UPA Tennessee

COVID-19 Updates

Here's What We Know as of October 2, 2020


Payer updates are changing frequently.

Stay current on policy updates to receive proper reimbursement for telehealth services. UPA has added general guidance from payers for patient cost-sharing to our telehealth services grid below to help ensure appropriate balancing billing and copay collection for patients. Payer policies and additional resources can be found below in our Payer Source Documents section.

Click to view: Telehealth Services by Payer (9/30/2020)


American Medical Association

Netters Atlas

BREAKING NEWS: AMA announces new CPT® codes for multi-virus tests to detect COVID-19 and flu

The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new code additions and editorial revisions for reporting medical services.

For quick reference, the two new Category I CPT code and descriptors are:

87636
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

CPT codes ranging from 87301 to 87430 were also revised by removing the undefined term “multi step method” from code descriptors. The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine.

87426
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

In accordance with the above revision, the CPT Editorial Panel approved a new category I code, 87811, to report infectious agent antigen detection by immunoassay with direct visual observation.

87811
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

In addition to the long descriptors, short and medium descriptors for CPT codes 87636, 87637, 87426 and 87811 can be accessed on the AMA website, along with several other recent modifications to the CPT code set.

For more information you can see the press release here.

Sincerely,

The AMA Team

CPT © Copyright 2020 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.

American Medical Association


On September 8, 2020 the AMA released two new COVID related CPT codes for immediate use.

  • Use CPT 99072 to report the use of additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility based service, when performed during a Public Health Emergency period, due to respiratory-transmitted infectious disease. CPT 99072 is reported for practice expenses related to PPE, staff time for patient symptom screening, and increased sanitation protocols to prevent disease spread.
  • New CPT 86413 is used to report quantitative antibody detection for SARS-CoV-2

Reference link to the following AMA Article for more details: https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance?gclid=EAIaIQobChMIvPPH8-vr6wIVx8DACh0W3gBREAAYASAAEgL0tvD_BwE

Reference link for AAPC Article Blog post: https://www.aapc.com/blog/51794-ama-approves-2-new-cpt-codes-for-covid-19/




Keep Scrolling Down for Payor Source Documents




COVID-19 Payor Source Documents

Intergy Support

The UPA Intergy Support team continues to be available by both email and phone. As things change, we may experience higher call volumes and/or we may transition to working from home as need dictates.

If you call the office with an urgent need and we do not answer the phone, please email Intergy Support and include the word “Urgent” in the subject line of your email. Please use discretion with the word “urgent”.

For after-hours support, continue to direct your team to the UHS IT Helpdesk (helpdesk@utmck.edu) or 865.305.4357)

The Helpdesk will contact whoever is covering after-hours call for the Intergy Support Team (UPA IS).

We are updating the Intergy logon “Splash Page” with a reminder to email Intergy Support at intsup@utmck.edu if anyone needs assistance and cannot reach us by phone.

Last, please remind your team members that UPA IS cannot assist with the following applications:

  • Paycom - contact UPA Human Resources
  • PowerChart Ambulatory

Feel free to share this information with your team members accordingly.

Thank you and stay well,

Teresa A. Matherly
Vice President Information Systems & Chief Information Officer

UPA Newsletters

Click to view release: 5.7.20 RCM



Click icon to view video "Telemedicine Coding & Billing under Waiver 1135 COVID 19"


Updated Document 4.3.2020

Click to view the UPDATED Telehealth Waiver 1135 4.3.20


Click to View Release: 3.30.20 RCM


Click to View: Telemedicine Common "Office" COVID-19 Waiver 1135


Click to view Update 3.24.20

*NOTE See Breaking News segment from the upper section for the updated payor grid details.

CMS

UPDATED DOCUMENT April 3, 2020

Click to view the UPDATED Telehealth Waiver 1135 4.3.20


Click to view: MLN 4.3.20

Click to view: CMS update 4.1.20

Click to view: CMS Trump 3.31.20

Click to view CMS Update 3.31.20

Click to view CMS Covid19 Update 3/30/20

Click to view: Emerg Declaration Fact Sheet 3-13-20

Click to view: CMS Medicare Telemedicine 3-17-20

Click to view: MLN Telehealth

Aetna


Click to view: 7/7/20 Update


Click to view: 4/21/20 Update


Click to view: 3/31/20 Telemedicine Policy


3/26/20

COVID-19: Taking Action

Dear Valued Partner:

We share the same goal: help people get and stay healthy. We’re your partners in health care, and act to serve you and the millions of patients who rely on us for their health care needs.

In response to the rapidly evolving COVID-19 outbreak, CVS Health and Aetna are here to support you with timely answers and information. Through CVS Health and Aetna’s combined resources and your partnership, we can best support your Aetna patients’ health and well-being, ensure their access to medication and remove barriers to care.

We’re here to help you, help your patients and recently announced these resources and enhancements when applicable:

If you request testing related to COVID-19,we’ll waive your Aetna patient’s cost sharing.

Aetna Commercial patients pay {Section} for covered telemedicine visits until June 4, 2020.

Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes.With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video.

Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay.

Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna’s Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient’s ID card to register a recently diagnosed patient.

Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.

We’re waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.

Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we’re waiving early refill limits for a 30-day supply.

Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

Please refer to the “What You Need to Know About the Coronavirus (COVID-19) - Aetna Providers” FAQs on Aetna.com for additional important information. There, you’ll find information about codes related to COVID-19 and selected labs approved to do COVID-19 testing. This page will continually be updated with information as it becomes available to help you care for your patients.

Let’s work together to provide your patients with a clear path to care. Thank you for your continued partnership.

Best Regards,

Angie Meoli
SVP, Network Strategy and Provider Experience


Amerigroup


View September 17, 2020


July 27, 2020

Dear Episodes of Care Provider,

In light of the additional burden of caring for our TennCare members during this pandemic, TennCare has decided to waive all 2019 risk-sharing payments for the Episodes program. This news has also been posted to the TennCare website under “News and Announcements” or you can follow this link: TennCare Memo: Waiving 2019 Episodes Risk-Sharing Payments.

Providers in gain-share on their final 2019 reports will still receive those payments.

Please note the following:

  • Final reports for 2019 AND Quarter 1 reports for 2020 will be out on August 21st. Please use these reports to see how you are trending. You will be notified by email when the reports are posted.
  • No action is required by providers in the risk-share group. You will still see the same data on the final reports but you will not be asked to submit a risk-share payment. Please take advantage of this report to impact your 2020 reports.
  • Providers who have a net gain-sharing payment across all episode types in their final 2019 performance report will receive those payments as planned, with no changes. This means that providers will have any risk-sharing amounts subtracted from their total gain-share to find their net gain-sharing amount. This is the same calculation that occurs every year to calculate a provider’s net gain- or risk-sharing amount.
  • Your Amerigroup team is eager and available to have a webex with your practice. We can review reports, offer provider education, and provide coaching on how to do well with the Episodes Initiative.
  • Reply to this email with requests or questions for your Amerigroup team.
  • TennCare is still analyzing the impact of the pandemic on the 2020 performance period and is open to input from stakeholders. You may provide feedback or suggestions to TennCare by e-mailing the state at Payment.Reform@tn.gov.

Be watching for your notification for your next reports on August 21st.

And we sincerely thank you for your excellent care of your patients during these unprecedented times.

Julie Riedel, APRN, Family Nurse Practitioner

Provider Clinical Liaison

22 Century Blvd., Suite 220, Nashville, TN 37214

O: (615) 316-2400 x 106-126-0154| M: (615) 806-4283

AGPEpisode.Reporting@Amerigroup.com

cid:image001.jpg@01D5DCF4.A4BE8D20


June 9, 2020

Click to view: Amerigroup Tenncare Telehealth Coverage Policy


June 5, 2020

Click to view: Amerigroup Medicare Advantage Telehealth Coverage Policy FAQ


June 2020

Click to view: Amerigroup Medicare Advantage Memo 6/17/2020


May 2020

Click to view: Amerigroup Medicare Advantage

BCBS


Click to view BCBST Provider FAQ 7.2.20


Click to view BCBST Provider FAQ 6.17.2020


Click to view BCBSTN FAQ 5.18.20


Click to view BCBS Telehealth Update 5.14.20


Click to view BCBS FAQ 4.24.20


Click to view BCBS FAQ 4.21.20


Click to view BCBS 4.7.20 UPDATES


Click to view BCBS 4.2.20 FAQ


Click to view PCP Lock-in Requirements


Click to view updated FAQ 3/26/20:

3/26/20 FAQ BCBS


Click to view the documents:

BCBST FAQs


BrightHealth

Click to view: Telehealth eMail 4.3.20

Click to view: DoctorOnDemand 4.3.20

Click to view: Bright 3.19.20 Utilization

Click to view: Bright 3.27.20 Claims

Cigna



11.20.20

Click to view


7.24.20

Click to view


7.23.20

Click to view


7.16.20

Click to view update 7.16.20


5.22.20 Update

Click to view 5.22.20 Update


5.13.20 Medicare Advantage Guidelines

Click to view Cigna Medicare Advantage Guidelines


5.11.20 Update

Click to view 5.11.20 Update


Referral Guidelines

Click to view Cigna Referral Guidelines


4.24.20 Update

Click to view


FAQ 4.13.20

Click to view Cigna 4.13.20 FAQ


Interim Virtual Care Billing Guidelines (3/30/20):

Click to view 3/30/20 Interim Virtual Care Billing Guidelines


3/27/20:

Cigna has released new Telehealth guidelines to expand covered services.

Click the logobelow to view this document:



3/24/20 Data:

PCP referrals for specialist office visits are being waived temporarily until May 31st, effective immediately, for SureFit and IFP Connect Network customers in response to the COVID-19 virus outbreak. Suspending the referral requirement will allow our providers and Clinical Intake teams to focus on COVID-19 critical care needs during this time, such as ER and Urgent admission authorizations.

  • Continue to follow all other processes as outlined in your summary plan description (e.g. Authorizations are still required)
  • Given this is a fluid situation the possibility of extending beyond the May 31st date will be evaluated on an ongoing basis.

Your claims will not be denied without a referral.


We’ve had several providers ask if Physical Therapy could be performed virtually and below are the updates around PT.

Q: Will Cigna temporarily expand coverage of benefits for physical therapy to include virtual care?

A: Yes. There are 2 scenarios:

-A homecare agency that traditionally has provided PT services in the home does them via telehealth and bills “G” codes that will pay according to the fee schedule.

-An traditionally outpatient PT clinic performs PT services in the home via telehealth and bills E&M codes will pay according to their fee schedule


Q: Will Cigna temporarily expand coverage of benefits for physical therapy to allow in network providers to provide care in home as alternative to “in center” traditional therapy services?

A: No. Face-To-Face services in the home are the purview of Carecentrix and homecare agencies.


Click to view Cigna link 3/24/20: Cigna Makes It Easier For Hospitals To Focus On COVID-19 By Helping Accelerate Patient Transfers

Click to view 3/24/20

Click to view 3/18/20

Click to view 3/17/20

Humana


Click to view TeleH Updates 5.21.20


Click to view TeleH updates 5.1.20


Click to view updates for FAQ 5.1.20


Click to view Update 4.13.20 FAQs


Click to view 4.1.20 FAQ


Click to view updated FAQ 3/30/20


Click to view documents below

Click to view 3/23/20 Provider News


Click to view 3/23/20 Telehealth Humana


Provider News 3/23/20



Telehealth Humana 3/23/20


Click to view documents:

Coding Guidance


Humana Website Reference:

https://www.humana.com/provider/coronavirus

https://www.humana.com/coronavirus/covid19-humana-member-resources

TennCare


Click to view Extended Revision 2020


Click to view COVID TennCare Memo Telehealth Extended to end of 2020


August 21, 2020

2019 Final Performance Reports

2019 Final Performance Reports and Q1 2020 Interim Progress Reports Are Now Available for Download

The final performance reports for the 2019 performance year are available on all MCO provider portals. Also available are the interim reports for the first quarter of 2020.

To access your Episodes of Care performance reports, go to each corresponding MCO’s portal:


Amerigroup report platform:
https://www.availity.com/


BlueCare report platform:

https://www.availity.com/


UnitedHealthcare report platform: https://www.uhcprovider.com/

COVID-19 and Episodes of Care

We recognize that the COVID-19 pandemic has created an unprecedented health and economic crisis for the community. In order to continue to support providers during this difficult time, the three TennCare Managed Care Organizations (MCOs) will waive all Episodes of Care risk-sharing payments in the final reports for the 2019 performance period. Gain-sharing payments will be paid out as planned. For more information, please see https://www.tn.gov/content/dam/tn/tenncare/documents2/TennCaresEpisodesOfCareIsWaiving2019RiskSharingPayments.pdf

Again, we are grateful for your continued partnership and thank you for the care you are offering to our members. You can find more information on TennCare’ response during this emergency period by visiting https://www.tn.gov/tenncare/information-statistics/tenncare-information-about-coronavirus.html.

For more information on the Episodes of Care program, please visit our website https://www.tn.gov/tenncare/health-care-innovation/episodes-of-care.html


Click to view Update July 1, 2020


Click to view Update June 4, 2020


Click to view: Bureau of TennCare Memo

May 8, 2020

COVID-19 Guidance


April 27, 2020

Attention TennCare Providers - Telehealth Updates

The original Telehealth cutoff date has been extended from April 30th. Please see the weblinks below for updated Telehealth guidance from each Managed Care Organization (MCO):

Amerigroup Telehealth Update

https://providers.amerigroup.com/Public%20Documents/TNTN_PU_TalkingPointsCOVID19.pdf

BlueCare Telehealth Update

https://bcbstupdates.com/provider-faq/

UnitedHealthcare Community Plan Telehealth Update

https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services.html

Each TennCare MCO will be posting frequent updates on important COVID-19 information to their websites. We encourage all providers to continue checking regularly.

TennCare appreciates all you do and thanks you for serving the healthcare needs of TennCare members.


Click to view Amerigroup 4.9.20 Update


Click to view: TennC MCO EPSDT Telehealth Guidance 4.7.20


Click to view Amerigroup 4.3.20


Click to view: Amerigroup 3/27/20


Click to view the documents:

Behavioral Health 3-18-20

Telehealth & Dx Testing 3-18-20

VA Health Plans


Click to view VA Community Plan Provider Reference Guide 7.23.20


Click to view Tricare East Telemedicine FAQ


Click to view Optum VA CCN Telehealth 3.20.20


Click to view General Provider FAQs


Click to view Telemedicine FAQs

TriWest

Click to view 4.9.20 TriW TeleH


Click to view 3.31.20 TriWest

UHC


UHC

Click to view Plans Provision Guide 7/24/20


UHC

Click to view Extends National Public Health Emergency Changes


UHC

Click to view Provider Billing Guidance


UHC

Click to view UHC COVID Date Provision Guide 7.1.20


UHC

Click to view update 6.17.20


UHC

Click to view update 6.1.20


UHC

Click to view update 5.29.20


UHC

Click to view update 5/7/20


UHC

Click to view update 4.27.20


UHC

Click to view UHC TeleH ABA Codes 4.24.20


UHC

Click to view 4.13.20 Update


UHC

Click to view 4.3.20 UHC Scenerios


UHC 4.2.20

Click to view 4.2.20 UHC


UHC (3/26/20)

Click logo to view details:


Click to view documents:

Telemedicine & Telehealth Policy


3/24/20 Prior Authorization

UnitedHealthcare will issue a press release today about reduced prior authorization requirements and will post the following updates to UHCprovider.com:

Reduced Prior Authorization Requirements
We’re committed to helping people access health care to the fullest extent possible as we come together to address this national emergency. To advance these efforts, UnitedHealthcare continues to adopt measures that will reduce administrative burden for physicians and facilities to help members more easily access the care they need under their benefit plan during this challenging time. The following provisions are effective March 24, 2020:

Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020. Details:

Waiving prior authorization for admissions to: long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF).

Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply.

Length of stay reviews still apply, including denials for days that exceed approved length.

Discharges to home health will not require prior authorization.

Prior authorization is not required for COVID-19 testing and COVID-19 testing-related visits.

Suspension of prior authorization requirements when a member transfers to a new provider through May 31, 2020. Details:

Providers are not required to submit a new prior authorization when a member moves to a different yet similar site of care for the same service (e.g., hospital transfers or practice transfers).

Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer so that the existing authorization can be transferred. Penalties still apply.

And, we may temporarily suspend or relax additional policies as needed in regions where inpatient capacity is most compromised and most at risk. Please watch for updates on UHCprovider.com.

Systems are being updated to reflect these changes. We are also developing a FAQ with additional information, including details about states that may reduce more requirements than these national guidelines. Please check back often for the latest information.

As a reminder, if you receive questions from a provider regarding COVID-19, updates to our policies, etc., please refer them to UHCprovider.com. This site serves as our external source of truth and has the most up-to-date information surrounding our efforts. When there are updates to share, they will be posted promptly to that site.

Thank you for your ongoing commitment during this time.



UHC Website Reference

https://view.yourhealth-wellnessteam.com/?qs=cd1c932b43dbbb4850ef12de896d5e8dd598acf4a3d58b880078c057ddc6cdb823584050391c5dee826c26f4d6681faa87a48975bada3552196b9fe05e2b82388e45610f9a628bf1ca578a269391c0a9

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-faqs.html

Wellcare

Click to view update 7/29/20

Toolkit Links

Telehealth Toolkit for General Pracitioners click:

https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf

End-Stage Renal Disease Providers Toolkit click:

https://www.cms.gov/files/document/esrd-provider-telehealth-telemedicine-toolkit.pdf