Private Payer COVID-19 Policies
Private Payer Updates
ASTRO has compiled recent changes private payers have made to telehealth and prior authorization policies for the COVID-19 public health crisis. This list will be updated as new information becomes available. Practices can email ASTRO’s Health Policy team to share policy additional updates.
United Healthcare
Telehealth Policy
Care providers may conduct a telehealth visit from any private, secure location that will support member privacy; UnitedHealthcare is waiving the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid and commercial members from March 18, 2020 until June 18, 2020. Eligible care providers can bill for telehealth services performed using interactive audio/video or audio only, except in the cases where we have explicitly denoted the need for interactive audio/video such as with PT/OT/ST, while a patient is at home.
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Additional
Medicare Advantage: www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/telemedicine-telehealth-services.pdf
Aetna
Telehealth Policy
The use of telemedicine is encouraged as a first line of defense in order to limit potential COVID-19 exposure in physician offices. Telemedicine visits are currently covered with no cost sharing to the member. Aetna reimburses all providers for telemedicine at the same rate as in-person visits.
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BCBS
Telehealth Policy
All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services. We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, chat and/or e-visits.
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AIM
Telehealth Policy
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eviCore
Telehealth Policy
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Humana
Telehealth Policy
Humana is encouraging the use of telehealth services to care for its members. Please refer to CMS, state, and plan coverage guidelines for additional information regarding services that can be delivered via telehealth.
Humana will temporarily reimburse for telehealth visits with participating/in-network providers at the same rate as in-office visits Humana understands that not all telehealth visits will involve the use of both video and audio interactions. For providers or members who don’t have access to secure video systems, we will temporarily accept telephone (audio-only) visits. These visits can be submitted and reimbursed as telehealth visits.
Link
www.humana.com/provider/coronavirus/telemedicine
Cigna
Telehealth Policy
Cigna will allow providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19.
This means that providers can perform services for commercial Cigna customers in a virtual setting and bill as though the services were performed face-to-face.
Providers should bill using a face-to-face evaluation and management code, append the GQ modifier, and use the POS that would be typically billed if the service was delivered face to face.
Providers will be reimbursed consistent with their typical face-to-face rates. Providers can also bill code G2012 for a 5-10 minute phone conversation, and Cigna will waive cost-share for the customer. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. laims will be processed consistent with these rules beginning April 6, 2020 for dates of service on or after March 2, 2020 and until at least May 31, 2020; Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Reimbursement will be consistent as though they performed the service in a face-to-face setting.
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Anthem
Telehealth Policy
State based adjustment, further divided by Medicare.
Link
www.anthem.com/coronavirus/providers/
GEHA
Telehealth Policy
GEHA has expanded our access to virtual care coverage. The use of virtual care options allows members to connect with care providers from home, minimizing potential exposure to infection while keeping emergency rooms and urgent care clinics available for those with the highest level of need.
Telehealth through MDLIVE provides members access to 24/7 online doctor visits. GEHA is waiving all copays, coinsurance and deductibles for all MDLIVE virtual care visits from now through June 30, 2020. Visit mdlive.com to to activate your MDLIVE account.
Other Virtual Care provided outside of MDLIVE is also covered at 100%, meaning GEHA is waiving all copays, coinsurance, and deductibles for telemedicine visits performed by in-network and out-of-network providers from now through June 30th, 2020. Please note: All virtual care appointments are subject to the same benefit and provider definitions, limitations, and exclusions set forth in the brochure.
Link
www.geha.com/geha-blog/healthy-living/2020/03/16/coronavirus-what-you-should-know
Highmark BCBS
Telehealth Policy
From from March 13 through June 13, 2020 providers are eligible to provide telehealth visits for covered services within the scope of their license, deemed appropriate using their medical judgment, and delivered within the definition of the code billed. In line with the OCR’s decision, Highmark will temporarily relax its current telemedicine policy requirements as they relate to the specific communication applications used.
Link
https://hbcbs.highmarkprc.com/COVID-19/Telemedicine-and-Virtual-Visits
Prior Authorization
United Healthcare
Prior Auth Policy
Prior Auth Submission updates: Revised to 90-day service period instead of prior to a single date of service. Provider does not need to call UHC to change service start or end date as long as it falls within the 90-day service period. Hospital setting: Prior authorization process will ask provider if procedure will be performed in ASC. If yes, prior auth is approved. If no, prior auth continues.
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Aetna
Prior Auth Policy
Prior Auth suspended for Post-Acute Care and Long-Term Acute Care Hospital Admissions. Aetna will revisit and possibly modify on May 6.
Link
https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/prior-authorization-notification.pdf
BCBS
Prior Auth Policy
FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance if diagnosed with COVID-19.
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AIM
Prior Auth Policy
We are closely monitoring Federal and State requirements around prior authorization and will implement changes as necessary. Beyond that, the decision to waive PA requirements for certain services lies with the individual health plans. AIM will work with its clients to support any requested changes to prior authorization programs.
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eviCore
Prior Auth Policy
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Humana
Prior Auth Policy
Effective April 1, Humana will suspend all medical records requests for pre-and post-paid claim review processes for individual and Group Medicare Advantage, Commercial Group, and Medicaid This suspension applies to all professional and facility claims from in-network and out-of-network providers.
Humana will release any claims currently under medical record review as of April 1 and issue payment to providers.
Although medical record claim reviews are suspended, we may request medical records retrospectively once the suspension is lifted. Humana is extending previously approved authorizations to a 90 day approval timeframe, except for home health authorizations, which are being extended for 60 days.
Link
www.humana.com/provider/coronavirus/continuity-of-service
Cigna
Prior Auth Policy
At this time, prior authorization (i.e., precertification) requirements are in place. Hospitals are asked by CMS to delay all elective procedures. Cigna is staffed adequately to respond to all prior authorization requirements for elective procedures. We will continue to assess the situation and adjust to market needs as necessary; Yes. Effective immediately, for all Cigna lines of business, we are temporarily increasing the authorization window for all services from three months to six months at least until May 31st, 2020. This applies to new authorizations as of March 25, 2020
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Anthem
Prior Auth Policy
State based adjustment, which is further divided by Medicare. Medicaid, and Inidividual/family plans.
Link
www.anthem.com/coronavirus/providers/
GEHA
Prior Auth Policy
GEHA has eliminated prior authorization and referral requirements related to COVID-19. Linkhttps://www.geha.com/geha-blog/healthy-living/2020/03/16/coronavirus-what-you-should-know Highmark BCBSPrior Auth PolicyHighmark has extended the timeframe for some procedure authorizations in order to avoid the need for providers to submit a second authorization request. Link |
