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News & Press: COVID-19

March 27 Update from Florida Blue

Monday, March 30, 2020   (0 Comments)
Posted by: DCMS
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Please see this message from Florida Blue:

In response to the coronavirus disease (COVID-19), we support the work of our providers, the Florida Department of Health and the Centers for Disease Control and Prevention (CDC). We’ve made additional process updates for our commercial, Affordable Care Act (ACA), Medicare Advantage and Federal Employee Program® (FEP) lines of business. These remain in effect until further notice. We’ll keep you informed as information changes. Note: For easy reference, new updates are noted in red throughout the communication.

 

COVID-19 Provider News and Announcements Repository

Click here for the latest provider coronavirus information on floridablue.com including past provider communications, additional resources and more.

 

COVID-19 Provider Billing Guidelines

We’ve established billing guidelines for our commercial, Affordable Care Act (ACA), Medicare Advantage and Federal Employee Program® (FEP) lines of business. To ensure proper, timely reimbursement, please submit claims using the guidelines in the link below. Note: Please check these guidelines often as they will be updated on a regular basis. These remain in effect until further notice. Click here for the COVID-19 Provider Billing Guidelines.

 

Medicare Advantage Members

·         Referrals. We are relaxing referral requirements for all service types during this time. Please attempt to obtain a referral through your existing process. If you are unable to obtain a referral, please proceed with providing treatment. Claims will not be denied for failure to obtain a referral, but will be reviewed for medical necessity and processed according to the member’s contract benefits.

·         Out-of-Network Providers. If a medically necessary service is not available from an
in-network provider, members may seek care from an out-of-network provider and claims will process at the in-network benefit.

·         Medical Test, Office Visits and Related Services.

o   The medical test for COVID-19 is available at no cost to our members.

o   Office visits and related services that result in an order for the COVID-19 test are at no cost to our members.

o   Testing is currently provided at no cost by state and federal health authorities.

o   If testing is provided by independent labs or physician offices, the member’s cost share for these tests only will be waived. The appropriate codes for COVID-19 testing are HCPCS codes U0001 and U0002 and CPT code 87635.

·         Telemedicine and Teladoc®. During the COVID-19 crisis, members are encouraged to take advantage of virtual visit options for less serious medical issues to limit the spreading of COVID-19. Members can access virtual visits in two ways:

o   Option 1: Teladoc

§  All Medicare Advantage members have access to Teladoc virtual visits.

§  Teladoc visits are at no cost to members through Florida Blue.

§  Click here to find the Teladoc information members received from us.

o   Option 2: Telemedicine

§  Primary care providers, behavioral health network providers and specialists can bill for virtual visits if they have telemedicine capabilities and want to consult with their patients virtually.

§  The virtual visit will be in effect for the next 90 days and reimbursement will be based on your current fee schedule. Florida Blue will assess any potential extension to this timeframe and update you as needed.

§  The member will be responsible for their normal office visit cost share for this
virtual visit.

§  For general medical care, you should submit a claim to Florida Blue using the regular Evaluation and Management (E/M) codes (99201-99215). The place of service should be 02 and the modifier should be 95 or GT.

§  For behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule with a place of service 02 and the modifier should be 95 or GT.

§  Expanding virtual visits. The expansion of the additional services for virtual visits will be in effect for the next 90 days. Florida Blue will assess any potential extension to this timeframe and update you as needed.

·         Network behavioral health outpatient facilities performing intensive outpatient and partial hospitalization services can bill for virtual visits if they have telemedicine capabilities and want to consult with their patient virtually. You should submit a claim to Florida Blue using the applicable revenue code and HCPCS code (IOP MH 0905, H0015, IOP SUD 0906, S9480, PHP 0912 or 0913, S0201). The place of service should be 02 and the modifier should be 95 or GT. Notification or authorization for services are required and the member’s cost share will apply. If you have an existing authorization the authorization does not need to be modified for place of service 02 and will apply based on the number and type of visits/units already authorized. Reimbursement will be based on your current fee schedule.

·         CareCentrix home health agency services are now available through virtual visits, if clinically appropriate and accompanied by patient consent. CareCentrix has established clinical guidelines to determine when services cannot be rendered as a virtual visit. Many CareCentrix home health services can be rendered virtually, including the initial assessment performed by a CareCentrix RN and standard services rendered by a CareCentrix RN, LPN, Clinical Social Worker and Physical, Occupational, and Speech Therapist. The ordering provider should use existing processes to submit home health orders to CareCentrix. Registration or authorization for services is required and existing registrations and authorizations do not need to be modified for place of service 02. The member’s cost share will apply to the virtual visit.

§  Florida Blue continues to explore other services related to virtual visits. We’ll keep you updated as new information is available.

 

Prescription Drugs

·         We’re providing early access to 30-day prescription refills of medications (consistent with the member’s benefit plan).

·         Members are encouraged to use the 90-day mail order benefit.

 

Additional Services                                 

·         In partnership with New Directions Behavioral Health, members experiencing stress related to COVID-19 can talk to specially trained behavioral health counselors at no cost via a 24/7 toll-free help line at 833-848-1762. Further referrals from these hotline calls will be covered per the member’s normal benefits/cost shares. Counselors will not be able to assist with questions about COVID-19 testing or treatment, so members should call Florida Blue at the number on the back of their member ID card for help with those questions.

 

Commercial / Affordable Care Act (ACA) Members

·         Medical Test, Office Visits and Related Services.

o   The medical test for COVID-19 is available at no cost to our members.

o   Office visits and related services that result in an order for the COVID-19 test are at no cost to our members.

o   Testing is currently provided at no cost by state and federal health authorities.

o   If testing is provided by independent labs or physician offices, the member’s cost share for these tests only will be waived. The appropriate codes for COVID-19 testing are HCPCS codes U0001 and U0002 and CPT code 87635.

·         Telemedicine and Teladoc®. During the COVID-19 crisis, members are encouraged to take advantage of virtual visit options for less serious medical issues to limit the spreading of COVID-19. Members can access virtual visits in two ways:

o   Option 1: Teladoc

§  Many members have access to Teladoc virtual visits.

§  Teladoc visits are at no cost to members through Florida Blue.

§  Click here to find the Teladoc information members received from us.

§  Note: For self-insured employer groups, it is at their discretion whether they offer this coverage and what the member’s cost share will be.

o   Option 2: Telemedicine

§  Primary care providers, behavioral health network providers and specialists can bill for virtual visits if they have telemedicine capabilities and want to consult with their patients virtually.

§  The virtual visit will be in effect for the next 90 days and reimbursement will be based on your current fee schedule. Florida Blue will assess any potential extension to this timeframe and update you as needed.

§  The member will be responsible for their normal office visit cost share for this
virtual visit.

§  For general medical care, you should submit a claim to Florida Blue using the regular Evaluation and Management (E/M) codes (99201-99215). The place of service should be 02 and the modifier should be 95 or GT.

§  For behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule with a place of service 02 and the modifier should be 95 or GT.

§  Expanding virtual visits. The expansion of the additional services for virtual visits will be in effect for the next 90 days. Florida Blue will assess any potential extension to this timeframe and update you as needed.

·         Network behavioral health outpatient facilities performing intensive outpatient and partial hospitalization services can bill for virtual visits if they have telemedicine capabilities and want to consult with their patient virtually. You should submit a claim to Florida Blue using the applicable revenue code and HCPCS code (IOP MH 0905, H0015, IOP SUD 0906, S9480, PHP 0912 or 0913, S0201). The place of service should be 02 and the modifier should be 95 or GT. Notification or authorization for services are required and the member’s cost share will apply. If you have an existing authorization the authorization does not need to be modified for place of service 02 and will apply based on the number and type of visits/units already authorized. Reimbursement will be based on your current fee schedule.

·         CareCentrix home health agency services are now available through virtual visits, if clinically appropriate and accompanied by patient consent. CareCentrix has established clinical guidelines to determine when services cannot be rendered as a virtual visit. Many CareCentrix home health services can be rendered virtually, including the initial assessment performed by a CareCentrix RN and standard services rendered by a CareCentrix RN, LPN, Clinical Social Worker and Physical, Occupational, and Speech Therapist. The ordering provider should use existing processes to submit home health orders to CareCentrix. Registration or authorization for services is required and existing registrations and authorizations do not need to be modified for place of service 02. The member’s cost share will apply to the virtual visit.

§  Florida Blue continues to explore other services related to virtual visits. We’ll keep you updated as new information is available.

 

Prescription Drugs

·         We’re providing early access to 30-day prescription refills of medications (consistent with the member’s benefit plan).

·         Members are encouraged to use the 90-day mail order benefit.

 

Additional Services                                 

·         In partnership with New Directions Behavioral Health, members experiencing stress related to COVID-19 can talk to specially trained behavioral health counselors at no cost via a 24/7 toll-free help line at 833-848-1762. Further referrals from these hotline calls will be covered per the member’s normal benefits/cost share. Counselors will not be able to assist with questions about COVID-19 testing or treatment, so members should call Florida Blue at the number on the back of their member ID card for help with those questions.

 

Federal Employee Program (FEP) Members

·         Prior authorizations are waived for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. 

·         Copays or deductibles are waived for diagnostic tests or treatments that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. 

·         Copays are waived for all telehealth services provided by Teladoc. If the member chooses to see a provider who is not in the Teladoc network, they will be responsible for their normal office visit cost share for the virtual visit.

·         FEP members should consult their pharmacy benefit manager for questions related to their prescription medications.

·         For more information, please visit fepblue.org.