03.09.2021
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Posted by Provider Relations
Coronavirus disease 2019 is a new and emerging illness in the United States. The virus causes a disease called COVID-19 that can lead to fever, cough and shortness of breath. There are thousands of confirmed cases in a growing number of countries internationally, and the virus is now spreading in the United States, including New York State. New information, obtained daily, further informs the risk assessment, treatment options, and next steps.
Fidelis Care is closely monitoring the developments across New York State and is following COVID-19 guidance from the New York State Department of Health (SDOH) and Department of Financial Services (DFS) guidance.
New York State has among the highest number of confirmed COVID-19 cases in the country. We are moving quickly to prioritize the health and safety of our employees as we care for the nearly 1.8 million members who rely on us for their health and well-being.
As we respond to this unprecedented and dynamic situation, Fidelis Care’s goals are to continue to serve our members and providers, minimize disruption, and support the health and safety of our employees.
As an important resource for providers, we encourage you to access the information on Fidelis Care’s provider portal at providers.fideliscare.org. On the portal, you can:
• check claim status
• confirm member eligibility and benefits
• submit authorization requests
• check on the status of an authorization
• view provider remittance advice
We also encourage you to use Fidelis Care’s Interactive Voice Response as another way to check claim status and member eligibility.
Using these tools and resources will provide you with the information you need, 24/7, and help to reduce anticipated call volume and wait times for our Provider Call Center.
Emergency Preparedness Plan
Providers should have an emergency preparedness plan in place for their facilities. The latest NYS-specific information can be found on the SDOH website at the following link: https://www.health.ny.gov/diseases/communicable/coronavirus/.
COVID-19 Background
Treatment: Currently there is no available antiviral to treat COVID-19, though some international clinical trials are underway.
Vaccine: At this point, there is no vaccine for COVID-19.
Identification and Testing of Persons Under Investigation (PUI): As of March 13, 2020, COVID-19 tests are being conducted at the CDC, the NYS Wadsworth Center, and the New York City Public Health Laboratory. Tests performed for suspected individuals at these current public health sites are provided at no cost. Additionally, some hospitals and commercial laboratories are now authorized to perform COVID-19 testing. Providers should follow CDC guidance for evaluating members with suspected illness. This information can be found on the CDC website at the following links: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html and https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html.
When a test is ordered and referred to a public health lab, it is critical that the order form included with the test sample is legible and completed in its entirety.
Healthcare providers should regularly check the SDOH website for the latest guidance on reporting of suspected cases of COVID-19 as the outbreak evolves.
https://www.health.ny.gov/diseases/communicable/coronavirus/providers.htm%20
Coverage and Copays: Some commercial laboratories and facilities have been granted approval to test for COVID-19. To ensure that cost-sharing is not a barrier to testing, Fidelis Care will cover services including testing for COVID-19 and for physician, clinic, urgent care, and emergency visits without copays, deductibles, or coinsurances for members when the purpose of the visit is testing for COVID-19, consistent with DFS an DOH guidelines.
Effective March 03, 2020, providers are responsible to ensure any copays, coinsurance, or deductible charges are waived for Fidelis Care members at the time of an office visit, urgent care visit, clinic, or emergency room visit when the purpose of that visit is testing for COVID-19. Claims with correct coding will be adjusted to reflect provider payments with $0 member liability upon processing. Providers should follow CDC coding guidelines below when submitting claims to Fidelis Care and ensure accurate diagnosis codes are included with other required elements of a clean claim.
Coding: Fidelis Care is updating claiming systems to be able to receive new codes associated with COVID-19 testing by April 1, 2020. Fidelis Care will add Healthcare Common Procedure Coding System (HCPCS) codes as they become available. In February 2020, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for COVID-19. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for COVID-19. This second HCPCS code should be used for tests developed by these additional laboratories when submitting claims to Fidelis Care. HCPCS code U0002 will be reimbursed at an interim fee established by New York State Medicaid. For additional information, please see the laboratory fee schedule at the following link:
https://www.emedny.org/ProviderManuals/Laboratory/index.aspx
On March 13, 2020, the American Medical Association Current Procedural Terminology (CPT® ) Editorial Panel approved a new, specific CPT code to describe laboratory testing for severe acute respiratory syndrome coronavirus 2. The fact sheet for this new code can be accessed at the following link: https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf
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
Fidelis Care is working to update systems and verify reimbursement benchmarks for this new code, and will provide more guidance on the use of this code as it becomes available.
Providers should follow CDC ICD-10-CM Official Coding Guidelines https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf when selecting a diagnosis code to ensure proper reporting.
Further guidance will be issued in partnership with the New York State Department of Health regarding additional coding parameters to ensure office visits, emergency room visits, clinic visits, and urgent care visits do not take member cost share. Any additional technical coding guidance will be provided as soon as it becomes available.
Pharmacy: Fidelis Care covers a 90-day supply for most prescription and over-the-counter (OTC) maintenance medications. Practitioners and pharmacists should consider ordering 90-day supplies of long-term maintenance medications for individuals in quarantine. Providers can find additional important updates regarding pharmacy changes in the context of the emergency declaration available here.
Telehealth: Fidelis Care expanded coverage of telehealth services in 2019 and strongly encourages providers to deliver their services via the telehealth modality wherever reasonably possible in order to support current social distancing and containment strategies. To the extent it is practical, Fidelis Care encourages the use of telehealth to provide COVID-19 related services to members and offers reimbursement for these services across all products.
Effective March 14, 2020, Fidelis Care is in the process of updating systems to ensure our members can use telehealth services from participating providers with cost sharing waived (in products that have member cost sharing). Providers are responsible to ensure any copays, coinsurance, or deductible charges are waived for Fidelis Care members at the time of telehealth services, and claims will be adjusted to reflect provider payments with $0 member liability upon processing.
More information on the current telehealth policy can be found in the Provider Manual here, Section 26. Fidelis Care will continue to support, promote, and align with New York State guidance to providers on allowable parameters to render telehealth and telephonic services to our members. Additional telehealth information for OMH programs regarding recent changes to telehealth regulations can be found in these guidance, self-attestation, and supplemental guidance documents. Additional information for OASAS licensed programs can be found here, including the self-attestation and supplemental guidance. Providers must follow continued guidance from their respective licensing authorities, and any questions on these forms or waiver approvals should be directed to the respective OMH and OASAS contacts indicated on the forms.
On March 16, 2020 New York State Medicaid issued an additional update authorizing telephonic services for reimbursement, and Fidelis Care is in the process of updating systems to align with this guidance across all products. Fidelis Care will continue to monitor changes in state and federal regulations related to any expansion of, additional approval, or change in regulation regarding telehealth services.
Prevention: COVID-19 can be spread from infected individuals to others through close personal contact and through the air by coughing and sneezing. Providers should encourage their patients to practice good hand washing, avoid touching their faces as much as possible, and avoid unnecessary contact with individuals who are ill.
Additional guidance can be found on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html