Protecting Our Members Against COVID-19

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.

COVID -19 is a respiratory disease that is caused by a new strain of the coronavirus. The number of cases is increasing around the country and the world.
The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, shortness of breath and lower respiratory illness. It may be contagious before a person begins showing symptoms.
Influenza (the flu), a contagious respiratory illness caused by Type A and Type B influenza viruses, is highly active in the United States now. Everyone 6 months of age and older should get a flu vaccine.
If you have been exposed or begin showing symptoms of the coronavirus or flu, contact your healthcare provider or health department right away.
We all have a role to play in protecting our communities and families from the spread of this virus, just as with other contagious viruses. You can also follow these tips to prevent infection:
  • 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.

QualChoice fully insured group plans cover COVID-19 testing and treatment. They also cover vaccinations. There is no copay, coinsurance or deductible cost sharing. No pre-authorization (pre-approval) is needed. Members of self-funded plans: Check with your Plan Administrator for questions about COVID-19 coverage. Vaccines are covered for members of self-funded plans using OptumRx through QualChoice.

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 care. Discuss balance billing with your provider if choosing out-of-network care.

Claims with COVID-19 testing, diagnosis, treatment or vaccine-related codes will be processed with no member cost share. This applies to claims with effective dates starting February 4, 2020.*

  • In-network: COVID-19 testing, treatment and vaccine-related codes will be processed with no member cost share.
  • Out-of-network: COVID-19 testing, treatment and vaccine-related codes will be processed at the maximum allowed charge (the rate that QualChoice will reimburse a provider).

No pre-authorization is needed for care from an out-of-network provider. But you should notify us within 48 hours if you are admitted to a hospital.

*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).

Early prescription refills at your pharmacy and by home or mail delivery are being allowed. This will ensure that you can get your regular prescriptions even if you can’t go to the pharmacy.
QualChoice urges members to schedule virtual doctor visits—by smartphone or other video-capable device—when appropriate, in place of face-to-face office visits. This also applies to care not related to COVID-19 during the outbreak.

  • There is no copay or cost sharing.*
  • Any care that can be delivered this way is covered.
  • No pre-authorization is required during this Public Health Emergency.
  • 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).

Yes, when medically necessary diagnostic testing or medical screening is ordered and/or referred by a licensed healthcare provider, your fully insured group plan will cover the cost of tests and the associated doctor’s visit.* Your copayment, coinsurance and/or deductible cost-sharing will be waived.**

*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).

Yes, when medically necessary diagnostic testing or medical screening is ordered and/or referred by a licensed healthcare provider, your fully insured group plan will cover the cost of treatment a)nd the associated doctor’s visit.* Your copayment, coinsurance and/or deductible cost-sharing will be waived.**

*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).

No, pre-authorization for medically necessary COVID-19 diagnostic testing/screening or treatment is not required when ordered and/or referred by a licensed healthcare provider.
Medically necessary COVID-19 diagnostic testing and/or medical screening and the associated doctor’s visit will be covered when ordered, referred and/or performed in the following in-network settings:
  • Virtual visit (telehealth services)
  • Doctor’s office
  • Independent laboratory/diagnostic facility
  • Urgent care facility
  • Emergency department facility
During this outbreak, a virtual care (telehealth) visit is recommended. This type of care, by smartphone or other video capable device--is covered for COVID-19 as well as unrelated care. This limits possible exposure in a doctor’s office or other healthcare 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.
No, your fully insured group plan will cover medically necessary COVID-19 diagnostic testing/screening and treatment at no charge to you when ordered and/or referred by a licensed healthcare provider.* Your copayment, coinsurance and/or deductible cost-sharing will be waived.**

*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).

Yes, QualChoice members will be able to refill prescriptions before the refill date if needed.
COVID-19 is a new disease and we are still learning more about it. At this time there is no evidence that pregnant women are more likely to contract COVID-19 or get more sick from it than other people. But pregnant women should always protect themselves from illness.

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.

We are working to quickly address and support screening, testing and treatment for COVID-19, and are closely following guidance from the Centers for Medicare and Medicaid Services (CMS). As of April 1, 2020, the following guidance can be used to bill for services related to the screening and treatment of COVID-19.

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.

Acute Transfers

To help facilities accept patients during the pandemic, the initial seven days of lower levels of care for patients moving from an inpatient hospital setting will be auto-approved.

Please provide notification of admission by submitting an authorization request review within the first five days of a patient’s admission. We will continue to provide concurrent review after the initial seven-day approval. This waiver is in effect from December 2, 2020 to March 15, 2021.

Skilled nursing facilities, long-term acute care and acute rehab for QualChoice will include respite as well.

Vaccines – Physician Offices

The Centers for Medicare and Medicaid Services (CMS) has begun to publish guidance for providers regarding vaccine administration. Similar to other COVID-19 services, vaccines will be offered at no cost to your patients. In addition:

  • QualChoice will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration.
  • Member liability will be $0.
  • Non-participating provider pre-auth requirements will be waived.
  • Two COVID-19 vaccines have received approval by the FDA of their emergency use authorizations (EUA). Both the Pfizer and Moderna products have been approved and have been/are being distributed. 

We strongly encourage Members to receive services from in-network providers to avoid the risk of balance billing.

Vaccines – Pharmacies

Vaccines are being administered by some pharmacies and will be covered, with no member cost share, for fully insured members and members of self-funded plans using OptumRx through QualChoice. Pharmacies may bill OptumRx through the pharmacy benefit per the instructions provided. Review OptumRx claim submission requirements.

We strongly encourage Members to receive services from in-network providers to avoid the risk of balance billing.

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

Vaccine Codes

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes will be billable when the specific vaccine has received official EUA approval.

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-BioNTech COVID-19 Vaccine

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNTech COVID-19 Vaccine

Administration – First Dose

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNTech COVID-19 Vaccine

Administration – Second Dose

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna COVID-19 Vaccine

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna COVID-19 Vaccine

Administration – First Dose

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna COVID-19 Vaccine

Administration – Second Dose

 

CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. For questions about upcoming vaccines or the COVID-19 services QualChoice covers, please contact Provider Services at 501.228.7111, ext. 7004.


Guidance will be updated as more information becomes available.

To ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

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.
  • Pre-authorization requirements for telehealth services are waived for the duration of the Public Health Emergency.
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care.**
Medical Coding
  • 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 will be covered for the duration of the Public Health Emergency. 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.
QualChoice Provider Relations
  • 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.

Early prescription refills at pharmacies and by home or mail delivery are being allowed. This will ensure that our members can get their regular prescriptions even if they can’t go to the pharmacy.

Vaccine Information

Learn when and where to get the shot in Arkansas. Find out more about the benefits of getting the vaccine benefits and its safety.

More Resources

For more information, including travel advisories, please visit cdc.gov.

For information on the outbreak in Arkansas: