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.

Category 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

The following list of Medicaid benefits have been updated in response to COVID-19 and will be extended through January 21, 2021.

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

The following list of benefits have been updated in response to COVID-19 and will be extended through January 21, 2021.

Type of Service CPT or HCPCS Comment Covered
COVID-19 Lab testing U0001 to U0005,0202U, 0223U to 0226U, 0240U, 0241U, 86328, 86408, 86409, 86413, 86769, 87426, 87428, 87635 to 87637, 87811, 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.


COVID-19 Vaccine and Vaccine Administration

  • As COVID-19 vaccines become available for administration, University of Utah Health Plans continues to actively monitor evolving developments related to the vaccines and will continue to update our website with information.
  • University of Utah Health Plans: Ensures commercial, Medicare Advantage and Medicaid members may receive the COVID-19 vaccine with no out-of-pocket costs.
  • University of Utah Health Plans: Reimburses in-network and out-of-network providers for vaccine administration consistent with CMS rates.
  • As a reminder and per CMS directive, providers that agree to participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek reimbursement, including through balance billing, from a vaccine recipient.
  • Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund (link to: https://www.hrsa.gov/CovidUninsuredClaim )
  • Providers must record details of vaccination in your system of record within 24 hours, and into the applicable public health system as soon as possible and within 72 hours of administration.
  • Providers should encourage patients receiving the first of a two-dose regimen to receive their second dose.
  • Additional information from CMS may be found at: https://www.cms.gov/covidvax
  • Monoclonal antibody treatments contain specific requirements for administration that are considerably more complex than for other services. CMS expects health care providers to maintain appropriate medical documentation supporting medical necessity for the service.

COVID-19 Vaccine and Vaccine Administration Billing Guidelines

Service Codes Comment
Healthy U Medicaid Vaccine and Vaccine Administration 91300, 91301, 0001A, 0002A, 0011A, 0012A
  • Submit claims for vaccine and vaccine administration to State Medicaid FFS
Healthy Premier and Healthy Preferred Vaccine Administration 91300, 91301 (optional on claim) 0001A, 0002A, 0011A, 0012A
  • U of U Health Plans covers the administration of COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by an in-network or out-of-network provider.
  • U of U Health Plans will reimburse the administration of the vaccine at the established CMS national rates.
  • No additional modifiers are necessary to include on the claim. Providers may submit the related vaccine CPT with a $ 0.01 charge amount or may submit the claim with the vaccine administration code only.
  • An E&M service and COVID-19 vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed on the same date of service as the vaccine administration.
  • U of U Health Plans does not reimburse for the vaccine itself.
Advantage U (Medicare Advantage) Vaccine and Vaccine Administration 90001A, 0002A, 0011A, 0012A
  • Submit claims to Medicare. Medicare will reimburse vaccine administration directly on behalf of Medicare Advantage plans. Medicare does not require the CPT for the vaccine itself to be submitted on the claim when provided free of charge (at no cost).
Healthy U Medicaid Monoclonal Antibody and Administration Q0239, M0239, Q0243, M0243
  • Submit claims for Monoclonal Antibody and Administration to State Medicaid FFS
Healthy Premier and Healthy Preferred Monoclonal Antibody Administration Q0239, Q0243 (optional on claim) M0239, M0243
  • U of U Health Plans covers the administration of monoclonal antibody with no customer cost-share (i.e., no deductible or co-pay) when delivered by an in-network or out-of-network provider.
  • U of U Health Plans will reimburse the administration of the monoclonal antibody at the established CMS national rates.
  • No additional modifiers are necessary to include on the claim. Providers may submit the related monoclonal antibody CPT with a $ 0.01 charge amount or may submit the claim with the administration code only if the monoclonal antibody is received free of cost.
  • An E&M service and monoclonal antibody administration code should only be billed when a significant and separately identifiable E&M visit was performed on the same date of service as the vaccine administration.
  • U of U Health Plans does not reimburse for the monoclonal antibody itself when the provider receives the monoclonal antibody free of cost. Otherwise, U of U Health Plans reimburses at 95% of AWP.
AdvantageU (Medicare Advantage) Monoclonal Antibody and Administration Q0239, M0239, Q0243, M0243
  • o Submit claims to Medicare. Medicare will reimburse monoclonal antibody administration directly on behalf of Medicare Advantage plans. Medicare does not require the CPT for the monoclonal antibody itself to be submitted on the claim when provided free of charge (at no cost).


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.


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