COVID-19 Update - Insurance Changes

March 16, 2020

Medicaid and Private Insurers Making Changes to Ease Care During COVID-19 CRISIS

MEDICAID CHANGES

NC Medicaid has announced the following key changes to ease care delivery during the COVID-19 outbreak:

• Allowing payment for telephone visits for existing patients under certain conditions.  Family physicians in private practices can use 99441, 99442 and 99443 for telephonic evaluation and management service with established patients for routine follow up.  Family physicians in private practices should use G2012 for brief technology-based communication with established patients with COVID symptoms.  In both instances, the modifier CR should be used and will bypass time limitations (7 day and 24 hour) and editing on these codes related to COVID-19.  FQHCs and Rural Health Centers have specific codes for those settings.  
• Providing easier access to pharmaceutical refills by extending emergency supply for beneficiaries waiting on prior authorization from 72 hours to 14 days; extending emergency supply for lock-in related medications for locked-in beneficiaries from 4 days to 14 days; allow for 90-day refills; and update the Preferred Drug List on an as-needed basis to account for any drug shortages that may occur.

For more details about Medicaid’s changes, you can go to the Medicaid COVID-19 website at: www.Medicaid.ncdhhs.gov/coronavirus.

 BLUECROSS NC Changes

Blue Cross NC implemented several changes effective March 6 to ease care during the COVID-19 outbreak.  They are as follows:  

• Visits to providers that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits so long as they are medically necessary and meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy. For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit.  Please use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits. 
• Waived early medication refill limits on prescriptions including allowing 60-day supplies should a member request two refills at once. In addition, Blue Cross is encouraging 90-day supplies that physicians can order via mail or at a retail pharmacy.
• No Prior Authorization and No Member Cost Share for COVID-19 Testing.
• Finally, Blue Cross NC will waive prior authorization requirements for diagnostic tests and covered services that are medically necessary services, consistent with CDC guidance, for members diagnosed with COVID-19.

UnitedHealthcare

Effective immediately and through at least April 30, 2020, UnitedHealthcare is expanding telehealth services for Medicare and Commercial membership with reimbursement for both video and audio only visits. The termination date may be extended, if necessary, based on the status of the COVID-19 pandemic. 

Please see this link for details regarding coverage information and reimbursable codes:  

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html.

Healthcare Coalition to allow for more rapid coordination and collaboration on the COVID-19 response.  Look for additional information in the coming days.