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WSMOS COVID-19 Resources

Important: This information is provided for informational purposes only, please go to the source documents and websites for the most up-to-date information.

Centers for Medicare & Medicaid Services (CMS)

CMS webpage Coronavirus (COVID-19) Partner Toolkit Includes links to information and resources on COVID-19 from several government departments and includes information for clinicians, health plans, health care consumers, Medicare beneficiaries, caregivers and more at: https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit.

Centers for Disease Control (CDC)

Latest updates and information on COVID-19 is available at: https://www.cdc.gov/coronavirus/2019-ncov/index.html.  Information for healthcare professionals can be found at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html.

Washington State Medical Association (WSMA)

Monitor the WSMA COVID-19 Response webpage for recent updates, resources, and Clinical and Practice Guidance on COVID-19 at: https://wsma.org/COVID-19

The WSMA also offers a private discussion forum for physicians and PAs in Washington state, regardless of membership status. 

About the COVID-19 Forum

To participate in forum discussions, you must have a WSMA account and be logged in. Any physician or PA licensed in Washington state can create an account, for free, to access the forum—you don’t have to be a WSMA member.

The forum is divided into four topic areas:

  • Testing & Treatment
  • Telemedicine
  • Caring for the Caregiver
  • General

American Society of Clinical Oncology (ASCO)

ASCO maintains a web page of information and resources on COVID-19 including patient care information, provider and practice information, government, reimbursement and regulatory updates and an electronic form to submit COVID-19 questions to ASCO. Access these resources at: https://www.asco.org/asco-coronavirus-information

American Society for Radiation Oncology (ASTRO)

The ASTRO COVID-19 Recommendations to Radiation Oncology Practices includes COVID-19 Clinical Guidance, COVID-19 FAQs, a sample Patient Communication – COVID letter. Access this information at:  https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information

The Society of Surgical Oncology (SSO)

The SSO website contains resources for many surgical oncology specialties which can be useful advice for dealing with delaying surgery, guidelines for triage of cancer surgery patients, managing COVID-19 in surgical systems and more.  Access SSO’s website at: https://www.surgonc.org/resources/covid-19-resources/

Washington Health Care Authority (HCA)

HCA maintains a webpage with resources on COVID-19 for providers that includes operational and billing information for Washington Apple Health (Medicaid) providers, billers and partners including information on telehealth services and technology at: https://www.hca.wa.gov/information-about-novel-coronavirus-covid-19. For COVID-19 billing, coding, or telehealth policy questions contact: HCAAH_COVID19@hca.wa.gov.  

Office of the Insurance Commissioner WA

The Office of the Insurance Commissioner, WA State maintains COVID-19 information, resources and FAQs for consumers, providers, and insurers & regulated entities at: https://www.insurance.wa.gov.

Washington Health Benefit Exchange

Update April 1, 2020 – The special enrollment period due to COVID-19 is now extended through May 8, 2020. Existing enrollees who are facing income changes can self-serve by signing in to report a change. New enrollees are encouraged to search for a local insurance expert or call customer support between 7:30a.m. - 5:30p.m. Monday through Friday to learn about coverage options. Learn More

UW Medicine

The UW Medicine COVID-19 Resource Site includes policies and protocols, developed in response to the outbreak in Western Washington, by the clinical and administrative teams in their system (Harborview Medical Center, UW Medical Center-Montlake, UW Medical Center-Northwest, Valley Medical Center, UW Neighborhood Clinics and Airlift Northwest) and partners Seattle Cancer Care Alliance.  Access the documents at: https://covid-19.uwmedicine.org/Pages/default.aspx.

Association for Community Cancer Centers (ACCC)

ACCC maintains a webpage with updated information on COVID-19 and includes links to information and resources from the Centers for Disease Control (CDC), Centers for Medicare & Medicaid Services (CMS) the Food and Drug Administration (FDA) as well as patient advocacy foundations.  

https://www.accc-cancer.org/home/news-media/coronavirus-response

TELEHEALTH SERVICES RESOURCES & INFORMATION

From the American Medical Association (AMA)

The AMA maintains updated information on telemedicine including: a quick guide, policy, coding and payment, practice implementation and other helpful resources on telemedicine:

https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice

From the Department of Health and Human Services (HHS)

On March 20, 2020, the HHS Office for Civil Rights (OCR) announced that it is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). Covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies.  Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA.  

The notice from HHS, which includes examples of technology that may be used by providers, can be accessed here:  

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Medicare Telemedicine Health Care Provider Fact Sheet:

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

From the New England Journal of Medicine (NEJM)

The NEJM hosts a collection of articles and other resources on the Coronavirus (COVID-19) outbreak, including clinical reports, management guidelines, and commentary on their website at: https://www.jejm.org/coronavirus?query=main_nav_lg. 

From the American College of Physicians (ACP)

The ACP website https://www.acponline.org  includes a COVID-19 Practice Management Toolkit, information and resources on telehealth coding and billing, and a tutorial Telemedicine: A Practical Guide for Incorporation into your Practice – access this tutorial at:  https://assets.acponline.org/telemedicine/scormcontent/?&_ga=2.50834473.1228759002.1584542301-395527866.1580950498#/.

From the Community Oncology Alliance (COA)

COA’s webpage for COVID-19 Practice Resources and Protocols contains many links to resources and information and tools for the oncology practice including COA’s webpage for COVID-19 Practice Resources and Protocols contains many links to helpful information including a very helpful Medicare Telehealth Cheat Sheet: https://communityoncology.org/wp-content/uploads/2020/03/MedicareTelehealthGuideFinal031820.pdf

Access the COA COVID-19 resources here:

https://communityoncology.org/coronavirus-covid-19-practice-resources-and-protocols/

Policy Updates from Private Payors – Expanded Telehealth Services and More

Note: please go directly to the payor’s website for the most up-to-date information.

From Regence BlueCross BlueShield – Updated April 7, 2020

Telehealth expansion

We are temporarily expanding medical and behavioral health telehealth services. This expansion will remain in effect through each state’s emergency declaration. 

Telehealth services can be provided if: 

  • You provide telehealth services to our Individual, group (including administrative only services groups who have opted in to the telehealth expansion) and Medicare Advantage members. View instructions for verifying ASO groups who will temporarily cover virtual services to replace in-person visits
  • You are an out-of-network provider and provide services to our Medicare Advantage PPO members. 
  • You conduct the telehealth visit with your patient using audio or video. We are following the U.S. Department of Health and Human Services’ (HHS’) lead on discretion with respect to HIPAA compliant platform requirementsPulsara offers a free, HIPAA-compliant, video-enabled platform. 
  • The services: 
    • Are safely and effectively delivered via telehealth 
    • Meet the code definition that is billed when provided via telehealth 
    • Meet existing coverage criteria, including pre-authorization requirements and medical necessity 

Member benefits and provider reimbursement 

  • The visits are considered the same as in-person visits and are paid at the same rate as in-person visits. 
  • The member’s copay, coinsurance and deductible will apply to telehealth services, if applicable. 
  • We will cover the telehealth visit related to COVID-19 testing at no member cost share for our Individual, group (including ASO group) and Medicare Advantage members. See below for information about coverage for COVID-19 testing
  • For claims to process correctly and for you to receive reimbursement consistent with an in-office visit, the place of service (POS) must be either POS 11, intensive outpatient (IOP) or partial hospitalization (PHP). The GT modifier will indicate that the services were rendered via telehealth.
    • Note: The location of the service does not need to be in an office. However, claims must be submitted using the instructions above to be paid at the same rate as an in-person visit. 
  • Claims can be submitted for dates of service beginning on March 19, 2020. 
  • Note: We will continue to cover the medical and behavioral health codes, as outlined in our Virtual Care (Administrative #132) reimbursement policy. Claims submitted following the guidelines in this policy will be paid as they have been. View instructions for verifying members' telehealth benefits


BCBS FEP telehealth expansion

In-network providers can provide telehealth services to Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) members. View the BCBS FEP telehealth expansion information

TriWest telehealth expansion
TriWest has determined that providers who wish to use virtual or phone visits to treat patients and provide continued care while staying in compliance with the Centers for Disease Control and Prevention (CDC) guidelines may do so, as long as the provider has an authorization on file first. View TriWest’s Community Providers COVID-19page for more information.

Credentialing

Temporary providers and expedited credentialing

During this health emergency, we are allowing an exception to our Locum tenens policy and expediting credentialing to help meet emerging demands for health care providers and to ensure that our members have access to care. 

Locum tenens

We are making the following exceptions to our Locum tenens policy to allow a provider to identify and authorize care for his or her patients by another provider, during this pandemic: 

  • The use of a locum tenens provider by a participating provider has been expanded to 180 days during this emergency. 
  • A locum tenens can have a valid license in a different state than the one in which they are practicing in. 

Expedited credentialing

If your practice has been directly impacted by COVID-19, please: 

View information below regarding temporary updates to telehealth.

Pharmacy pre-authorization and medication refills

Pharmacy pre-authorizations

All pharmacy pre-authorizations that are due to expire between March 23, 2020, and June 30, 2020, will be extended six months from the current expiration date to alleviate work by providers’ offices. Members will be notified via letter that their pre-authorization has been extended with the new expiration date. We will evaluate any pre-authorizations that expire after this period at a later date. 

Early prescription medication refills

We are allowing for an extended supply of medications:

Commercial members (with the exception of a few self-funded groups)

Allowing for a 90-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease

Members can order home-delivery prescriptions through the AllianceRx Walgreens Primewebsite or by calling 1 (844) 765-2894.

Medicare Advantage members who have medical and pharmacy benefits

Allowing for a 100-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease

Members can order home-delivery prescriptions through the Postal Prescription Services.

Members who have a Medicare Part D prescription drug plan

Allowing for a 90-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease.

Members can order home-delivery prescriptions through the Postal Prescription Services.

Note: Some drugs are not eligible for extended day supply, including controlled substances and certain specialty drugs. Drugs listed on our formularies in the Narcotics and section marked SP are not eligible for an extended supply.

Note: BCBS FEP members: 

  • Can receive early medication refills for 30-day prescription maintenance medications 
  • Have access to a 90-day mail order benefit for prescription medications 
  • Do not have a cost share for prescriptions for up to a 14-day supply

For more information on Regence BC/BS Covid-19 updates and resources go to: https://www.regence.com/provider/library/whats-new/covid-19

From UnitedHealthcare – Updated April 5, 2020:

COVID-19 Telehealth Services

Last update: April 5, 2020, 11:00 p.m. CDT

Starting March 18, 2020, UnitedHealthcare expanded our policies around telehealth services for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. In addition, effective from March 31, 2020 until June 18, 2020, we will also waive cost sharing for in-network telehealth visits for medical, outpatient behavioral and PT/OT/ST, with opt-in available for self-funded employers.

Expanded Provider Telehealth Access

UnitedHealthcare is waiving the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid, and Individual and Group Market health plan members from March 18, 2020 until June 18, 2020. Eligible care providers can bill for telehealth services performed using interactive audio-video or audio-only, except in the cases where we have explicitly denoted the need for interactive audio/video, such as with PT/OT/ST, while a patient is at home.  

NEW! Cost Share Waived for In-Network Telehealth Services 

We will also waive cost sharing for in-network telehealth services for medical, outpatient behavioral and PT/OT/ST services from March 31, 2020 until June 18, 2020 for Medicare Advantage, Medicaid, and Individual and fully insured Group Market health plan with opt-in available for self-funded employers.

For medical and outpatient behavioral telehealth visits, providers can utilize both interactive audio/video and audio-only.

Cost sharing will be waived for in-network telehealth visits. According to plan benefits, out-of-network providers also qualify for telehealth and member benefit and cost sharing will apply, if applicable.

NEW! Expanded List of Services for Telehealth and Virtual Check-Ins.

From March 30, 2020 until June 18, 2020, UnitedHealthcare has expanded the services that can be covered using telehealth, as well as through a Virtual Check-In for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. A list of reimbursable codes that can be used during the waiver period can be found under the Billing Guidance section of Telehealth or Virtual Check-Ins.

Link to UnitedHealthcare's telehealth services update: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services.html

Learn more about UnitedHealthcare's response to COVID-19.

From Aetna and CVS Health:

  • If you request testing related to COVID-19, we’ll waive your Aetna patient’s cost sharing.
  • Aetna Commercial patients pay $0 for covered telemedicine visits until June 4, 2020.
  • Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes. With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video. 
  • Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay. 
  • Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna’s Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient’s ID card to register a recently diagnosed patient. 
  • Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.
  • We’re waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.
  • Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we're waiving early refill limits for a 30-day supply.
  • Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

    Read the lastest updates at:

https://www.aetna.com/health-care-professionals/provider-education-manuals/covid19-letter.html 

From Premera Blue Cross

Updates as of April 7, 2020

  • As of April 7, Premera is following CMS guidance on telehealth payments during the COVID-19 health crisis. 
  • Providers who normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (GT can't be used for a Medicare claim). This allows claims to process for reimbursement consistent with an in-office visit during the public health emergency. This change is in effect through June 30, per CMS guidance. We'll be reviewing claims back to March 6 and will remit any additional funds due.

Cost shares waived for telehealth services: 

Telehealth cost shares will be waived for all in-network providers.  If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through June 30, Premera will reimburse when the claim is processed.

Who is eligible for this in-network expansion?

  • This will not apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, Medicare Advantage, and self-funded plans who opt out.
  • Fully insured plans will be loaded and available on March 25, 2020. Self-funded plans that opt in will be loaded and available by end of day March 26, 2020.
  • This cost share waiver applies to all providers that offer telehealth services through June 30, 2020.

Extensions for prior authorizations for prescriptions:

For drugs with an initial length authorization of 3 months, we’ll extend the authorization for 180 days for reviews performed between March 30, 2020 through June 30, 2020.

We’ll also pull a list of expiring authorizations and anything that expires in the next 3 months will have the authorization extended for 180 days from March 30, 2020.

Be sure to check the latest updates at: https://www.premera.com/wa/provider/coronavirus-faq/.

From PacificSource:

PacificSource has expanded coverage to allow most provider types to bill appropriate E/M services that can be performed in real time via telehealth. PacificSource reimburses for telehealth services as if the service was done in the clinic setting (for services appropriate for telehealth delivery).

PacificSource is suspending prior authorization (PA) and referral requirements related to medical necessity for care rendered March 27 through June 30 for services included on the Prior Authorization Grid. To determine if a service formerly required preauthorization, consult the Prior Authorization Grid at https://authgrid.pacificsource.com. 

Prior authorizations are still required for all benefit coverage exceptions. 

PacificSource has extended most prescriptions and medical drug authorizations that expire between now and June 30 an additional 90 days. New CMS and state regulations will be incorporated into our processes as released. New requests will follow standard prior authorization procedures for medical and prescription drugs. 

For more information go to: https://www.pacificsource.com/providers/

Reminder: This information is provided for informational purposes only, please go to the source documents for the most up-to-date information.