Coronavirus disease 2019 (COVID-19) is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, the total impact of the illness, and many other factors.
- Wash your hands thoroughly and often. Use soap and water for at least 20 seconds.
- Use an alcohol-based hand sanitizer with at least 60 percent alcohol.
- Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
- Promptly dispose of tissues in a wastebasket after use.
- Clean public surfaces thoroughly.
- Stay home when you are sick.
- Avoid shaking hands.
- Avoid close contact with people who are sick.
- Get a flu vaccine.
QualChoice is taking extra steps to care for our members during the coronavirus outbreak. In accordance with guidance from the Centers for Medicare & Medicaid Services, we are taking the following measures to enhance coverage for care related to COVID-19.
Claims with COVID-19 testing and/or diagnosis or treatment codes will be processed with no member liability, beginning April 1, 2020 with a retroactively effective date of February 4, 2020.*
- In-network: COVID-19 testing and treatment codes will be processed with no member cost share.
- Out-of-network: COVID-19 testing and treatment codes will be processed at the maximum allowed charge (the rate that QualChoice would normally reimburse a provider).
No pre-authorization is required for care from an out-of-network provider. However, QualChoice should be notified of any hospital admission within 48 hours.
NOTE: Out-of-network providers may balance bill the member. This means they may charge you for any difference between the maximum amount allowed by QualChoice and the amount they charge for the services. Discuss balance billing practices with your provider if choosing out-of-network care.
*Although cost sharing will be waived, out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
- There is no copay or cost sharing.*
- Any care that can be delivered this way is covered.
- No pre-authorization is required from March 17, 2020 through July 25, 2020.
- Any type of connection technology may be used.**
*For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.
**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.
QualChoice is committed to the health of our members. Our fully insured employer group plans will cover the cost of medically necessary COVID-19 tests, treatment and the associated doctor's visits.* There is no cost sharing or pre-authorization required for these services.**
*Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
**Although cost sharing will be waived, out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
*Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
**Although cost sharing will be waived, out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
*Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
**Although cost sharing will be waived, out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
- Virtual visit (telehealth services)
- Doctor’s office
- Independent laboratory/diagnostic facility
- Urgent care facility
- Emergency department facility
UAMS Health, a QualChoice in-network facility, provides online screening.
If you have been exposed to or show symptoms of the coronavirus or flu, contact your healthcare provider or health department right away.
*Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
**Although cost sharing will be waived, out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
Learn more about COVID-19, Pregnancy and Breastfeeding.
We want you to be aware of the tools available to help you identify the COVID-19 virus and care for your patients during this time of heightened concern. New information, obtained daily, will further inform the risk assessment, treatment options and next steps.
- Ask patients complaining of fever and lower respiratory illness about known, suspected or potential COVID-19 exposure.
- Instruct symptomatic patients with known, suspected or potential COVID-19 exposure to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
- Healthcare personnel encountering symptomatic patients with known, suspected or potential COVID-19 exposure should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
- Refer to the Centers for Disease Control and Prevention (CDC) criteria for a patient under investigation for COVID-19. Notify local and/or state health departments in the event of a patient under investigation for COVID-19. Maintain a log of all healthcare personnel who provide care to a patient under investigation.
- Monitor and manage ill and exposed healthcare personnel.
- Safely triage and manage patients with respiratory illness, including COVID-19. Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.
- Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
- Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
- Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
- Refer to the CDC and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing and treatment information.
Testing and Treatment Services
For fully insured group plans, QualChoice will cover medically necessary COVID-19 diagnostic testing and/or medical screening services as well as treatment at no charge to members, when services are ordered and/or referred by a licensed healthcare provider. Members’ copayment, coinsurance and/or deductible cost-sharing requirements will be waived for testing and/or medical care, along with the associated physician’s visit. Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
Claims
Claims with COVID-19 testing and/or diagnosis or treatment codes will be processed with no member liability, beginning April 1, 2020 with a retroactively effective date of February 4, 2020.
- In-network: COVID-19 testing and treatment codes will be processed with no member cost share.
- Out-of-network: COVID-19 testing and treatment codes will be processed at the maximum allowed charge (the rate that QualChoice would normally reimburse a provider).
QualChoice will not require pre-authorization for out-of-network COVID-19 care but we do expect to be notified within 48 hours of any hospital admission. NOTE: Out-of-network providers may balance bill. Out-of-network claims will be processed at the maximum allowed charge.
Screening Codes
If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:
- Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
- Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation
Testing Codes
For dates of service from February 4, 2020, through March 31, 2020 providers should use the ICD-10 diagnosis code:
- B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere
For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:
- U07.1 – 2019-nCov Confirmed by Lab Testing
Guidance will be updated as more information becomes available.
Effective immediately, the policies we are implementing include:
- Waiving all member liability (copays, cost sharing, etc.) for care delivered via telehealth, including Health Savings Account (HSA) eligible plans.*
- Any services that can be delivered virtually will be eligible for telehealth coverage.
- All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through July 25, 2020.
- Telehealth services may be delivered by providers with any connection technology to ensure patient access to care.**
- Audio-visual telehealth services should be billed using Modifier 95 or Modifier GT and Place of Service code 02. Any services that can be delivered virtually will be eligible for telehealth coverage. For questions regarding audio-visual telehealth coverage, please contact your QualChoice Provider Relations Representative.
- Telephone-only services have historically not been covered but will now be covered through July 25, 2020. Any services that can be delivered via telephone will be eligible for coverage. For questions regarding telephone based service coverage, please contact your QualChoice Provider Relations Representative.
- 800.235.7111 or 501.228.7111, ext. 7004
- pr@qualchoice.com
- Provider Relations Representatives
*For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.
**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.
More Resources
For more information, including travel advisories, please visit cdc.gov.
- CDC General Information on COVID-19
- WHO General Information on COVID-19
- CDC Information on Travel
- CDC Videos on COVID-19
- CDC Print Resources
For information on the outbreak in Arkansas:
- Arkansas Department of Health COVID-19 information page
- UAMS Online Screening
- For screenings or questions regarding COVID-19, you can now call the UAMS Health hotline at 1-800-632-4502.
- For patients less than 18 years old, call 1-800-743-3616 to speak with an Arkansas Children’s pediatric nurse. Nursing staff will be available for questions and phone screenings 24 hours a day, seven days a week.