Meridian - COVID Operational Changes

December 4, 2020

In support of easing administrative burden during this pandemic, we (Meridian) are reinstituting  many of our operational changes from the spring.  If there’s anything we can do, please let us know and we'd be happy to champion it through the organization. 

Thank you for what your organization is doing on the front lines during this time!   We’re very proud of our partnership!

 

IP Authorizations – Urgent & Emergent

o   In Network/Out of Network – Medicaid

§  COVID-19 Requests*

·         No Prior Authorization Required

·         Requesting notification to coordinate discharge planning and follow-up

·         Cost share waived for Prevention, Screening, Treatment

§  Non-COVID-19 Requests

·         Notification extended to 72 hours from date of admission

·         Submission of clinical documentation extended to 30 days of admission

·         Meridian will apply plan policies for medical necessity determination

 

o   In Network/Out of Network – Medicare

§  COVID-19 Requests*

·         No Prior Authorization Required

·         Requesting notification to coordinate discharge planning and follow-up

·         Cost sharing will be waived for Prevention, Screening, and Treatment

 

§  Non-COVID-19 Requests

  • No change

 

o   In Network– Marketplace

§  COVID-19 Requests*

·         No Prior Authorization Required

·         Cost sharing will be waived for Prevention, Screening & Treatment

§  Non-COVID-19 Requests

·         No change

o   Out of Network– Marketplace

§  No change

 

·         Existing Authorizations (Medicaid only)

o   Any existing authorizations will be honored 90 days after the end of the state of emergency

  • Current Michigan State of Emergency in place until the end of January 2021

 

·         Peer to Peer Requests –

  • Extended to 15 days from date of denial
  • Applies to MI Medicaid

 

·         Continued Stay Reviews (Non-Post-Acute)-

  • Applies to MI Medicaid
  • Extended to 10 days from initial review and 5 days thereafter

 

·         Continued Stay Review (Post-Acute)-

  • Applies to MI Medicaid
  •  Extended to 7 days from initial review and 7 days after

 

·         Recoupments

o   Pause all recoupments during state of emergency

  • Restart 30 days from the end of the state of emergency
    • Current Michigan State of Emergency in place until the end of January 2021

 

·         Claim Audits with Record Requests

o   Teams/Vendors will still process

  • Extend timeline to respond to January 31st, 2021

 

·         Telehealth Services:  (Extended thru Public Health Emergency)

o   No prior authorization is required

o   Cost sharing is waived

o   This applies to all services that may be administered virtually

o   This applies to all lines of business

o   This applies to all providers in or out of network

 

 

·         Pharmacy Changes: 

o   Extended Days Supply

§  Formulary limits on Extended Days Supply have been raised to 90 days for non-controlled medications

 

·         Durable Medical Equipment

o   COVID-19 Requests*

§  No prior authorization, quality limits or documentation requirements in accordance with MSA 20-14

§  This applies to all lines of business

§  This applies to in network providers only

o   Non-COVID-19 Request

§  Medicaid/Marketplace will follow MSA 20-14

§  Medicare will follow normal plan policies

 

*COVID-19 Related Diagnostic Code Set

Code

Description

U07.1

2019-nCoV Confirmed by Lab testing (effective 4/1/20)

U07.2

2019-nCOV Lab confirmation is inconclusive or not available (effective TBD)

B97.39

Confirmed Cases-other coronavirus as the cause of diseases classified elsewhere (prior to 4/1/20)

Z03.B818

Exposure to COVID-19 and the virus is ruled out after evaluation

Z20.828

Contact with and (suspected) exposure to other viral communicable disease