Provider Coronavirus Information

Provider Billing Guidance for COVID-19 Testing

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) and the Washington State Health Care Authority (HCA) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. 

HCPCS and CPT Codes for COVID-19 Testing Services

• Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
  • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
    Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
• All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
• We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
• These testing codes do not require prior authorization.
• Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
• We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
• Adjudication of claims is currently planned for the first week of April 2020.

CMS-Established Reimbursement Rates for COVID-19 Testing Services for All Provider Types*

• We are complying with the rates published on 3/12/20 by CMS:
  • U0001 = $35.91
  • U0002 = $51.31
  • Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.
• Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

Telehealth for Apple Health/Medicaid

For our Medicaid members, Coordinated Care covers telemedicine services provided by our community providers in accordance with all Health Care Authority (HCA) policies and guidelines as outlined in HCA’s published billing guidelines and fee schedules.

• For Apple Health members, visit our Coordinated Care telehealth page.
• For Apple Health/Medicaid providers, please refer to the HCA telehealth FAQ (PDF)
• We recommend all providers refer to the HCA clinical and policy guide for COVID-19 (PDF)
• In addition, Coordinated Care contracts with Teladoc, a telehealth provider network. Teladoc delivers 24-hour access to in-network healthcare providers for non-emergency health issues at no cost.
• Members can receive medical advice, a diagnosis, or a prescription for colds, flu, fever, rash/skin conditions, sinuses/allergies, respiratory infections, and behavioral health.
• For more information on Teladoc, visit the Teladoc web site. 
• To make telehealth more accessible, members with SafeLink wireless smart phones will have an extra 5GB of data for the remainder of March and another 5GB for the month of April. Members with Connection plus phones have unlimited minutes/text.
• HCA has purchased a limited number of licenses for Zoom, a video conferencing technology platform that helps providers with telehealth visits. Please visit HCA’s website to see if you are eligible and to apply for this benefit.

Behavioral Health and Billing During COVID-19

HCA's Behavioral Health Policy and Billing FAQ (PDF) reinforces the state's current policies regarding telemedicine as defined in WAC 182-531-1730 and covers new telehealth policies that will only be in effect during this health care crisis.

Health Home (HH) and Home Visits

• Per CDC guidelines and CMS guidance, we are not currently doing any home visits with our members. 
• We are following HCA’s Health Home Guidance (PDF).

Alien Emergency Medical COVID-19 Coverage Expansion

• Alien Emergency Medical (AEM) clients can access care within the provider’s office setting (outside of the emergency department, inpatient and other outpatient settings) to diagnose and treat COVID-19.
  

General claims processing, including initial bills and appeals

• We do not anticipate issues and will continue to operate as normally as possible. If there is an issue where we cannot process claims, we will notify you.
• For fastest payment, enroll in EFT.

Existing Authorizations 

• We have extended existing authorizations by an additional 60 days and we have issued written communications and outreaching to members affected by this. We will be re-evaluating extensions as needed. 
• If you have questions on a specific authorization, please check the Provider Portal for an updated status.
  
  

Telehealth for Ambetter Members

To ensure all our members have access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency. 

Effective immediately, the policies we are implementing include:

• Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth* 
• Any services that can be delivered virtually will be eligible for telehealth coverage 
• All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020 
• Telehealth services may be delivered by providers with any connection technology to ensure patient access to care**

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services. 

**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.

• Our Ambetter members also have access to Teladoc, a telehealth provider network. Teladoc delivers 24-hour access to in-network healthcare providers for non-emergency health issues with $0 copay. 
• Members can receive medical advice, a diagnosis, or a prescription for colds, flu, fever, rash/skin conditions, sinuses/allergies, respiratory infections, and behavioral health.

For more Coronavirus Guidance related to Ambetter, visit our Coronavirus Guidance page for providers on our Ambetter web site.