March 2020 4

Aetna Eligibility Response Changes Regarding Covid-19

Aetna just sent out the following message:

Overview:

Eligibility and Benefits Inquiry (270/271):

We’ll make the following change:

  • To support our policies regarding member access to telemedicine and diagnostic testing in response to the novel coronavirus (COVID-19), we’re adding the following messages to our Eligibility and Benefits Inquiry responses:
    • Telemedicine cost share
      • Medicare Advantage Plans – While the COVID-19 public health emergency is in effect, there is no cost share for a Medicare member for covered Telemedicine services performed by a PARTICIPATING provider only. Cost share is required if a member sees a non-par provider.
      • Commercial Plans – There is no cost share for a Commercial member for covered Telemedicine services regardless of provider’s participating status with the plan.
    • Diagnostic
      • All Plans – While the COVID-19 public health emergency is in effect, there is no cost share for the member for all COVID-19 and SARS-CoV-2 diagnostic testing performed in an approved laboratory location.

These messages will be available to providers on March 28, 2020. Providers will be able to see these messages when they submit an Eligibility and Benefits Inquiry transaction with any service type code.

COVID-19 Claim Submissions to UHC

UHC just sent out the following announcement:

UNITEDHEALTHCARE SYSTEM NOTIFICATION

DATE: 03/18/2020

RE: COVID-19 Claim Submissions

Effective today, UnitedHealthcare can accept EDI 837 claims with COVID-19 codes. It’s important our trading partners and health professionals are aware of appropriate coding for Novel Coronavirus (COVID-19) claims. Codes to use are as follows:

  • HCPCS: U0001, U0002
  • CPT: 87635

ACTION BY UNITEDHEALTHCARE:

A system update was put in place to add the COVID-19 codes, allowing us to accept claims electronically.

How Has Covid-19 Changed Your Workplace?

Happy Tuesday all. This week I’ve been thinking a lot about how every part of our lives had been changed by Covid-19. Everything from church, to work, to how we socialize with friends has been completely upended in a short period of time. These are crazy times.

My company recommended that we start working from home until further notice. This started me thinking about what other employers are doing so I figured I would ask. How has the Covid 19 pandemic changed your workplace? I know that many of you are on the front lines at doctor’s offices and hospitals. What has your facility or office changed to keep you safe and reduce the chances of exposure? Leave our responses in the comments.

CMS Release 3/14/2020

CMS will have their Q1 release on Saturday March 14th. This is a relatively small release but there is one change in particular that I wanted to bring to your attention. Currently CMS returns the next eligible date for the Pneumococcal Pneumonia Vaccination (PPV) and booster (90670 and 90732)  if you specifically request them. On 3/14, CMS will be removing that information from their eligibility response temporarily. They’re planning to change the way they return that benefit and will add it back to the response at some point in April.

When it’s added back to the response next month, they will return the dates of the last 10 times these services were provided to the beneficiary. They will also be returning the NPI of the provider that rendered the service. They haven’t released the date it will be returned to the response but said it will be “early April”.

 CMS will also be migrating to a more reliable and stable processing environment that should improve any slowness or downtime you currently experience.

They will also be changing the way they require clearinghouses to “enroll” NPIs to get access to the eligibility transactions. Unless you’re a large trading partner/clearinghouse that sends batches, this shouldn’t affect you.