Payer COVID-19 policies continue to come in, with anticipated additions over the days and weeks ahead. Payers are relaxing their policies and implementing emergency actions to accommodate the influx of healthcare services needed at this time. Please see below for the latest update(s) since our last alert.
Anthem – Beginning March 26, 2020 Anthem health plans will suspend SELECT prior authorization requirements. The adjustments apply to all lines of business, including self-insured plan members. One important change to note as of March 16, 2020, Anthem is removing prior authorization requirements for skilled nursing facilities (SNF) for the next 90 days. Please note timely filing requirements will remain in place at this time. Anthem has created an FAQ
document to keep providers updated with answers to common questions surrounding COVID-19. For prior authorization details see page two (2) (Click Here).
Paramount – In response to the current and coming impact of COVID-19, Paramount is adjusting its SNF admission criteria to allow for immediate admission to SNF from an inpatient setting, as long as new presumptive admission criteria has been met. For details and applicable documents (Click Here).
UnitedHealthcare (UHC) – UHC continues to adopt measures that will reduce the administrative burden for physicians and facilities to help members more easily access the care they need. In addition to waived costs associated with COVID-19 diagnostic testing; and suspension of prior authorization requirements to post-acute care settings for admissions and transfers, UHC has also suspended review of site service until April 30,2020. For details (Click Here).
Other payer telemedicine information provided by a third party we believe to be reliable, however, due to urgency has not been vetted. For this information (Click Here).
We will continue to partner with our managed care payers throughout the situation and provide updates accordingly. See below for a few things to remember:
- As always, remember to verify benefits and eligibility for each patient prior to providing non-emergent services to ensure coverage, as benefits are plan specific and all enrollees may not be eligible.
- Per payer communications, CMS has removed the three-day waiver for transfers to nursing facilities.
- Telehealth visits should be billed with a place of service 02 with the appropriate modifiers.
- For a list of CMS-approved codes as of 3/17/2020 (Click Here)
We will keep you abreast of the latest information regarding suggestions, policies, and changes surrounding the pandemic.
For more information please contact the Access Advantage Service Box at email@example.com.