Priority Health - COVID 19 Updates on Deadlines, Telemedicine and More

April 13, 2020

COVID-19 update for providers

We’re in this together and are committed to working with you. As promised, we’ll stay in touch with information you need to care for our communities.

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

 

Member cost sharing waived for COVID-19 treatment

To support our members during this crisis, we’re waiving all copays, deductibles and coinsurance for the testing and treatment of COVID-19 through June 30, 2020 when COVID-19 is the primary diagnosis.

This means all commercial group, individual, Medicaid and Medicare members can get the testing and treatment they need for COVID-19 from an in-network provider with no out-of-pocket health insurance costs. Members covered by self-funded employer groups are included unless the employer chooses to opt-out.

 

Free at-home prescription delivery
Our members can get free at-home prescription delivery for a limited time through Meijer, CVS and Walgreens. Learn more about our member’s prescription drug options.

 

Bill correctly with the COVID-19 diagnosis code

To help your patients get the right coverage and costs waived for their COVID-19 treatment, add ICD-10 code U07.1 COVID19 when your patients have a diagnosis of COVID-19. This code became available as of April 1.

 

We’ve extended program deadlines

As we continue to assess the COVID-19 situation, we’re reviewing our PCP Incentive Program (PIP) and risk adjustment deadlines.

We have extended some deadlines to give you more flexibility. See the complete list of program deadlines and updates.

 

Moving and credentialing providers

As you address your organization’s capacity needs, we’re making it quicker for you to credential and temporarily move providers.

Moving providers to new locations
Participating providers can treat our members at different locations under the same tax ID. If providers need to move between organizations with different tax IDs:

Credentialing providers
If you have providers who needs to be credentialed to meet demands for capacity during COVID-19, complete our Provider Information Form and check "yes" on the COVID-19 question at the top. For more information, see our Disaster Credentialing process within the Practitioner Credentialing Overview policy.

 

Telehealth updates

Care management codes now billable using Place of Service 02
We know the importance of continuing to manage your patients’ health. To support you and ongoing care management, we’ve expanded your options to bill care management codes with a Place of Service 02.

See our COVID-19 telehealth page for a list of codes.

Clarifying telehealth billing and coding
We’ve extended the timeframe for our expanded coverage of telehealth codes. Effective March 26 through June 30, 2020, we'll temporarily allow credentialed providers to bill routine practice codes with a Place of Service 02 and be paid the standard facility-based rate.  The visit must follow the guidelines of each code, including the time requirements. 

We’re also allowing for real-time, interactive audio-only telehealth encounters so you can serve patients who don’t have internet access or audio-visual capabilities.

Learn more at our COVID-19 telehealth page.

 

Prior authorizations

Prior authorizations should be quick and easy. Even before this situation, we: 

  • Processed urgent inpatient admissions and post-acute requests in 24 hours
  • Never required authorization for observation stays
  • Reviewed and auto-approved ICU and critical care cases
  • Worked seven days a week for quick turnaround

We've also made changes to remove barriers and facilitate access to patient care during COVID-19.
 

Facilities

  • You have 90 days to submit a retro authorization
  • We're processing authorization requests for inpatient and post-acute admissions within 24 hours
  • Intra-hospital transfers via ambulance to create bed capacity for COVID-19 treatment do not require authorization

 

Post-acute care
We have:

  • Never required a three-day inpatient stay before transfer to post-acute care
  • Shortened the processing time for post-acute authorizations to 24 hours to help discharge patients quickly

 

Elective procedures
We're honoring prior authorizations for elective procedures approved prior to the COVID-19 outbreak that were canceled or are pending rescheduling for members who have continuous enrollment in their plan at the time of service.

 

High-tech imaging, genetic testing and musculoskeletal services
We've:

  • Removed all out-of-network rendering site restrictions for Medicare Advantage and Medicaid, effective Mar. 23, 2020
  • Moved all authorizations to a 180-day period, effective Mar. 26, 2020, dependent on continuous enrollment at time of service
  • Streamlined COVID-19-related high-tech imaging guidelines

Learn more about prior authorization requirements.

 

We’ll stay in touch

We appreciate your ongoing partnership and patience as we work together to serve our communities during this crisis.

Stay safe and well,
Your Priority Health team