Priority Health - COVID-19 Resource Updates

April 23, 2020

COVID-19 update for providers

We’re in this together. Our commitment is to work with you and keep you updated with the information you need to care for our communities.

See our COVID-19 Provider Information Center page for the latest news

 

Remember, to help your patients have $0 cost share for COVID-19 testing and treatment, you need to:

  • Use ICD-10 code U07.1 for patients with a COVID-19 diagnosis so your patient doesn’t have cost-sharing for COVID-19 treatment.
  • Add the CR or CS modifier for visits that result in a COVID-19 test being ordered. Facilities should add condition code DR.

 

Billing and coding updates

We’ve added recently released codes to our website, including U0003, U0004, G2023 and G2024. See our COVID-19 billing and coding page for more details.

 

Telehealth

Billing for telehealth is new to many providers. Here are a few reminders:

  • You must follow the guidelines of the code you’re billing, including time requirements
  • You cannot use codes that specify in-person services or describe services that can only be performed in-person. For example, a chiropractic manipulation must be done in person and cannot be billed using a Place of Service 02.

For more information about our temporarily expanded billable telehealth services and proper coding and billing, see our COVID-19 telehealth page.

 

Member access to free COVID-19 mental wellness tools

To empower our members, we've partnered with a digital health specialist to offer free access to MyStrength, a mental wellness resource specifically focused on COVID-19.

Learn more and share information with your patients.

For immediate behavioral health support
Our on-staff behavioral health team is available 24 hours a day, seven days a week. Members should call the number on the back of their member ID card or log in to their member center.

 

Transitions of care

The decision to discharge a patient from the hospital should be made based on the clinical condition of the patient.

In accordance with guidance from the Centers for Medicare and Medicaid Services (CMS) and the Michigan Department of Health and Human Services (MDHHS), we support the discharge of patients back to their prior living arrangements, including assisted living facilities.

Get more information about transitions of care.

 

Telehealth for Advanced Health Assessments (AHA)

The Centers for Medicare and Medicaid Services (CMS) has issued guidance that telehealth visits (real-time video with audio) are acceptable as risk adjustment encounters, as long as the visit meets the criteria for risk adjustment eligibility. This applies to both Medicare and Patient Protection and Affordable Care Act (PPACA) plans.

What does this mean for you?
If your practice participates in our AHA program, you can see patients via a virtual visit and it will qualify as an AHA encounter. We’ll also pay AHA incentives for AHA-targeted members for AHA visits done via virtual visits.

To meet criteria for a risk adjustment encounter, visits must be done using real-time telehealth that includes video with audio.

More information
Get more information, including how to bill for an AHA visit done via telehealth.

 

We’ll stay in touch

Thank you for your dedication and the care you’re providing our members and communities. We appreciate you and will stay in touch when we have updates.

Stay safe and well,
Your Priority Health team