Coronavirus (COVID-19) Updates for Providers

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Last updated 4/20/2021 with coverage updates for bamlamivimab, effective for dates of service on or after April 16, 2021.

During the COVID-19 Public Health Emergency (PHE), 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.

This page contains the most up-to-date information about CarePartners of Connecticut's policies and coverage during the PHE. As the PHE 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 Vaccinations, Testing and Treatment

COVID-19 Vaccinations

Once a COVID-19 vaccine becomes available to members, CarePartners of Connecticut will cover the vaccine in full. There will be no cost to members. Refer to the COVID-19 Vaccination Payment Policy and the Coronavirus (COVID-19) Vaccination Frequently Asked Questions (FAQs) for Providers for additional information.

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

COVID-19 Diagnostic Testing - Effective until further notice

  • 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 unsless 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.

In person, COVID-19 Treatment - 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.
  • CarePartners of Connecticut will waive member cost share, including copays, for COVID-19 treatment when ICD-10 code U07.1 is present, in any position, on an Inpatient Facility claim and when ICD-10 code U07.1, Z03.818 or Z20.822 is present on an Outpatient Facility or Professional claim. Note: For Professional claims, when one of the codes noted above is billed, member cost sharing is waived for only the service lines related to COVID-19 testing/treatment.
    • U07.1 was developed by the World Health Organization (WHO) and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis. For further guidance, please refer to the official ICD-10-CM guidelines for coding encounters related to the COVID-19 coronavirus outbreak.
    • Prior to April 1, 2020, B97.29 was accepted as a positive diagnosis for COVID-19. For discharge/dates of service on or after September 1, 2020 this code is not accepted as a positive diagnosis for COVID-19.
  • Monoclonal antibody treatment (bamlamivimab) is covered (without utilization management) in conjunction with etesevimab (Q0245, M2045) 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. Treatment is administered in the outpatient setting. Due to the FDA's revocation of bamlamivimab when used as a stand-alone treatment for COVID-19, effective for dates of service on or after April 16, 2021, bamlamivimab is not covered when administered alone (Q0239, M0239). Member claims should be submitted to Medicare Administrative Contractors (MACs).
  • Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

Telehealth/Telemedicine

Temporary COVID-19 Telehealth Payment Policy

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

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

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 as outlined below

The following is effective until further notice:

Diagnoses and treatments related to COVID-19 or known or suspected of having COVID-19 contraction:

  • Prior authorization is not required, including for transfers to post-acute non-hospital facilities and home health care.
  • Notification is required within 2 business days of the admission.

*Note: Refer to the In Person, COVID-19 Treatment section above for ICD-10 codes to be present for the diagnosis and treatment of COVID-19.

Prior authorization for services unrelated to the diagnoses and treatments for COVID-19 are in effect and pre-COVID-19 processes should be followed.

Inpatient Notification and Concurrent Review Guidelines - Effective as outlined below

The following inpatient notification guidelines are in effect until further notice and apply to all diagnoses and not specific to a COVID-19 diagnosis:

  • Effective for dates of service on or after April 1, 2021, notification is required within 2 business days after the date of admission.
  • CarePartners of Connecticut continues to require inpatient notification pursuant to standard timelines for elective non-COVID-19 admissions.

Concurrent review requirements were reinstated for services occurring after December 31, 2020 and pre-COVID-19 processes should be followed.

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 PHE. 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 PHE 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.

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.

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.

Medicare Advantage Reimbursement - Effective through December 31, 2021

CMS has extended the suspension of the sequestration payment reduction through December 31, 2021. As such, Tufts Health Plan 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. This applies to Tufts Medicare Preferred, Senior Care Options, and Tufts Health Unify.

Pharmacy

Pharmacy - Effective until further notice

  • 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

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 PHE Only

  • Practitioners seeking to provide care during the PHE 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.

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