Coronavirus (COVID-19) Provider Update |

Coronavirus (COVID-19) Provider Update

Posted on March 12, 2020

Effective May 12, 2023 – Changes to Over-the-Counter COVID-19 Test Kit Coverage

Health New England covered the costs of FDA-authorized, rapid, at-home COVID-19 tests and will continue to cover until the end of the public health emergency (PHE), which will end on May 11, 2023. Any reimbursement requests for test kits purchased before May 12, 2023, must be submitted by November 11, 2023. Any cost sharing waived due to the PHE (i.e., for COVID-19 testing) will return to normal cost sharing effective May 12, 2023. Check this page for updates about member reimbursements. Read the Biden-Harris administration announcement here.

Effective 1/20/2022 – COVID-19 Testing Information

At-Home Tests: Health New England is reviewing all state and federal guidance related to coverage for over-the-counter at-home COVID-19 tests starting January 15, 2022. We are working on how to implement this requirement and more information will follow. Please continue to check this page for updates about member reimbursements. Read the Biden-Harris administration announcement here.

Previously Posted on January 14, 2022

COVID-19 Vaccine News

Health New England is monitoring the progress of upcoming vaccine solutions for COVID-19, including the Emergency Use Authorization of vaccine(s) for health care workers and high-risk patients. We plan to have regular updates as the local and national situation evolves, so that we can use the collective wisdom and experience of early use to guide our policies and procedures. In the meantime, we encourage you to continue to protect yourself against COVID-19 infection by wearing masks, social distancing, frequent handwashing, and avoiding gatherings in indoor spaces as much as possible. Health New England will be covering the cost of COVID-19 vaccine for members. Check back often on our COVID-19 Vaccine page for the most up-to-date information.

COVID-19 Booster Shot Eligibility

Get vaccine booster shot answers here – read Mass.gov Booster FAQs.

For more information, read the Baker-Polito COVID-19 booster press release.

Impact of COVID-19 on Behavioral Health and the Importance of Perinatal and Pediatric Behavioral Health Screening during the Pandemic

MassHealth would like share this important bulletin to provide behavioral health screening guidance to MassHealth providers, including resources, referrals, and screening requirements for providers treating children, youth, and pregnant and postpartum (perinatal) mothers and caregivers.

For more MassHealth Provider Guidance on COVID-19 coverage of services and benefits delivered via telehealth and expand eligibility for residents of the Commonwealth, view here.

TeleHealth Update: January 12, 2021

Health New England continues to allow clinically appropriate and medically necessary telehealth services with our in-network providers through the state of emergency. We shared earlier that we will waive member cost-sharing for COVID-19 and non-COVID-19 related medically necessary telehealth services.* The waiver of member cost sharing has been extended until March 31, 2021 for most plan members.**

*Some self-funded employer groups do not participate in Health New England’s Teladoc benefit, and/or have decided to not waive member cost sharing for telehealth services. Members are advised to check plan materials for additional information.

**Health New England’s Medicare Advantage Members may be limited to cost share waivers only during the declared state of emergency based on guidance from CMS.

Member Cost Sharing

As previously communicated, Health New England is following the guidance issued by the Massachusetts Division of Insurance and will handle member responsibility as follows:

Health New England is waiving cost sharing (copayments, co-insurance and deductible) for COVID-19 Diagnostic testing.
Health New England is waiving cost sharing for emergency department, inpatient and in-network outpatient services, including professional, diagnostic and laboratory services, related to COVID-19. In addition, copays will be waived for out-of-network outpatient COVID-19 treatment.
If a vaccine becomes available, Health New England will cover the cost of the COVID-19 vaccine.
When an in-network provider services our member via telehealth or telemedicine, Health New England is waiving all cost share (copayment, coinsurance, deductible) for all conditions, not just for COVID-related diagnosis. This will be effective back to March 6, 2020, but expired on March 31, 2021.

COVID State of Emergency Guidance

Please refer to our Coding Best Practice & Tips at https://healthnewengland.org/providers/coding for appropriate diagnosis and coding guidance. The following new information has been added:

Telehealth and Telemedicine

From the beginning of this state of emergency, we have stated:

All contracted providers, including specialists and urgent care facilities, may continue to provide services to our members for all medical (well visits/preventive and sick visits), behavioral health, ancillary health and home health care visits (i.e., skilled nursing, PT, OT and ST) through some type of remote clinical care as noted below. This is for new and established patients.
Health New England will compensate providers for telehealth services based on the contractual rate or fee schedule specified in their provider agreements.

Billing and Coding Guidelines:
Health New England is processing telehealth claims in support of the guidance received to allow the expansion of telehealth services during the State of Emergency. Until further notice, claims should be billed based on the billing guidelines provided in this communication.

With the release of the March 17, 2020, notification from the Office of Civil Rights, at the Department of Health and Human Services (HHS), regarding the use of audio or video communication technology to provide telehealth to patients during this time period, Health New England recommends the provider become familiar with the notification and work with their internal compliance department, privacy officer, and/or information security officer to ensure they are in compliance with their organization policies.

Health New England requires, when appropriate, one of the telehealth-associated modifiers (GT or 95) to report when performing a service via telehealth to indicate the type of technology used and to identify the service as telehealth:

GT: synchronous telecommunications
95: synchronous telemedicine services rendered via a real-time interactive audio and video telecommunication system

Contracted Services Provided, Clinically Appropriate & Medically Necessary: If you are in-network with Health New England, and you can provide contracted services in a clinically appropriate way and it’s medically necessary for new and established patients, Health New England will cover those services at your contracted rate.

For a Commercial and MassHealth member, you may bill the CPT or HCPCS code under your contract using POS 02
For a Medicare member, bill according to CMS guidelines.
For Behavioral Health services to our members, you may bill the code under your contract with POS 02.
For Physical Therapists, Occupational Therapists and Speech Therapists, we recommend that you bill with an online digital evaluation and management service code. Clinicians who may not independently bill for E&M, can also provide these services through E-Visits and bill codes 98970-98972. Please see E-Visits section below for how to conduct E-Visits.

(E-Visits) Online Digital Evaluation and Management Services: If you are an in-network provider treating a Health New England Commercial member, we cover digital online evaluation and management (E/M) services (E-Visits).

These E-Visits are non-face-to-face patient-initiated communications with their provider using an online HIPAA compliant platform, such as an electronic health record portal, secure email or other digital applications.
E-Visits should be billed using CPT code 99421 – 99423.
o CPT code 99421: online digital evaluation and management services, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
o CPT code 99422: 11-20 minutes
o CPT code 99423: 21 or more minutes
Clinicians who may not independently bill for E&M, can also provide these services through E-Visits and bill codes 98970-98972.
For Medicare members, these are covered based on CMS Guidance.
For Medicaid members, these are covered based on MassHealth Guidance.

Providers Contracted to Submit Professional Claims on UB04: If you are in-network with Health New England, and submit your claims using a UB04, provide the appropriate revenue code and CPT to report the telehealth services performed. In addition, submit the appropriate GT or 95 modifier.

Reimbursement does not include facility charges for distant or originating sites.

Documentation Requirements:
If choosing to provide services via telehealth/telemedicine, documentation requirements for a telehealth service are the same as those required for any face-to-face encounter, with the addition of the following:

A statement that the service was provided using telemedicine or telephone consult;
The location of the patient;
The location of the provider; and
The names of all persons participating in the telemedicine service or telephone consultation service and their role in the encounter.

Telephone Services (99441 – 99443 and 98966 – 98968)

Health New England is expanding coverage of telephone evaluation and management service CPT codes 99441-99443 and 98966-98968. You may use these codes during this state of emergency, if:

You are providing services to an established patient under our Commercial plan, and it does not require a face-to-face visit. Please bill with POS 02 or POS 11 and no modifier depending on where you provided the service. (Member responsibility does not apply.)
You are servicing an established Medicare or Medicaid patient. Please follow the CMS guidelines and MassHealth Directives.

Telephone Service codes are evaluation and management codes and are not considered part of telehealth.

As always, should you have questions or concerns, please call your Provider Relations Representative at (800) 842-4464, ext. 5000.

Previously Posted on March 26, 2020

As Health New England continues to monitor the coronavirus, and with the help of the Centers for Disease Control, Massachusetts Division of Insurance, Centers for Medicare & Medicaid Services, and the many regulated entities, we are adjusting our policies as well as the operational procedures necessary for you to provide services to our members during this time period.

COVID-19 Testing and Treatment

As previously communicated, Health New England is following the guidance issued by the Massachusetts Division of Insurance and will handle member responsibility as follows:

Health New England is waiving cost sharing (copayments, co-insurance and deductible) for COVID-19 Diagnostic Testing.
Health New England is waiving copayment for medically necessary COVID-19 treatment at doctors’ offices, emergency rooms and urgent care centers.
If a vaccine becomes available, Health New England will cover the cost of the COVID-19 vaccine.

Please refer to our Coding Best Practices & Tips at https://healthnewengland.org/providers/coding for appropriate diagnosis and coding guidance.

Telehealth and Telemedicine

Health New England’s Telehealth (Telemedicine) Services payment policy can help guide you when providing medically necessary services via telehealth technology to our members. To view the policy, go to https://healthnewengland.org/Providers/Resources, then click on Payment Policies.

In order to restrict face-to-face encounters to treat health conditions, Health New England is encouraging all in-network providers to deliver clinically appropriate, medically necessary covered health services via telehealth to covered members during the duration of the State of Emergency. This includes medical, behavioral health, and ancillary health visits for all diagnosis and is not specific to a COVID-19 diagnosis.

Health New England also covers digital online evaluation and management (E/M) services. These services include:

CPT codes 99421-99423: Physicians independently billing E/M services
CPT codes 98970-98972: Qualified, non-physician health care professional who cannot independently bill E/M services

Documentation requirements for a telehealth service are the same as those required for any face-to-face encounter, with the addition of the following:

A statement that the service was provided using telemedicine or telephone consult
The location of the patient
The location of the provider
The names of all persons participating in the telemedicine service or telephone consultation service and their role in the encounter

Coding and Billing Guidance:

Providers must submit Commercial and BeHealthy Partnership claims with POS 02 and use the appropriate modifiers (95 or GT) to indicate when telehealth services have been rendered.
Providers must submit Medicare Advantage claims in accordance with CMS guidelines.
Providers must submit BeHealthy Partnership claims in accordance with MassHealth guidance/directive.
Health New England will compensate providers for telehealth services based on the contractual rate or fee schedule specified in their provider agreements.

Telephone Services

Health New England also covers telephone services billed with CPT codes 99441-99443 and 98966-98968, if the telephone service is rendered to an established patient and the service provided meets the billing guidelines.

Additional Information

During this time, member cost share responsibility still applies according to the member’s benefit plan, other than what is noted above for COVID-19 related care. To find more information on benefit cost sharing, please go to HNEDirect.

To learn more about Health New England policies on Evaluation and Management, please go to https://healthnewengland.org/Providers/Resources, then click on Payment Policies.

Health New England’s 24/7 Nurse Advice Line at (866) 389-7613 remains available for free to all our members. In addition, effective 4/1/2020, Health New England is removing the copay for medical telehealth services through Teladoc® for our fully funded commercial members. If a member’s plan applies a deductible for these services, the deductible will still apply. A copay will still apply to behavioral health services through Teladoc.

HIPAA Guidance

When using telehealth technology, Health New England encourages providers to use the appropriate technologies when communicating with members to ensure their same rights to confidentiality and security as provided in a face-to-face service.

As always, should you have questions or concerns, please call your Provider Relations Representative at (800) 842-4464 ext. 5000.

Previously Posted on March 12, 2020

Cost Sharing and Access for Members

Following recent mandates by the Massachusetts Division of Insurance, Health New England will be:

Covering the cost of diagnostic tests for COVID-19 for our fully insured and Connector members (including high deductible health plan members), and Medicare members. These members will pay no copay, co-insurance, or deductible for these tests. We will be working with our self-funded employer groups to implement the same measures or those of their choosing.
Waiving copays for medically necessary COVID-19 treatment at doctors’ offices, emergency rooms and urgent care centers, consistent with the guidance issued by the Massachusetts Division of Insurance.
Covering the cost of vaccination when a COVID-19 vaccine is available.
Removing any administrative barriers, such as prior authorizations, for members receiving medically appropriate care for COVID-19.
Consistent with Health New England’s policies, referrals will remain unnecessary.
Working on waiving copays for members with access to Teladoc®, our telehealth platform, and telehealth services with local providers as they become available. Our 24/7 Nurse Advice Line (866) 389-7613 remains available for free to all members.
Ensuring access to prescription medication by allowing early refills of 30-day prescription maintenance medication. In addition, Health New England, has a 90-day maintenance medication benefit available to members for both retail and mail-order. We will have formulary flexibility if there are shortages or access issues, or if new treatment options become available.
Continuing to educate and inform our members about the virus and how contain the spread at this Coronavirus FAQ webpage.

Payment and Reimbursement Guidelines

To understand the payment and reimbursement guidelines, please go to healthnewengland.org/providers/Resources, then click on Payment Policies and reference our Evaluation and Management payment policy as well as our Telehealth (Telemedicine) Services payment policy.
To understand general coding guidance on diagnosis codes for COVID-19, please go to https://healthnewengland.org/providers/coding and click on Coronavirus (COVID-19) Testing and Treatment Physician Tip Sheet.

Business Continuity Planning

We are prepared to operate effectively under conditions of increased absenteeism or quarantine by utilizing our technological capabilities for associates to work from home, if necessary.
Although the precautions to avoid the spread of COVID-19 may impact where staff works, we will still maintain full infrastructure capacity. This means we do not have to reduce critical functions because our day-to-day member and provider operations capabilities can be operated remotely minimizing impact to services and needed care.
Health New England will continue its efforts to complete the annual HEDIS and Risk Adjustment audits. We are aware of impacts to the deadlines, especially with HEDIS, and we are waiting for direction from our regulatory partners on adjusting the timeline. As soon as we know, we will communicate. In the meantime, the Risk Adjustment and Quality teams stand ready to assist offices in whatever way they can to expedite the collection of medical records that have been requested as part of these audits. If your office requires additional assistance, please email qualityimprovement@hne.com and someone will contact you to discuss options.

Should you have questions or concerns, please call your Provider Relations Representative at (800) 842-4464, ext. 5000.

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Categories: HNE/Industry News and Information, Notice of Policy Changes, Provider Newsletter