For dates of service from May 11, 2020, through Sept. 30, 2020, cost-sharing for all network primary care physician and specialist office visits, as well as network visits for therapy services, is waived for Peoples Health patients.
For patients diagnosed with COVID-19 who are discharged from an inpatient stay during the COVID-19 public health emergency, Peoples Health will automatically reprocess applicable claims for these patients with any increased-weight, diagnosis-related group values once they are released by CMS.
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) should use the following guidelines when submitting claims for distant site telehealth services
The health of our plan members and the safety of those who deliver care are our top priorities. COVID-19 is a rapidly evolving public health emergency, and we’re working closely with national, state and local health organizations.
On this page, we will post COVID-19-related updates to our operational processes, as well as other relevant information that will be pertinent to your provision of care to Peoples Health patients during this time. We’re monitoring the COVID-19 public health emergency closely and updating this site with new information as it’s available. Be sure to check back frequently for updates.
Last updated: 05/15/2020 5:00 p.m.
LATEST COVID-19 NEWS
Waiver of Network Physician Office Visit Cost-Sharing
For dates of service from May 11, 2020, through Sept. 30, 2020, cost-sharing for all network primary care physician and specialist office visits, as well as network visits for therapy services, is waived for Peoples Health patients. The patients are not required to pay a copay for these visits (including those via telehealth) during this time.
This change is part of our ongoing efforts to address COVID-19 challenges by expanding coverage to support the health care system and patients.
The waiver doesn’t require a COVID-19 diagnosis, and it applies to physician evaluation and management services provided in physician offices, facility-based clinics, patient homes (via telehealth), rural health clinics, and federally qualified health centers, as well as to outpatient therapy services.
If the office visit includes additional services, such as labs and diagnostic tests, a Peoples Health patient may have cost-sharing based on their plan benefits, unless cost-sharing is already waived because it is for COVID-19-related treatment.
The information below is updated as of 5/8/2020.
The cost-sharing waiver applies to the following services from network providers:
- Primary care physician office visit
- Specialist physician office visit
- Associated physician assistant/nurse practitioner or other health care professional office visit
- Medicare-covered chiropractic care
- Medicare-covered podiatry
- Medicare-covered eye exams
- Medicare-covered hearing exams
- Outpatient physical, occupational or speech therapy
- Cardiac and pulmonary rehabilitation
The cost-sharing waiver does not apply to the following additional services:
Unless cost-sharing is already waived because it is for COVID-19-related treatment, cost-sharing is not waived for these services when performed in an office or in other settings:
- Lab services
- Diagnostic procedures and tests
- Diagnostic radiological services
- Therapeutic radiological services
- Part B drugs and chemotherapy drugs
- Medicare-covered dental services
- Medicare-covered eyewear
- Part D drugs
- DME, prosthetics/orthotics and medical supplies
- Blood and blood products
- Hearing aids
- Diabetes monitoring supplies, therapeutic shoes or inserts
Cost-sharing for any services below/rendered in the below settings is also not eligible for the waiver:
- Inpatient hospital
- Outpatient surgery or observation services
- Skilled nursing facilities
- Home health
- Emergency services, urgently needed services and ambulance services
Inpatient Claims Reprocessing for Weighted Payments
For patients diagnosed with COVID-19 who are discharged from an inpatient stay during the COVID-19 public health emergency, Peoples Health will automatically reprocess applicable claims for these patients with any increased-weight, diagnosis-related group values once they are released by CMS. You do not need to resubmit these claims for processing once the new weighting factors are released. For contracted providers, the claims will be processed initially at the contracted rate, and once the updated weighting factors are available, we will automatically reprocess and adjust claims appropriately for any applicable, additional payment. Claims for non-contracted providers will follow Medicare pricing as appropriate. For information on related diagnosis codes and corresponding time frames used for these payment adjustments, refer to this MLN Matters article.
Electronic Funds Transfer (EFT)
Did you know you can enroll in EFT to receive claims payments from Peoples Health? To learn more about enrolling in EFT or to request an EFT enrollment form, email email@example.com or contact your provider representative. Note that to enroll in EFT, you must also be able to receive electronic remittance advice.
FQHC and RHC Claim Guidelines
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) should use the following guidelines when submitting claims for distant site telehealth services, to ensure the claims accurately indicate the services were provided via telehealth:
- For telehealth services rendered from 27, 2020, through June 30, 2020: Include modifier 95
- For telehealth services rendered between July 1, 2020, and the end of the COVID-19 public health emergency: Use the RHC/FQHC-specific G code, G2025
Claims will be paid according to CMS reimbursement guidelines for each time period. Note: FQHCs and RHCs are required, per Medicare, to waive cost-sharing for COVID-19 testing, including telehealth. RHCs and FQHCs must include the modifier “CS” on the service line for these services.
Claims Processing Update
As part of our ongoing efforts to support you in your operations, Peoples Health will accelerate the timing of payments for your submitted claims starting April 15, 2020, and throughout the COVID-19 public health emergency. Payments will be issued the week immediately following adjudication of a claim.
Home Health Agencies
Home health agencies can provide more services to patients using telehealth within the 30-day episode of care, so long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. We acknowledge that the use of such technology may result in changes to the frequency or types of in-person visits outlined on existing or new plans of care. For more information, please visit the CMS website.
Prior Authorization for Drugs
COVID-19 Treatment Cost-Sharing
Peoples Health is waiving patient cost-sharing for any COVID-related treatment provided through May 31, 2020. The waiver applies to all locations of services and from both in-network and out-of-network providers.
Early Prescription Refills
Your Peoples Health patients can fill existing prescriptions early (up to a 90-day refill) through direct pharmacy or mail order. This early-refill option is available through June 15, 2020. To get an early refill, patients can call the pharmacy number on their ID card or speak directly to a pharmacist.
COVID-19 Testing-Related Telehealth Visits
From March 18, 2020, and throughout this public health emergency, we will waive patient cost-sharing for in-network and out-of-network COVID-19 testing related telehealth visits, including both interactive audio/video and audio only.
Expanded Provider Telehealth Access
Peoples Health is waiving the CMS originating site restriction and audio-video requirement for patients from March 18, 2020, until June 18, 2020. Eligible care providers can bill for telehealth services performed using interactive audio/video or audio only, except in the cases where we have explicitly denoted the need for interactive audio/video such as with PT/OT/ST, while a patient is at home.
Peoples Health is closely monitoring the drug supply chain to determine if any coverage changes are necessary.