COVID-19 Information Center

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.

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.

• 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.