What you need to know about coronavirus (COVID-19) 

For WellFirst Health providers

WellFirst Health is taking measures to support our valued in-network providers who are caring for our members amid concerns of the coronavirus COVID-19 spreading in our area. Check this web page regularly for updates.

If you have questions contact your Provider Network Consultant directly and email your question to ProviderRelations@wellfirstbenefits.com for a prompt reply.

In alignment with COVID-19-related federal and state regulations, WellFirst Health is:

  • implementing $0 member cost share
  • removing authorization requirements for certain services
  • putting temporary policies into use
  • increasing network adequacy monitoring.

Our intention is to remove potential barriers and delays to COVID-19 testing and treatment across all WellFirst Health product lines. 

Provider communications

COVID-19 Communication: 4/2/20: Includes health plan waiver information

COVID-19 Communication: 3/26/20

COVID-19 Communication: 3/12/20

Telemedicine information: 3/18/20

WellFirst Health's COVID-19 Policies

WellFirst Health is waiving copayments and cost sharing for diagnostic screenings and associated evaluation and management (E&M) services related to COVID-19. There will be no member out-of-pocket costs for all products, including Commercial, Medicare, Medicaid and Dean Administrative Services Only (ASO) self-funded groups.
Updated 3/26/20

We are complying with CMS coding guidelines for COVID-19 testing.
 
The American Medical Association created a new CPT code effective for dates of service on or after March 13, 2020, to describe COVID-19 testing by amplified probe technique:
  • 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
 
Previously, CMS released two HCPCS codes effective for dates of service on or after February 20, 2020, available for use on April 1, 2020:
  • U0001 - CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel
  • U0002 - 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19)
 
Laboratories using the CDC test kit should report U0001. Laboratories not using the CDC test kit should report 87635 if the testing method meets the code description. If your laboratory uses any other method not described by CPT 87635, HCPCS U0002 may be billed. We do not anticipate a need to receive code U0001 at this time as the government is testing at no cost.
 
The implementation date for ICD-10-CM code U07.1 (COVID-19) has been moved up to April 1, 2020, from Oct. 1, 2020. Effective for discharge/dates of service on and after April 1, 2020, diagnosed cases of COVID-19 and presumptive positive COVID-19 tests should be reported with ICD-10-CM code U07.1, except in the case of newborns and obstetrics patients. Appropriate codes for associated medical manifestations should be reported as additional diagnoses.
 
For discharge/dates of service before April 1, 2020, providers should follow previously communicated guidelines using the ICD-10 code for the condition as the primary diagnosis followed by B97.29 as the secondary diagnosis.
Updated 3/26/20

Waiving authorizations
WellFirst Health is waiving authorizations for diagnostic services related to COVID-19 testing. 

We are temporarily removing the prior authorization requirement for CT Chest Current Procedural Terminology (CPT) code 71250 for chest scans when the primary reason for the chest scan is related to COVID-19.

Postponing elective surgeries and non-essential procedures
On March 18, 2020, CMS released a recommendation that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the COVID-19 outbreak for the preservation of personal protective equipment, beds, and ventilators. In response, Utilization Management is evaluating all approved prior authorizations on file for elective inpatient admissions with a surgery/admit date on or before March 16, 2020, to determine if the surgery was rendered:
  • If the surgery has been performed, we will process the applicable provider claims using our standard process.
  • If the surgery was not performed, we will change the admit/start date on the prior authorization to a future date. We will continue to do so, as necessary, during the COVID-19 public health emergency. Authorizations with a changed start/admit date will be denoted by a COVID-19 statement in the Provider Portal authorization summary.
    
Providers do not need to obtain a new prior authorization for any already-approved surgeries. Once CMS lifts its recommendation and the surgery is scheduled, providers will need to call our Customer Care Center to report the date of surgery, as required by our current process.
 

Providers who are not equipped to handle COVID-19 patient inquiries or collect specimens for testing can contact us for the nearest in-network provider at DHP.PNCInquiry@deancare.com.

Providers who do not have access to a qualifying laboratory for COVID-19 testing can contact one of the following in-network FDA-approved laboratories:
  • The State Lab
  • Quest Diagnostics
  • LabCorp
WellFirst Health will not be amending contracts for COVID-19 measures. We will add applicable COVID-19 codes to all appropriate fee schedules.
WellFirst Health will regularly poll providers to monitor network adequacy related to provider availability for needed COVID-19 diagnosis and treatment. We ask for your prompt response to these inquiries.

Please notify your Provider Network Consultant immediately of any site closures or if you are deploying practitioners to other locations.
Updated 4/2/20

We are referring to the CMS Medicare Telemedicine Health Care Provider Fact Sheet for our expanded telemedicine coverage guidance effective for dates of service beginning March 6, 2020. Our expanded coverage will remain in effect until further notice.

To support needed provider network adequacy, protect members and providers, and promote access to care, we are offering Zoom meeting licensure to providers without the ability to conduct telemedicine services during the COVID-19 public health emergency. Providers may contact their Provider Network Consultant if they are interested in obtaining a Zoom license to provide telehealth services.

WellFirst Health’s coverage of COVID-19 telemedicine services includes the 85 additional services temporarily added by CMS. In alignment with CMS guidance, these temporary services should be billed with the Place of Service (POS) equal to what would have been billed if not for the public health emergency.

Modifier 95 should be appended to indicate that the service rendered was actually performed via telehealth. Traditional telehealth services should continue to be billed with POS ‘02’.

Our coverage of COVID-19 telemedicine services includes CPT codes 99441, 99442, and 99443 (non-face-to-face telephone services) for all WellFirst Health products. Other telephone-service codes include 98966, 98967, 98968 (qualified non-physician providers) and G2010 (remote evaluation of recorded video or image) and G2012 (Brief communication technology-based service, e.g., virtual check-in). Standard coding and billing rules apply, although, rules surrounding the use of codes for “established patients” only, have been relaxed.

See CMS MLN “Telehealth Services” for acceptable telehealth CPT codes.

Virtual check-in visits will also be covered during the COVID-19 state of public health emergency. Acceptable codes include G2010 and G2012 for brief telephone check-ins for established patients.

Providers should continue to only bill codes that are on their fee schedules. If you need assistance verifying the codes on your fee schedule or have specific questions on allowable codes other than those listed within our guidelines, contact your Provider Network Consultant.

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