Coronavirus (COVID-19) Updates for Providers

Last updated 1/12/2022: Formatting updates; added vaccine coverage information from retired COVID-19 Vaccination Payment Policy; updated billing instructions for monoclonal antibodies

During the COVID-19 Public Health Emergency (PHE), CarePartners of Connecticut has adapted policies and business operations to support members in receiving care and to aid providers in their efforts to provide patients with safe access to the care they need.

As states lift PHE orders, CarePartners of Connecticut is returning to pre-pandemic operations and policies. Refer to the resources below for the most up-to-date information about CarePartners of Connecticut's policies and coverage.

The policies below will be revisited on a continuing basis.

Note: Providers should follow these guidelines for the dates of services listed during the COVID-19 PHE. For all other billing guidelines, refer to the Professional Services and Facilities Payment Policy and the benefit-specific payment policies located in the Provider Resource Center.

COVID-19 Vaccinations

The federal government has purchased the vaccine and is supplying it to vaccinators. Providers will receive the vaccines from the state and/or federal health agencies.

CarePartners of Connecticut complies with federal and state guidelines for vaccines. Refer to the Connecticut Department of Public Health for information on vaccines.

Consistent with federal requirements, CarePartners of Connecticut is waiving cost sharing for the administration of COVID-19 vaccines.

CarePartners of Connecticut is not requiring referrals or prior authorizations for the administration of the COVID-19 vaccination, this includes the COVID-19 vaccine being administered by out-of-network (OON) providers during the PHE.

CarePartners of Connecticut Plan is reimbursing for administration of the vaccines and services associated with vaccine administration for all products. The reimbursement rate includes vaccine administration, public health reporting, and patient outreach, education, and counseling.

While CarePartners of Connecticut encourages the use of in-network providers, we will reimburse in- and out-of-network providers for the administration of the vaccine.

Refer to the COVID-19 Vaccine and Testing Codes list for details for billing information.

COVID-19 Testing and Treatment

  • CarePartners of Connecticut will pay 100% of the allowed amount for medically necessary testing (including, but not limited to radiology and lab tests). Click here for a list of procedure codes.
  • There will be no member cost sharing (i.e. no copays, deductible, or coinsurance) for viral and antibody testing. Providers should not collect a copay from members.
  • Testing for COVID-19 is covered when ordered or referred by a physician or appropriately licensed health care professional.
    • Tests self-ordered by members, including tests ordered through an online self completed questionnaire, are not covered for reimbursement.
    • At home viral tests are not covered unless ordered by a physician or attending provider.
  • FDA-authorized antibody testing for COVID-19 is covered only when it has been determined by a provider who has performed an individualized clinical assessment to be medically necessary to make decisions about a member's care in accordance with current CDC and state public health department guidelines, which are being continuously updated.
  • Testing is not covered if conducted solely for return-to-work or return-to-school purposes, for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment.
    • When performing any such tests, including non-diagnostic or occupational tests for return-to-work scenarios, providers should bill the appropriate laboratory code following our existing billing guidelines (e.g U0002) and use the diagnosis code.
  • Testing for asymptomatic members, including those with no known or suspected exposure to COVID-19, is covered when being admitted to a health care facility or when it has been determined by a provider who has performed an individualized clinical assessment to be medically necessary to make decisions about a member's care in accordance with current CDC and state public health department guidelines, which are being continuously updated.
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

Members are encouraged to see in-network providers, whenever possible. However, these policies apply to in-network and out-of-network (OON) providers:

  • Provider Reimbursement: CarePartners of Connecticut will reimburse providers for treatment according to covered benefits in our plans for those members positively diagnosed with COVID-19.
  • Monoclonal Antibodies: CarePartners of Connecticut covers medically necessary monoclonal antibody treatment in outpatient settings, without prior authorization as per the Food & Drug Administration’s (FDA) EUA criteria, for the treatment of mild to moderate COVID-19 in adult and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Refer to monoclonal antibody treatment information from the CMS and CDC for details on limitations of authorized use and instructions for healthcare providers. Member claims should be submitted to CarePartners of Connecticut.

Telehealth/Telemedicine

Refer to the Temporary COVID-19 Telehealth Payment Policy for the following:

  • Telehealth guidelines for in-network providers
  • Telehealth billing guidelines
  • Temporary COVID-19 Telehealth/Telemedicine Code Lists

CarePartners of Connecticut will continue to evaluate market conditions and will inform the network in advance of an end date or further changes to this temporary policy.

Billing and Reimbursement Guidelines

CPT Code 99072 is designed for providers to report expenses incurred during a PHE, including PPE, cleaning supplies and additional clinical staff time. This code is non-reimbursable for CarePartners of Connecticut.

  • Certified registered nurse anesthetists (CRNA) are not required to include the supervising physician information on claims. Note: CarePartners of Connecticut will continue to compensate for medically necessary CRNA services.
  • Anesthesia claims should be billed with the appropriate procedure code, modifier and applicable time units, as described in the Anesthesia Payment Policy.
  • CarePartners of Connecticut defers to providers to determine whether physician supervision is required under the laws of the state in which they practice and/or hospital policies.

CMS has extended the suspension of the sequestration payment reduction through December 31, 2021. As such, CarePartners of Connecticut has implemented this CMS requirement and suspended the reimbursement reductions for Medicare Advantage hospital rates and professional rates for the same time period for acute care hospitals, clinicians, physicians and PCPs.

Pharmacy

  • CarePartners of Connecticut allows early refills of a medication prescription prior to the expiration date, including specialty pharmaceuticals. Controlled substance drugs are excluded from this policy.
  • Maintenance medications may be refilled for up to a 90-day supply, assuming the days supply is available based on the unused portion of the prescription.

Tips for Prescribers

For information for members on Warfarin that require international normalized ratio (INR) testing, click here.

Credentialing

New practitioners are credentialed through Tufts Health Plan's Credentialing Program, on behalf of CarePartners of Connecticut, as outlined below:

Practitioners who seek to join the CarePartners of Connecticut network on a permanent basis should follow the usual contracting and credentialing processes. Go to the Provider Resource Center, select Credentialing and Contracting in the Filter by Category drop-down, and then click Submit.

If you have any questions regarding expedited credentialing or provisional credentialing, please contact Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Providers may also refer to the Frequently Asked Questions to Tufts Health Plan’s Credentialing Department.

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