COVID-19 Provider Resources
New Telehealth Policies Expand Coverage for Healthcare Services
In order to ensure that all of our members have needed 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. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.
Effective immediately, the policies we are implementing include:
- IlliniCare Health will pay providers for telemedicine visits in lieu of in-person visits to support evaluation, assessment and treatment of members
- Any services that can be delivered virtually will be eligible for telehealth coverage
- 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.
Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.
We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people.
Provider Billing Guidance For COVID-19 Testing, Screening & Treatment Services
We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).
- IlliniCare Health will remove Prior Authorizations for physical, occupational, and speech therapies, home health and certain durable medical equipment and supplies.
- Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy® through their mail order pharmacy at www.caremark.com.
- All current pharmacy prior authorizations have been extended for an additional 60 days.
- IlliniCare Health is waiving early refill limits on 30-day prescription maintenance medications for all IlliniCare Health members with pharmacy benefits administered through CVS Caremark.
- IlliniCare Health members may request early refills on 30-day prescription maintenance medications and request 90-day refills of maintenance medications for all pharmacy benefits administered through CVS. This includes new prescriptions and refills. Please allow 90-day supply of maintenance medications through both mail order and retail pharmacies, especially for members discharging from an inpatient facility given the current availability of follow-up appointments.
- Through existing care management programs, IlliniCare Health will proactively reach out to your patients who are most at-risk for COVID-19.
|B97.29||Other coronavirus as the cause of diseases classified elsewhere||U0001||This code is used specifically for CDC testing laboratories|
|Z03.818||Encounter for observation for suspected exposure to other biological agents - ruled out||U0002||This code is used for non-CDC testing laboratories|
|Z20.828||Contact with and (suspected) exposure to other viral communicable diseases||87635||This code is used for non-CDC testing laboratories (effective 3/13/2020).
Provider can choose to use U0002 or 87635
Telehealth Related Denials
To be reprocessed automatically by IlliniCare Health.
Medical Claim Denials:
- EXCL deny: no action needed - will be reprocessed after state reviews new code
- EX46 deny: this service is not covered, do not bill member
BH Claim Denials:
- EXXE deny: revenue/procedure code billed for the diagnosis submitted is not covered
- EX46 deny: this service is not covered, do not bill member
- EXRM deny: inappropriate taxonomy submitted for services provided
Additional COVID-19 Provider Information
A specimen must be collected by a health care provider for COVID-19 testing. The test requires a nasopharyngeal (NP) swab in viral transport medium, bronchial washings, or bronchoalveolar lavage (BAL) specimen, which are collected from the nose, throat or lungs.
Members will not be billed for COVID-19 testing, as the new Families First legislation requires all health plans to provide full coverage of COVID-19 testing without cost share.
Physicians and providers managing suspected COVID-19 cases will contact the appropriate public health department in accordance with local reporting requirements. The public health department will then initiate diagnostic testing and guide people on any at-home, self-monitoring, at-home supervised isolation or quarantine requirements. It's unknown how much COVID-19 lab testing will be done outside of CDC and state labs. The commercial labs will help with the testing, but it's unclear what volume or capacity they will be able to take on.
The Families First Coronavirus Act was signed into law on March 18, 2020. The legislation provides a range of benefit that address the needs of individuals and families related to the COVID-19 outbreak. It provides people with paid leave, protects public health workers, delivers important benefits to children and families and establishes no-cost COVID-19 testing nationally.
Prior authorizations are not required for testing or treatment related to COVID-19. We continue to monitor the situation and will keep providers informed when/if additional changes to our current prior authorization policies are necessary. Currently there is no FDA approved treatment specific to COVID-19. PA for PT/OT/ST, home health, and some DME is waived in accordance with the 1135 waiver until the end of the emergency.
In addition to the appropriate oral evaluation code, (for example D0140) one of the following codes should be reported:
- D9995 tele-dentistry – synchronous; real time encounter. Reported in addition to other procedure (e.g. diagnostic) delivered to the patient on the date of service.
- D9996 tele-dentistry – asynchronous; information stored and forwarded to dentist for subsequent review. Reported in addition to other procedures (e.g. diagnostic) delivered to the patient on the date of service.
Yes. IlliniCare Health’s telemedicine policy is not limited by specialty. If the provider is licensed to render the service, and provides/bills the service according to policy, the service will be covered for members.