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Univera Healthcare Updates on COVID-19 (Coronavirus)
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Last Updated: 03/26/2020
COVID-19 Information and Resources
We are closely monitoring Novel Coronavirus (COVID-19). Our top priority is the health and well-being of the members that we serve. We are also committed to sharing the information we have when it becomes available to us. Because information is changing and evolving daily, please check back regularly. We are in contact with local, state and federal health and other officials and we will implement applicable orders, regulations,and requirements as they become effective.
Please continue to refer to the following websites for up-to-date health information:
§ U.S. Centers for Disease Control and Prevention § New York State Department of Health § Your County Health Department
THANK YOU for your patience, understanding and collaboration as we all rally to navigate this new health care landscape.
- COVID-19 testing will be covered, at no cost to our members, where it is not covered as part of the Public Health Service response. We will also ensure that patient testing and any needed care are done in close coordination with federal, state and public health authorities.
- Members will be covered, at no out-of-pocket expense, for in-network provider office visits, in-network urgent care visits, emergency room visits, and medically necessary diagnostic tests consistent with CDC guidelines related to COVID-19.Providers should not collect a copay or coinsurance for these services from our members.
- Under new guidance from the Internal Revenue Service, members with high deductible health plans will not be responsible for copayments and/or coinsurance for COVID-19-related testing, even if their deductible has not been met.
- If an in-network provider is not available, we will cover testing at an out-of-network provider at an in-network benefit level.
- We will waive preauthorization requirements for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19.
- Dedicated clinical staff are available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19.
- The American Medical Association has released a new CPT® code to streamline COVID-19 testing offered by hospitals, health systems and laboratories in the United States. The code is effective as of March 13, 2020 for use as the industry standard for reporting COVID-19 testing.
CPT Code 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.
COVID-19 LABORATORY TESTING
- Report U0001, U0002 or 87635, as directed by American Medical Association guidance (refer to AMA link below)
- To report a confirmed COVID-19 diagnosis, use U07.1 (COVID-19), as directed by guidance from the U.S. Centers for Disease Control and Prevention (refer to CDC 3.18.2020 link below)
COVID-19 OFFICE VISIT, URGENT CARE OR EMERGENCY ROOM SERVICES
- Report Z20.828* or Z03.818 to indicate the evaluation and management (E/M) initial visit for COVID-19 screening,
- Use U07.1 as the primary diagnosis if COVID-19 is confirmed at the initial encounter, as directed by CDC guidance. (refer to CDC links below)
*Z20.828 should be used when the provider indicates that COVID-19 is “suspected,” “possible,” or “probable.”
- AMA CPT Lab guidelines 3.13.2020Open a PDF
- CDC Release 3.18.2020: U07.1 effective April ,1, 2020 COVID-19 confirmed diagnosisOpen a PDF
- CDC Release 2.20.2020: B97.29 interim code February 20,2020 COVID-19 confirmed diagnosisOpen a PDF
Please refer to the AMA’s CPT Assistant publication for additional information related to CPT code 87635.
Telehealth Visits During the COVID-19 State of Emergency
- A telehealth visit is an option for initial screenings when an in-office visit is not an option. Telehealth services are covered under all product lines.
- During the COVID-19 State of Emergency declared by Governor Cuomo, electronic information and communication technologies for telehealth include telephonic and video modalities, including technology commonly available on smart phones and other devices (e.g., Skype, FaceTime, Zoom), when medically appropriate to deliver health care services.”
- We will waive the cost-share for all telehealth visits (not just those related to COVID-19) for all of our members until the State of Emergency has been lifted.
- In-network telehealth visits will be covered with no member cost-share when the services would have been covered under the member’s policy if delivered in-person, including behavioral health treatment. To be covered as an office visit, the telehealth consultation must include all elements necessary for the service to be considered an office visit.
- The patient must provide consent prior to rendering telehealth services. The consent can be written or verbal and must be documented in the patient’s medical record. Our website contains an example of a telehealth patient consent formOpen a PDF.
- Place of service code 02 is required for all telehealth services. To address concerns of virus spread/contraction during this outbreak, we will reimburse all telehealth visits billed with place of service code 02 at the same rate as in-person visits for the same CPT code, and we will use the higher non-facility (office) relative value units for dates of service from March 13, 2020 until the State of Emergency has been lifted.
- The appropriate modifier should also be used, when applicable:
- 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
- GQ: Via asynchronous telecommunications system
- GT: Via interactive audio and video telecommunications system
- G0 (Zero): New – telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
- Physical therapists: Teletherapy must meet the criteria set forth in our corporate medical policy. You can bill a non-MD phone only or non-MD video visit.
Please review our corporate medical policyOpen a PDF related to telehealth services.
To learn more about telehealth services, including training on the use of telehealth technology, please send an email to UniveraPR@univerahealthcare.com. Please include any questions you have about telehealth so that we can make every effort to provide information that is relevant to you.
Will you allow early refills on prescriptions?
- We are closely monitoring the supply of medications that are available during the COVID-19 outbreak.
- We have implemented early refill overrides for prescription medications. Pharmacists can make the override at the point of sale.
- We are increasing access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan).
- Members are also encouraged to use their 90-day mail order benefit for prescription medications.
- We will ensure formulary flexibility if shortages or access issues do occur. Members will not be liable for additional charges that stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues. Emergency prescription drug overrides are also available as part of our standard exception process on an individual member basis.
Last Updated: 03/26/2020