READ MORE

5/8/2020 - Limited Systems Availability on Dark Day May 8, 2020. There was a Common Working File "dark day" on May 8, 2020, to perform a history archive.

4/30/2020 - COVID-19 News. New codes for laboratory tests for the novel coronavirus (COVID-19). The Centers for Medicare & Medicaid Services has established new codes for laboratory tests for COVID-19. READ MORE

4/7/2020 - Novitas identified an error with the maximum payment amounts for acute care hospitals, cancer hospitals, and children's hospitals when they requested accelerated payments. They are working diligently to identify the impacted facilities and determine the appropriate maximum payments. Novitas will issue a supplemental accelerated payment to those impacted facilities as soon as possible. No further action is required by the impacted facilities. READ MORE

4/3/2020 - Repetitive Non-Emergent Ambulance Prior Authorization Prepayment Pause due to COVID-19 Update. READ MORE

3/30/2020 - There will be Common Working File "Dark" days from Friday, April, 3, 2020 through Sunday, April 5, 2020 due to the April 2020 release upgrades. The Interactive Voice Response Unit and our Customer Service representatives will have limited availability. Customer Service Representatives will not be able to assist providers with Eligibility Inquiries, Claim Status Inquiries Relating to Eligibility or Claim Denial Inquiries Relating to Eligibility.