U of U Health Plans Provider Information Regarding COVID-19

Like you, U of U Health Plans is diligently working to ensure the health and safety of our members as we all navigate through the Coronavirus (COVID-19) pandemic. Our foremost priority is, as always, the health and well-being of our members, providers, and communities. Our hearts go out to all people in the US and worldwide who are suffering directly from COVID-19, or indirectly by the measures that have been taken to contain its spread.

This interim COVID-19 bulletin includes information about benefit and operational decisions that have temporarily been updated in support of COVID-19 testing and treatment. We highly encourage the use of telemedicine services and virtual visits to help avoid the further spread of the virus. We will continue to review, monitor, and enhance this information to keep you informed about this changeable environment. Additional updates will be posted as they become available.

We’ll also notify you of updates regarding this and other U of U Health Plans information through our provider newsletter, Provider Connection. Accessing the newsletter online makes it easier to share with everyone in your office. To ensure you receive the latest newsletter as soon as it’s available, subscribe to our email list at the bottom of the newsletter web page. We promise we won’t spam you, and we’ll never share your information.

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Provider Information

University of Utah Health Plans is committed to supporting our providers in this important effort to help contain and manage through the COVID 19 pandemic by ensuring our members and your patients have continued access to quality health care despite such challenging circumstances.

We appreciate our provider partners and hope that the following changes and information benefits your efforts in responding to the COVID-19 pandemic.

Latest Updates

Updates
Prior Authorization Beginning April 1, 2020 U of U Health Plans temporarily suspended most of its prior-authorization requirements. The prior authorization requirements that remain in effect are focused on patient safety, supporting member care needs, minimizing the potential for “surprise bills,” and maintaining our commitment to timely and accurate claims payment. UUHP is taking this step to support hospitals, physicians and other clinicians as they manage the disruption caused by the COVID-19 pandemic.
Provider Network Administration U of U Health Plans is also suspending or postponinge various provider network administrative processes, such as re-recredentialing and quality reporting. These changes will be made as allowed by state and federal law. For questions about your credentialing status, email provider.credentialing@hsc.utah.edu or call 801-587-2838 option 3.
The prior authorization changes and the provider credentialing changes will be in effect for 90 days, through the end of June 2020. This time frame will be reexamined periodically, and may be extended as appropriate.

Additional Information

Updates
Early refill of prescriptions may be considered, however, other options include 90-day prescriptions and/or mail order service. Certain DME supply quantities or authorization requirements for identified supplies have been relaxed during this pandemic.
Enteral and DME supply quantities (e.g., 30 or 90-day supplies) will remain unchanged.
Effective immediately and for a minimum of 90-days, any contracted provider who is eligible to provide telehealth services may extend this option to our members. Eligible provider types include contracted physicians, nurse practitioners, physician assistants, certified nurse midwifes, CRNAs, psychologists, licensed clinical social workers, registered dieticians, licensed behavioral analysts, rehab therapists, clinical mental health counselors, licensed professional counselors, and licensed addiction counselors.
Payment rates for telehealth visits are equivalent to face-to-face visits.
There are no geographical restrictions on telehealth visits (i.e., does not need to be a rural designation).

Coding Information

Type of Service CPT or HCPCS Comment Covered
COVID-19 Lab testing U0001 to U0004, 86328, 87635, 86769, and related specimen-collection codes Yes
Telehealth visits Per the CMS Medical and Behavioral approved list of services and CPTs 97153, 97155, and 97156 for ABA therapy; CPTs 99381 to 99387 and 99391 to 99397 for Preventive Exams
Refer to CMS Telehealth Codes
Bill with POS 02 or Modifier-95 Yes
Telephone visits CPTs 99441 to 99443 and 98966 to 98968
(Physician Assistants and Nurse Practitioners)
Yes
Brief check-in HCPCS G2010 and G2012 No
Online E & M CPTs 99421 to 99423, HCPCS G2061 to G2063 No

Member Benefits

To help support you in assisting your patients, the following grid summarizes member benefits implemented temporarily to ensure coverage of COVID-19 testing and treatment.

Benefit Description Coverage
In person office visits, urgent care and emergency room visits related to COVID-19* Commercial: Covered 100% with in network provider
Healthy U Medicaid: Standard benefit applies
Testing related to COVID-19 ordered by a healthcare provider Commercial: Covered 100% with in-network provider
Healthy U Medicaid: Covered 100% with in-network provider
Treatment related to COVID-19 Commercial: Covered at the current benefit level
Healthy U Medicaid: Covered at the current benefit level
Telehealth visits with member’s healthcare provider (audio or video) related to COVID-19 Commercial: Covered 100% with in-network provider
Healthy U Medicaid: Standard benefit applies
Telehealth urgent care medical visits through MDLive* or U of U Health Virtual Urgent Visits (COVID-19 related or non COVID-19 related) Commercial: Covered 100%
Healthy U Medicaid: Covered 100%
* MDLive not in-network for Healthy U and some employer group members. See member ID card for appropriate vendor.
Pharmacy prior authorization The U of U Health Plans has worked with its Pharmacy Benefit Manager (PBM) partner to reduce administrative burden on prescriptions for certain medications. The changes will be in place through the end of July (07/31/2020). The list will be re-evaluated monthly to determine the continuing need. The medication list includes: Respiratory Inhalers, Gastrointestinal Therapy Agents, Migraine medications, Diabetes drugs, and, prescriptions for mood.
Future updates will be posted on the website. For a full list of affected prescriptions, please see Covid-19 Reduced Administrative Burden Prescription list
Early prescription refills Available on a case-by-case basis by working through member’s local pharmacy. Options also include 90-day refills and mail-order services.

As you know, these are changeable times for health care policies. Please regularly visit Coverage Policies for the most current updates.


Questions?

For member benefits or claims questions, please contact Customer Service for the following lines of business:

Line of Business Customer Service Phone
Healthy U Medicaid801-213-4104 or 833-981-0212
U of U Health Plans Commercial Groups801-213-4008 or 833-981-0213
U of U Health Plans Individual and Family Plans801-213-4111 or 833-981-0214

For any other questions, contact your Provider Relations consultant.

We appreciate the outstanding care you have and continue to provide our members. Times like these prove the unequaled commitment of the healthcare professionals in our networks.