Coronavirus (COVID-19) Updates for Providers

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Last updated 8/12/2020 with coverage information for asymptomatic members and out-of-network authorization policies for COVID-19 services.

In response to the COVID-19, CarePartners of Connecticut has activated its Pandemic Planning work group, established to respond to public health issues and crises. The group meets regularly as it continuously prepares to respond to changing events. It is monitoring and following recommendations from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), State of Connecticut Department of Public Health and other official sources on an ongoing basis.

Where can I find more information?

This page contains the most up-to-date information about CarePartners of Connecticut's policies and coverage pertaining to COVID-19. As the COVID-19 situation continues to develop, updates will be posted here. Please check back regularly.

Please note, this information, including member cost sharing changes, may differ from what is reflected in the secure Provider portal. Refer to the Claims Guidelines section for additional information.

Effective Dates

Unless otherwise noted, all policies are effective beginning with dates of service on or after March 6, 2020. These policies have been put in place in connection with the COVID-19 crisis and are not intended to be permanent changes. For any policy without an end date listed or for which it states "until further notice," we continue to evaluate CarePartners of Connecticut policies with the state of emergencies and other regulations in mind, and will aim to provide at least four week notice in advance of any termination of the policy. Coverage and policies for CarePartners of Connecticut members is as follows:

COVID-19 Diagnostic Testing and Treatment

CarePartners of Connecticut is following the National Uniform Billing Committee recommendation regarding the usage of appropriate hospital bill types, main hospital address and National Provider Identifier (NPI) for diagnostic testing and specimen collection locations at off-campus facilities, such as parking lots, tents, and football stadiums.

COVID-19 Laboratory Diagnostic Testing - Effective until further notice

  • CarePartners of Connecticut will pay 100% of the allowed amount for medically necessary lab testing. Click here for a list of procedure codes.
  • There will be no member cost sharing (i.e. no copays, deductible, or coinsurance). Providers should not collect a copay from members.
  • Testing, including antibody testing and rapid testing, is covered when determined by a PCP or other treating provider to be medically necessary in accordance with the current CDC and state public health department guidelines, which are continuously updated. COVID-19 testing may be ordered by any state-authorized health care professional. CarePartners of Connecticut will continue to update this guideline as new guidance is issued.
  • Member reimbursement requests for home testing kits, or other tests that are self-ordered by members, are not covered.
  • Testing is not covered if conducted solely for return-to-work or return-to-school purposes, for travel purposes unrelated to seeking medical care, 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.
  • 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.
  • Testing for asymptomatic members is covered when being admitted to a health care facility or when the member has been identified by a health care provider, the state or local board of health as someone who is a close contact of someone who has COVID-19. For all other asymptomatic persons, testing is not covered.
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

COVID-19 Other Diagnostic Testing - Effective until further notice

  • CarePartners of Connecticut will pay 100% of the allowed amount for other medically necessary diagnostic testing (including, but not limited to radiology and other lab tests).
  • There will be no member cost sharing (i.e. no copays, deductible, or coinsurance). Providers should not collect a copay from members.
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

In person, COVID-19 Treatment (Confirmed Positive Diagnosis) - Effective until further notice

  • CarePartners of Connecticut will reimburse providers for treatment according to covered benefits in our plans for those members positively diagnosed with COVID-19.
  • There will be no member cost sharing (i.e. no copays, deductible or coinsurance). Providers should not collect a copay from members. This applies to all in-person treatment regardless of place of service, including inpatient and skilled nursing facility (SNF) services. Note: This applies to all services (i.e. medications, DME, etc.) provided at the appointment by the provider.
  • CarePartners of Connecticut will affirm a positive diagnosis with the presence of the following diagnosis codes:
    • ICD-10 code U07.1 is used as a primary diagnosis.
    • ICD-10 code B97.29 is used as either a primary diagnosis or a secondary diagnosis appended to a respiratory illness.
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

In person, Non-positive COVID-19 Treatment (Initially Suspected But Without Confirmed Positive Diagnosis) - Effective until further notice

  • CarePartners of Connecticut will reimburse providers for treatment according to covered benefits in our plans for those for whom COVID-19 is suspected but without a positive diagnosis of COVID-19.
  • There will be no member cost sharing (i.e. no copays, deductible or coinsurance). Providers should not collect a copay from members. This applies to all in-person treatment regardless of place of service, including inpatient and SNF services. Note: This applies to all services (i.e. medications, DME, etc.) that are provided at the appointment by the provider.
    • CarePartners of Connecticut will affirm a non-positive diagnosis with the absence of ICD-10 code U07.1 as a primary diagnosis.
    • CarePartners of Connecticut will affirm a non-positive diagnosis with the absence of ICD-10 code B97.29, used as either a primary diagnosis or a secondary diagnosis appended to a respiratory illness. 
    • CarePartners of Connecticut may further affirm a non-positive diagnosis with the presence of ICD-10 code Z03.818, which denotes a ruled-out COVID-19 diagnosis.
    • CarePartners of Connecticut may further affirm a non-positive diagnosis with the presence of ICD-10 code Z20.828, which denotes exposure but no confirmed COVID-19 diagnosis.
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and OON providers.

Telehealth/Telemedicine

Telehealth/Telemedicine Policy and Billing Guidelines

The following telehealth/telemedicine policy has been implemented to prevent members from needing to leave their home to receive care. This policy applies for all diagnoses and is not specific to a COVID-19 diagnosis.

  • For dates of service after July 20, 2020 pre-COVID-19 coverage policies and cost share will apply for out-of-network (OON) telemedicine. In-network telehealth guidelines will remain in place until further notice.
  • CarePartners of Connecticut will compensate in-network providers at 100% of their contracted rate for services, as specified in provider agreements, until further notice. The telehealth reduction will not apply.
  • OON providers will be reimbursed using CarePartners of Connecticut standard processes for reimbursing OON claims. Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and OON providers.
  • Plans which require referrals and/or authorizations to see OON specialists continue to require referrals and/or authorizations for telehealth services, unless services are related to the following:
    • COVID-19
    • Inpatient care
    • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
    • Primary care or outpatient behavioral health services
  • All CarePartners of Connecticut contracting providers, including specialists and urgent care facilities, may provide telemedicine services to members for all medical (well visits/preventive, sick visits, preadmission screenings), behavioral health ancillary health and home health care visits (i.e. skilled nursing, PT, OT and ST) for both new and existing patients). Prior authorization is not required.
  • CarePartners of Connecticut will waive member cost shares for in-network telemedicine services. This includes both facility and professional services. Providers should not collect a copay from members.
  • Telehealth also includes telephone consultation. Note: For Medicare products, under CMS rules, special codes already exist for certain telephonic services and those codes will be paid at the CMS fee schedule.
  • Documentation requirements for a telehealth service are the same as that required for any face-to-face patient encounter, with the addition of the following:
    • A statement that the service was provided using telemedicine;
    • The location of the patient;
    • The location of the provider; and
    • The names of all persons participating in the telemedicine service and their role in the encounter.
  • Services covered under telehealth should be clinically appropriate and not require in-person assessment and/or treatment. CarePartners of Connecticut defers to the provider to make this determination.
  • Note for Behavioral Health Providers: There are no restrictions on service type, including individual and group behavioral health services. Additionally, the usage of audio without video is acceptable.
  • Providers must submit professional claims in accordance with applicable state and federal requirements and, at a minimum, bill with place of service (POS) 02 OR the appropriate telehealth modifiers.
    • Providers may submit claims with the POS they would have reported had the service been rendered in person, as well as the appropriate procedure codes and telehealth modifiers. Note: Claims submitted with POS 02 will continue to process with the appropriate in person rate.
    • Providers should continue to bill with the appropriate license-level modifer as specified in the applicable payment policy.
  • For facility claims, providers should submit the appropriate Revenue Code CPT/HCPCS code(s) and modifier(s).
  • Refer to the Telehealth Coverage and Policies Update for additional information regarding telehealth and the Claims Submission and Timely Filing section below for additional billing guidelines.

Telehealth/Telemedicine Guidelines for Out-of-Network Providers - Effective through July 20, 2020

For dates of service after July 20, 2020, pre-COVID coverage policies and benefits (including applicable cost share) will apply for out-of-network (OON) telemedicine.

Prior to July 20, 2020 the following telehealth policies were in place for OON providers:

  • Referrals and/or authorizations for plans which require referrals and/or authorizations to see OON specialists were waived for telehealth services, when services were related to the following:
    • COVID-19
    • Inpatient care
    • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
    • Primary care or outpatient behavioral health services
  • No member cost share for facility and professional services.

Referrals and Out-of-Network Authorizations

Referrals and Out-of-Network Authorizations - Effective as outlined below

Out-of-Network Authorization Policies for COVID-19 Services – Effective until further notice

If a member’s plan requires a referral or authorization to receive out-of-network (OON) services, CarePartners of Connecticut is waiving such requirements for the OON services listed below when related to a COVID-19 diagnosis regardless of member’s plan type:

  • Inpatient care
  • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
  • Primary care or outpatient behavioral health services
  • Urgent/emergent services

Out-of-Network Authorization Policies for Non-COVID-19 Services – Effective through July 20, 2020

For dates of service after July 20, 2020, CarePartners of Connecticut's pre-COVID coverage policies and benefits (including applicable cost share) will apply for out-of-network (OON) services. All plans that require a referral or authorization to receive OON services will again need to follow standard, pre-COVID procedures for receiving OON care. The only exception is for COVID-related care, for which authorization requirements continue to be waived.
 
Prior to July 21, 2020 the following were in place for OON providers:
  • If a member's plan requires a referral or authorization to receive OON services, CarePartners of Connecticut waived such requirements for OON services related to the following, regardless of a COVID-19 diagnosis or of member's plan type:
    • COVID-19
    • Inpatient care
    • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
    • Primary care or outpatient behavioral health services
  • Plans which required referrals and/or authorizations to see OON specialists continued to require referrals and/or authorizations unless services are related to the above. Note: The referral and/or authorization requirement refers to in-person and telehealth services.
  • The in-network cost share was applied at the authorized level of benefits for all OON services listed above unless it is for a service that CarePartners of Connecticut waswaiving cost share.
  • CarePartners of Connecticut reserved the right to transfer inpatient care from an OON provider to an in-network provider when the transfer can be facilitated appropriately.
  • Claims for the services above will not be denied for being OON for dates of service on or before July 20, 2020. Note: There is an industry-standard possibility that claims may deny for other unrelated and appropriate reasons.

Note: CarePartners of Connecticut follows regulatory guidance and/or standard processes for determining payment to OON providers.

Utilization Management

Prior Authorization and Notification Flexibility for the Diagnosis and Treatment of COVID-19 - Effective until further notice

The following is effective until further notice:

Diagnoses and treatments related to COVID-19 or known or suspected of having COVID-19 contraction: (presence of ICD-10 codes U07.1, B97.29, Z03.818, and/or Z20.828):

  • Prior authorization is not required.
  • Notification is required within 5 days after the date of admission. 

Prior Authorization Guidelines - Effective as outlined below

The following prior authorization guidelines are in effect until further notice and apply to all diagnoses and not specific to a COVID-19 diagnosis:
  • Prior authorization is not required for non-hospital locations for post-acure care (i.e. inpatient rehab, LTAC, skilled nursing facilities and home care), including following an inpatient hospital admission. All other post-acute care policies remain unchanged.
  • Prior authorization is not required for hospice services.

Prior authorization and concurrent review was reinstated for scheduled surgeries and admissions at hospitals for services occurring after July 1, 2020 and pre-COVID processes should be followed. As a reminder, urgent/emergent admissions are never subject to prior authorization.

Note: Providers are still responsible for confirming services are covered by the individual treatment plan and the member meets medical necessity criteria for the service.

Inpatient Notification Guidelines - Effective until further notice

The following inpatient notification guidelines are in effect until further notice and apply to all diagnoses and not specific to a COVID-19 diagnosis:
  • CarePartners of Connecticut  is relaxing admission notification requirements for urgent/emergent inpatient admissions and post-acute admissions by requiring notification within 5 days after the date of admission.
  • CarePartners of Connecticut continues to require inpatient notification pursuant to standard timelines for elective non-COVID-19 admissions.
  • Hospice services do not require inpatient notification.

Note: CarePartners of Connecticut remains available to assist with discharge planning for all admissions and reserves the right to retroactively review services for medical necessity.

Concurrent Review - Effective through September 30, 2020

The following concurrent review guidelines apply to all diagnoses and not specific to a COVID-19 diagnosis until September 30, 2020:

  • Concurrent review is suspended for all urgent/emergent hospital inpatient services.
  • Concurrent review is suspended for any inpatient or outpatient scheduled surgeries, for behavioral health or non-behavioral health admissions at acute care and mental health hospitals.

Note: Post-acute care treatment at non-hospital locations are subject to concurrent review for COVID-19 and non-COVID-19 related admissions.

Note: CarePartners of Connecticut remains available to assist with discharge planning for all admissions and reserves the right to retroactively review services for medical necessity.

Claims and Billing Guidelines

Claims Guidelines

CarePartners of Connecticut is informed when CMS and state insurance agencies issue new billing and reimbursement guidelines in response to the COVID-19 emergency. These guidelines are reviewed by CarePartners of Connecticut and implemented, as appropriate.

Providers should follow guidelines on this page for dates of services listed during the COVID-19 emergency and continue to submit claims as they currently do. Providers should not await billing instructions from CarePartners of Connecticut. or 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.

Unless otherwise stated, CarePartners of Connecticut follows industry standard coding guidelines. Refer to current coding guidelines for a complete list of ICD, CPT/HCPCS, revenue codes, modifiers and their usage.

Note: Providers may bill inpatient services provided at alternative inpatient sites.

Billing by Certified Registered Nurse Anesthetists - Effective until further notice

  • 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.

Claims Submission and Timely Filing - Effective through July 20, 2020

The filing deadline for initial claims submission was extended for 180 days from the date of service or date of discharge through July 20, 2020. Note: This filing extension did not apply to pharmacy claims.

All claims submissions and timely filing policies outlined in the CarePartners of Connecticut Provider Manual will be reinstated for services occurring after July 20, 2020.

Provider Appeals and Audits - Effective through September 30, 2020

The following applies to all CarePartners of Connecticut products, effective through September 30, 2020:

  • The timeframe for filing provider appeals has been extended by up to 90 days from CarePartners of Connecticut's standard appeals timeline, upon request.
  • CarePartners of Connecticut is providing extended timeframes for provider audits through September 30, 2020.

Pre-Payment Billing Review and Post-Payment Billing Audit - Effective through September 30, 2020

The following changes will be effective April 8, 2020 through September 30, 2020:

Pre-Payment Billing Review Programs

Record requests:

  • New requests: No new requests will be issued beginning April 8, 2020
  • Outstanding requests (i.e., record requests to which the provider has not responded) will be waived and claims will be released for adjudication.

In process reviews:

  • Vendors will complete reviews and issue findings per existing processes.
  • Providers may appeal, as indicated below.

Appeals:

  • In-process appeals: Vendors will complete previously-submitted appeals and issue findings per existing processes. 
  • New appeals: Providers will have 90 days from the date of the determination to submit new appeals.

Post-Payment Billing Review Programs

Record requests

  • New requests: 
    • Vendors will continue to request records per existing processes. 
    • Providers will have 90 days from the date of the initial request to submit records.
  • Outstanding requests (i.e., record requests to which the provider has not responded): Providers will have 90 days from the date of the initial request to submit records.
  • Second request timeframes will remain the same.
  • CarePartners of Connecticut reserves its right to request previously agreed-upon numbers of records. If fewer records are requested from April 8, 2020 to June 1, 2020, CarePartners of Connecticut may increase the number of records requested in subsequent months by a commensurate amount.   

In-process Reviews

  • Vendors will complete reviews and issue findings per existing processes.
  • Providers may appeal, as indicated below.

Appeals

  • In-process appeals: Vendors will complete previously-submitted appeals and issue findings per existing processes. 
  • New appeals: Providers will have 90 days from the date of the determination to submit new appeals.
  • Providers will have 90 days from the date of the appeal determination to submit second-level appeals. 

Fraud Investigation

CarePartners of Connecticut reserves the right to conduct medical record reviews during the aforementioned time frame if there is an indication of potential fraud, waste or abuse.

Medicare Advantage Reimbursement - Effective through December 31, 2020

In accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS has suspended sequestration from May 1, 2020 through December 31, 2020. As such, CarePartners of Connecticut is implementing this CMS requirement and suspending 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

Pharmacy - Effective until further notice

  • CarePartners of Connecticut will allow early refills of a medication prescription prior to the expiration date, including specialty pharmaceuticals. 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.  Controlled substance drugs are excluded from this policy.
  • CarePartners of Connecticut has extended pharmacy authorizations expiring through June 30, 2020 for an additional 90 days from the original expiration date.
  • Due to drug shortages, CarePartners of Connecticut has made some brand alternative albuterol inhalers temporarily available. Providers should write ‘covered by plan’ on albuterol inhalers, unless a specific product is medically necessary, to allow the flexibility in dispensing a product on-hand. Note: Pharmacies may contract providers to facilitate the switch of the products are not AB-rated and automatically substitutable.
  • If a vaccine for COVID-19 is developed, CarePartners of Connecticut will provide 100% coverage. Members will have no cost sharing responsibility.

Tips for Prescribers

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

Credentialing

Credentialing of New Practitioners - Effective until further notice

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

Practitioners to Provide Services during the COVID-19 Public Health Emergency Only

  • Practitioners seeking to provide care during the COVID-19 public health emergency only, but do not seek to join the CarePartners of Connecticut network on a more permanent basis, should complete the COVID-19 Deployment Only Enrollment Roster and submit to: Provider_Information_Dept@tufts-health.com.
  • Include “COVID-19 Enrollment Only” in the subject line of the email containing the completed form
  • Examples of such practitioners include:
    • Retirees granted temporary licensure in order to work during the COVID-19 public health emergency
    • Recent medical student graduates who may be granted temporary licensure who are working in a hospital or facility during the COVID-19 public health emergency and have not begun their residency programs
    • Clinical fellows and clinical researchers who have been granted temporary privileges to provide care in the facility setting
    • Any out-of-network practitioners granted a temporary license to provide services in Connecticut, and not typically their home practice state in order to work during the COVID-19 public health emergency. Note: This category of practitioner will need to have verifications completed, including inquiry about 1135-based licensure waivers from CMS.

Practitioners Seeking to Join CarePartners of Connecticut

  • Practitioners who seek to join the CarePartners of Connecticut network on a more 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.
  • The Tufts Health Plan Credentialing Department, on behalf of CarePartners of Connecticut, will make every effort to expedite the credentialing process. 

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.

The above policies will be revisited on a continuing basis.

Note: Providers should follow these guidelines for the dates of services listed during the COVID-19 emergency. 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.

* If necessary, the date may be extended.

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