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COVID-19 Information

AHCCCS Frequently Asked Questions (FAQs)

AHCCCS will present a Telehealth webinar on April 9, 2020 at 2 p.m.
Click here to register.

Ambetter and Allwell COVID-19 Information

Coronavirus Guidance

Coronavirus disease 2019 (COVID-19) is an emerging illness.  Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.  New information, obtained daily, will further inform the risk assessment, treatment options and next steps.  We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance

  • Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches.  Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.  
  • However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
  • Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
  • Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
  • Monitor and manage ill and exposed healthcare personnel.
  • Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible. 

Take Action

  1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.
  3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
  4. Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
  5. Be familiar with the intended scope of available testing and recommendations from the FDA. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.

HCPCS and CPT Codes for COVID-19 Testing Services

  • Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
    • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
      Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.  
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
  • Adjudication of claims is currently planned for the first week of April 2020.

Medicare Reimbursement Rates for COVID-19 Testing Services for All Provider Types*

  • We are complying with the rates published on 3/12/20 by CMS:
    • U0001 = $35.91
    • U0002 = $51.31
    • Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.
  • Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

TELEHEALTH DELIVERY & BILLING

AHCCCS Medical Policy Manual 320-I states in part that there are no AHCCCS restrictions for where the provider is located when providing services via telehealth.

The AHCCCS Covid-19 FAQ page states: Arizona was authorized by CMS on March 23rd to provisionally and temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare for the duration of the public health emergency.

For more information about telehealth services, please see this March 20, 2020 presentation, or visit the AHCCCS Medical Policy Manual 320-I Telehealth and the AHCCCS Telehealth Code Set.

Visit the Telehealth section on the AHCCCS FAQ page to find information on AHCCCS Telehealth Code Set, AHCCCS Telephonic Code Set (Temporary) (PDF), and AHCCCS Telephonic Code Set (Permanent) (PDF).

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.  These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020 for Allwell and Ambetter lines of business (LOB) and from March 17, 2020 through the end of the COVID declaration of emergency for the Medicaid LOB.
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care**

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services. 
**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.

Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people.