New! Coverage for At-Home Tests
As of January 15, 2022, QualChoice Members can get COVID-19 Home Testing kits at no cost.
See Coverage Help to Learn MoreCoronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. People of all ages can be infected. Older adults and people with pre-existing medical conditions like asthma, diabetes and heart disease may be more likely to become severely ill if infected.
- 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.
- Wear a face covering/mask when in public and/or around others who do not live in your home if you are not fully vaccinated
- 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.
Coverage for Testing, Treatment and Vaccinations
For all members, QualChoice plans cover COVID-19 testing and vaccinations at no member cost sharing. There is no copayment, coinsurance or deductible cost sharing for COVID-19 testing or vaccinations.
The treatment of COVID-19 is covered and member cost sharing will apply. Please refer to your plan documents for cost sharing details.
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.
COVID-19 Home Testing Kits
As of January 15, 2022, QualChoice Members can get COVID-19 Home Testing kits at no cost. The best way to get a testing kit is to go to a QualChoice in-network pharmacy. If you purchase a testing kit outside of QualChoice in-network pharmacies, you will simply complete a medical claim form (PDF). The following FAQs will assist you in this process.
Yes. QualChoice is making COVID-19 tests available at no cost if you go to an in-network pharmacy. Also, the Biden Administration is making free tests available by the United States Postal Service. Every home in the U.S. is eligible to order 4 free at-home COVID-19 tests. Orders will usually ship in 7-12 days. Please visit https://www.covidtests.gov/ for more information.
QualChoice is currently working with our pharmacy partners to ensure the COVID-19 tests are available at no cost if you go to an in-network pharmacy. If you purchased the at-home COVID-19 test at the pharmacy we will reimburse you for the cost of the test after you complete the medical claim form (PDF).
The reimbursement will be limited up to the amount set in the federal guidance ($12, or the cost of the test if less than $12, per test per covered individual) released on January 10, 2022.
If you purchased a kit prior to January 15, 2022, QualChoice will reimburse when accompanied by a physician prescription.
Yes, if you purchased the at-home COVID-19 test at any location outside of our pharmacies (e.g., Amazon, grocery store, etc.), we will reimburse you for the cost of the test after you complete the medical claim form (PDF).
The reimbursement will be limited up to the amount set in the federal guidance ($12, or the cost of the test if less than $12, per test per covered individual) released on January 10, 2022.
If you purchased a kit prior to January 15, 2022, QualChoice will reimburse when accompanied by a physician prescription.
Please print an image of the digital receipt along with the member reimbursement form. If you are unable to produce a digital receipt, please put the order or invoice number for the purchase on the reimbursement form for tracking and validation.
Yes, QualChoice will only cover 8 at-home COVID-19 tests or 4 at-home COVID-19 test kits (each kit contains 2 tests) obtained over-the-counter per covered individual in a 30 day period, consistent with the federal guidance released on January 10, 2022.
Telehealth Services
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.
- Any care that can be delivered this way is covered.
- Any type of connection technology may be used.*
*Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.
Yes. When medically necessary treatment ordered and/or referred by a licensed health care provider will be covered. Please refer to Plan Documents for member cost sharing.**
**Out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
- Physician’s/Practitioner’s Office
- Independent Laboratory/Diagnostic Facility
- Urgent Care Facility
- Emergency Department Facility
*Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
**Out-of-network providers may bill the member for the difference between the maximum allowable charge and the bill amount (balance bill).
Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.
Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.
If you are fully vaccinated and have a known exposure to someone with COVID-19, the CDC says that you may refrain from quarantine and testing if you are asymptomatic. It is recommended to continue to monitor for symptoms for 14 days.
- Take care of your body. Take deep breaths, stretch or meditate.
- Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
- Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
- For more information, see the CDC’s suggestions for mental health and coping during COVID-19
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.
In an effort to help facilities accept patients during the COVID-19 pandemic, QualChoice has implemented the following changes to allow more flexibility for inpatient stays and post-acute transfers.
These changes will be effective until March 31, 2022, but the end date may be changed. Please be sure to sign up for our provider emails so that you can receive important notifications from us.
The changes apply to inpatient admissions, skilled nursing facilities, long-term acute care, and acute rehabilitation facilities for all lines of business. Acute transfers from psychiatric stays at behavioral health facilities are excluded.
Inpatient Admissions:
QualChoice will allow notification of admission up to five days after the initial admission date and will complete medical necessity reviews once the notification is received.
Post-Acute Accommodations for Rehab Hospitals and Long-Term Acute Care Hospitals (LTACH):
QualChoice is relaxing the following requirements related to facility transfers:
- QualChoice will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities.
- We will not require sending facilities to provide notification of transfer to participating providers.
- However, we will require receiving facilities to notify the health plan of patient admission. We will accept notification up to five days post-transfer.
- QualChoice will continue to conduct medical necessity review.
As we will not have visibility prior to transfer, we request that hospitals utilize our in-network post-acute facilities.
Skilled Nursing Facilities:
QualChoice will allow a post-admission notification and authorize up to a seven-day stay before an additional continued stay review is required.
If you have questions about this notification or would like to speak to one of our provider relations representatives, please call us at 1-800-235-7111 (TTY: 711). Thank you for your continued partnership in helping our members live better.
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 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. Members of self-funded plans should refer to their Plan Administrator for questions regarding COVID-19 coverage.
Acute Transfers
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.
- Three COVID-19 vaccines have received approval by the FDA of their emergency use authorizations (EUA). The Pfizer, Moderna and Janssen (Johnson & Johnson) 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 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 codes will be processed with no member cost share.
- Out-of-network: COVID-19 testing 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 approval by the U.S. Food & Drug Administration (FDA).
The following codes are billable for the specific vaccines below.
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 |
91303 |
SARS-CoV-2 VAC 5/1010 VIRAL PARTICLES/.5 ML |
Janssen |
Janssen COVID-19 Vaccine |
0031A |
SARS-CoV-2 VAC 5/1010 VIRAL PARTICLES/.5 ML |
Janssen |
Janssen COVID-19 Vaccine Administration |
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.
Effective immediately, the policies we are implementing include:
- Any services that can be delivered virtually will be eligible for telehealth coverage.
- 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 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.
- 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.
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.
- QualChoice COVID-19 Vaccination Flyer (PDF)
- Arkansas COVID-19 Vaccination Plan
- COVID-19 Vaccination Locations
- CDC Facts About COVID-19 Vaccines
vaccine is the best protection against getting and spreading the coronavirus. It can help protect other family members who cannot get vaccinated or are at greater risk
for health problems.
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.