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California Health & Wellness Alerts for Providers

All providers and office staff are encouraged to attend an upcoming training to learn more about the COVID-19 vaccine(s), best practices, how to address vaccine hesitance and more.

Register today!

Register to attend one or more of the trainings below.

Date Time (Pacific time)
January 21, 2021 9–10:30 a.m.
January 29, 2021 9–10:30 a.m.
February 4, 2021 Noon–1:30 p.m.
February 23, 2021 Noon–1:30 p.m.
March 11, 2021 2–3:30 p.m.
March 23, 2021 Noon–1:30 p.m.
April 14, 2021 2–3:30 p.m.
April 27, 2021 Noon–1:30 p.m.

Training topics

  • COVID-19 vaccines
    • Provider selection
    • State and federal programs
    • Approach to mass vaccination
  • Vaccine best practices
    • Administration
    • Documentation
    • Adverse event notification
  • Vaccine hesitancy
    • Communication strategy
    • Key points on communicating about the COVID-19 vaccine
  • Health plan updates
    • HEDIS® medical record collection
    • State minimum performance measures released
    • Supplemental data: Claims and encounters

Health Net Sharing New COVID-19 Support Program to Assist Providers with Grant Writing & Small Business Loan Applications

Health Net is providing assistance to network providers in CA who are seeking relief amid the COVID-19 pandemic through the Small Business Administration (SBA) and the CARES Act.


COVID-19 (Coronavirus)

Questions and Answers for California Health & Wellness Plan Network Providers

Due to the rapidly changing environment as a result of COVID-19, the information included in this section is intended to serve as a guide for COVID-19-related information. This information and guidance is in response to the current COVID-19 pandemic and is subject to change, and may be retired at a future date. Unless stated otherwise, special coverage and waivers stated herein expire when the public emergency period ends. This section shall be updated as new information and guidance becomes available; however, providers should continue to refer to the Department of Health Care Services (DHCS) website for the most up-to-date information.

21-037B

Updated 1/22/21

The following sections were added and/or updated with additional guidance and information:

COVID-19 Vaccine (updated)

California Health & Wellness Plan (CHWP) is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a health care provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage. For regular and frequent updates on the vaccine information and distribution in California, visit Vaccinate ALL 58.

Important! Enroll to get your California Immunization Information System (IIS) ID

During the Public Health Emergency, COVID-19 vaccines are being provided by state and federal governments at no cost to providers. The California Department of Public Health (CDPH) is overseeing the registration for the COVID-19 vaccination program in California. Enrollment to become a vaccinator is currently limited to providers who are authorized by their local health department (LHD). You may enroll in early 2021 as vaccine supply increases.

Step 1: Get your IIS ID

Prospective immunizers must enroll in California Immunization Registry (CAIR) and receive your Immunization Information System (IIS) ID for enrollment.

Step 2: Enroll in CalVax

Make sure you meet all the requirements (PDF) before enrolling. Use the Provider Enrollment Worksheet (PDF) to gather information needed ahead of time to complete enrollment in CalVax.

Refer to the Readiness Checklist: Quick Start Guide (PDF) for additional steps to help providers onboard to the COVID-19 Vaccination Program.

More information on how to prepare for the COVID-19 vaccination can be found in the Health Care Professionals: Preparing for COVID-19 Vaccination from the Centers for Disease Control and Prevention (CDC.

Updated 1/22/21: How are the COVID-19 vaccines being prioritized?

Refer to Vaccinate All 58 for the vaccine prioritization process.

Moving through vaccine phases

Health departments and providers may offer doses promptly to people in lower priority groups when:

  • Demand subsides in the current groups, or
  • Doses are about to expire according to labeling instructions, or
  • Doses have been thawed and would otherwise go to waste

To achieve the timely and maximum vaccination of Californians, CDPH recommends the use of 50 percent of doses providers have received as second doses to vaccinate individuals as described above. Refer to the CDPH website for more information on vaccine distribution, availability, enrollment and training requirements, and other resources.

Where can I find the latest guidance for the COVID-19 vaccine?

What are the codes to report and bill the COVID-19 vaccine?

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 have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives 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

What are the reporting requirements for the COVID-19 vaccine?

Providers must record details of the vaccination into their system of record within 24 hours, and into the applicable public health system within 72 hours.

Updated 1/22/21: How can I help prepare for the COVID-19 vaccine?

  • CMS toolkits – Providers can use this set of toolkits to help prepare to swiftly administer the vaccine once it is available.
  • Immunization Action Coalition (IAC) – Provide clinics with resources and tools that cover the different COVID-19 vaccine products available, address vaccine hesitancy, help educate patients on the vaccines, and more.

How will the COVID-19 vaccine be covered for members?

Similar to other preventive immunizations, the COVID-19 vaccines will be offered at no cost to members. In addition:

  • The Department of Health Care Services (DHCS) intends to pay the vaccine administration fee, pending CMS waiver approvals. More information will be communicated by DHCS at a later date. The vaccine itself will be available from the federal government free of charge.
  • CHWP will not be able to process these claims.
  • Providers must submit claims for administering the COVID-19 vaccine to DHCS. More information will be communicated by DHCS at a later date.

What resources are available to help with reminders about the second dose of the vaccine, and reporting vaccine side effects?

Providers should refer to the Talking to Your Patients About the COVID-19 Vaccine section below for helpful information on how to engage and talk to your patients about the vaccine.

Second-Dose vaccine reminders

Providers can offer patients VaxTextSM, a free text messaging service that patients can opt in to receive convenient text message reminders to get their second dose of the COVID-19 vaccine. Vaccine recipients can text ENROLL to 1-833-VaxText (829-8398) to start getting their weekly second dose reminders.

Visit the CDC website for more information.

Reporting vaccine side effects

Patients can report any side effects from the vaccine directly to the Centers for Disease Control & Prevention (CDC) using v-safeSM smartphone-based tool. Patients may be contacted by someone from CDC to check on them and get more information, depending on the answers provided. V-safe will also remind patients to get their second COVID-19 vaccine dose if needed. For more information, visit the CDC website.

As COVID-19 vaccines are approved and distributed, providers will be a key part in its adoption and administration to the American public. Patients look to their health care professionals for medical guidance and assurance, and while much is still unknown, you can start laying the groundwork now for when the vaccines are available. As your partners in health care, we want to share some tips for effectively setting expectations and addressing questions from your patients.

Start COVID-19 vaccine conversations early

Even before you are able to offer COVID-19 vaccinations, consider including the topic in your conversations with patients. This will give you the opportunity to set expectations about vaccine availability, including if/when you might recommend vaccination for them, and learn about any concerns they have.

Engage in effective COVID-19 vaccine conversations

Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

Start with empathy and understanding

  • Acknowledge the disruption COVID-19 has caused in all our lives.
  • Provide an opportunity to recognize common concerns that can be addressed by a vaccine.

Assume patients will want to be vaccinated but may not know when to expect it

  • Consider providing the following general information to patients about the timeline for COVID-19 vaccines:
    • Limited COVID-19 vaccine doses may be available in 2020.
    • It is anticipated that vaccine supply will increase substantially in 2021.
    • The goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available. However, not everyone will be able to get vaccinated right away.
  • Encourage patients to continue taking steps to protect themselves from COVID-19 and let them know how you plan to share updates about vaccine availability.

Give your strong recommendation

  • Let your patients know if you plan to recommend COVID-19 vaccination for them.
  • Share the importance of COVID-19 vaccines to protect patients’ health as well as the health of those around them.
  • Talk about your personal plans to get a COVID-19 vaccine.
  • Reassure your patients that the vaccine is safe.

Listen to and respond to questions

  • If a patient has concerns or questions, this doesn’t mean they won’t accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
  • Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
  • Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it (see Q&A below).

Keep the conversation open

  • After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
  • Encourage patients to take at least one action like:
    • Scheduling another appointment.
    • Reading any additional information you provide them about COVID-19 vaccination.
    • Encourage others to get their COVID-19 vaccine when available.
  • Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.

Resources to help you build vaccines confidence with your patients

View videos developed in collaboration with the CDC, U.S. Department of Health and Human Services (HHS), National Institute of Allergy and Infectious Diseases (NIAID), and top health and medical institutions that cover a range of topics to help physicians and health care providers build vaccine confidence in their patients and address questions about COVID-19 vaccines.

Access the video series through the California Medical Association (CMA) or directly on YouTube.

Answering patient questions about the vaccine

Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers.

Q: Why are some people getting the vaccine before others? Why can’t I get mine yet?

A: Initially, there will be a limited number of vaccines available.  Because of the limited supply, some groups are recommended to get the vaccine first:

  • Phase 1A will include residents and employees of nursing homes and long-term care facilities.  They are recommended to get the vaccine first, as they are deemed highly vulnerable.  Long-term care facilities account for a high percentage of the deaths from COVID-19 (40%).
  • Additional phases are being developed by federal and state governments.  This will address first-responders, essential workers, older adults and people more at risk for either contracting the virus or becoming seriously ill with the virus.

Q: How do we really know if COVID-19 vaccines are safe?

A: The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials. It only authorizes emergency vaccine use when the expected vaccine benefits outweigh potential risks.

  • The Advisory Committee on Immunization Practices (ACIP) reviews all safety data before recommending any COVID-19 vaccine for use.
  • FDA and CDC will continue to monitor the safety of COVID-19 vaccines to make sure even very rare side effects are identified.

Q: Is the vaccine that helpful? I heard getting COVID-19 gives you better and longer immunity than the protection a vaccine can give. Can it actually make my illness worse if I do end up getting COVID-19?

A: Explain the potential serious risk COVID-19 infection poses to them and their loved ones if they get the illness or spread it to others.

  • Remind them of the potential for long-term health issues after recovery from COVID-19 disease, especially for those who have chronic conditions, are older, or have weakened immune systems.
  • Explain that scientists are still learning more about the virus that causes COVID-19. And it is not known whether getting COVID-19 disease will protect everyone against getting it again, or, if it does, how long that protection might last. Therefore getting a vaccine is a safer choice.
  • Some vaccines are more effective than the natural illness; it is not clear whether natural illness or vaccination will provide more effective immunity in this case.
  • Early information indicates that COVID-19 vaccination may reduce the severity of illness, as well as the incidence of illness. As we learn more about the efficacy of the vaccine, we will also learn more about potential long-term protection it may bring.
  • Describe how the vaccine was tested in large clinical trials and what is currently known about its safety and effectiveness.
  • Be transparent that the vaccine is not a perfect fix. Patients will still need to practice other precautions like wearing a mask, social distancing, handwashing and other hygiene measures until public health officials say otherwise.

Q: I heard I need 2 vaccines. Why? I don’t want to come back for a second vaccine.

A: Two vaccines are needed to provide the best protection against COVID-19.

  • The first vaccine primes the immune system and helps recognize the virus. The second vaccine strengthens the immune response.
  • The two doses are given a few weeks apart (e.g. 21 or 28 days depending on vaccine type). Explain the dosing options available in your office and advise the patient that they can set up an appointment before they leave to come back for a second dose.
  • Provide members with a vaccination record card to ensure that they know when they received their first vaccine, what type of vaccine they received, and when they need to come back and receive their second vaccine.
  • Direct them to their insurance health plan to set up non-emergency transportation, if applicable.

Q: Will the shot hurt? Can it cause you to get sick? I don’t want to get the vaccine because it will give me COVID.

A: List the most common side effects from vaccination are and how severe they may be (e.g. fever, headache, body aches, cold symptoms). Emphasize that a fever could be a potential side effect and when to seek medical care.

  • Symptoms will typically go away on their own within a week. Let them know when they should seek medical care if their symptoms don’t go away.
  • Explain that the vaccine cannot give someone COVID-19 as the vaccine does not contain a live coronavirus.
  • Explain that side effects are a sign that the immune system is effectively working.

Q: Do I have to pay for my vaccines?

A: No! The vaccine will be at no cost to patients. They will not have to pay for either dose of the COVID-19 vaccine.

Q: If I have had COVID-19, do I need to be vaccinated?

A: If you have had COVID-19, getting the vaccine may help prevent reinfection and lower your risk of getting sick again. The Centers for Disease Control and Prevention (CDC) currently advises that people with a known history of COVID-19 may wait up to nearly 90 days after their prior infection to get vaccinated, if they prefer to do so.

On October 5, 2020, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through January 21, 2021.

With this renewal the various testing, screening, billing, and telehealth coverages that were implemented in response to the COVID-19 Public Health Emergency earlier this year will be extended to California Health & Wellness Plan (CHWP) members through late January, until the PHE is either terminated or extended again.

In accordance with this extension, CHWP has updated its information and guidance for COVID-19-related information posted on this page.

Please note, the dates for the COVID-19 Federal Public Health Emergency extension may or may not align with California regulatory requirements or guidance.

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the additional distributions from the Provider Relief Fund to eligible Medicaid and Children's Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens.

For additional information, visit HHS.

What is California Health & Wellness Plan (CHWP) doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans CHWP has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented within CHWP's history, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, CHWP regularly reviews and updates its emergency business continuity protocols. As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations. In particular:

  • CHWP's Provider Network Management (PNM) and Provider Relations personnel remain available to providers, with no current impact in their ability to assist with provider issues.
    • However, on-site meetings are being replaced with telephonic and other forms of support.
  • Our key operational units will continue to provide updates to PNM leadership if and when challenges arise.
  • We have created the following website link, "California Health & Wellness Alerts: COVID-19," on cahealthwellness.com/providers.html to provide regular updates.

Does CHWP allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, CHWP encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for covered services.

During the course of this declaration of emergency CHWP's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

  • Federally Qualified Health Centers (FQHCs), Regional Health Centers (RHCs), and Indian Health Service (IHS) Clinics - During the course of this declaration of emergency CHWP's Medi-Cal coverage for telehealth services will follow guidelines released by the Department of Health Care Services (DHCS), which includes virtual/telephonic visits consistent with in person visits. Additionally, virtual/telephonic visits provided pursuant to this guidance are eligible for prospective payment system (PPS) rates, or all-inclusive rate (AIR), as applicable, and as communicated by DHCS via email to all Managed Care Plans on April 6, 2020.
  • During the public emergency period, CHWP will reimburse fee-for-service providers the same contracted rate, whether service is provided in person or through telehealth technology.
  • Services that cannot be appropriately delivered remotely are not eligible for telehealth coverage and reimbursement.
  • Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above. Claims processing risk will follow the in-person location place of service where the service would have been delivered in lieu of telehealth.

In addition to telehealth services offered through our network of providers, CHWP has expanded access to telehealth services through third parties. Updated information on those vendor arrangements can be found in the Telehealth Vendors and Other Resources Supporting Your Primary Services section below or at California Health & Wellness Alerts: COVID-19.

How do I bill for telehealth services during this declaration of emergency period?

Use appropriate American Medical Association (AMA) CPT and HCPCS codes most descriptive for the service delivered

  • Use Place of Service code 02 (Telehealth) – excluding FQHC/RHCs
  • Use appropriate modifiers, when applicable – excluding FQHC/RHCs
    • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
    • Modifier GQ (Asynchronous store and forward telecommunications systems)

The same amount of reimbursement will be provided for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.

Updated Medi-Cal telehealth billing guidance, as well as information regarding FQHC telehealth coverage and billing guidance details, can be found at:

Examples of benefits or services not appropriate for telehealth delivery:

Below are some examples (not exhaustive) of benefits or services that would not be appropriate for delivery via a telehealth modality:

  • Benefits or services that are performed in an operating room or while the patient is under anesthesia
  • Benefits or services that require direct visualization or instrumentation of bodily structures
  • Benefits or services that involve sampling of tissue or insertion/removal of medical device
  • Benefits or services that otherwise require the in-person presence of the patient for any reason

Capitated Physician Groups/IPAs:

Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above, including the waiver of member cost share. Waived cost shares for capitated physician groups' or IPAs' paid telehealth services will be reimbursed by the health plan. Details regarding the process for capitated telehealth services to receive reimbursement for waived member cost shares will be released at a later date.

What is CHWP's strategy to support telehealth services for providers and members?

CHWP is committed to supporting your relationship with your patients. We continuously encourage members to first take advantage of the telehealth services provided by their primary care provider before considering CHWP's contracted vendors.

What additional support does CHWP provide to enhance access to care for my patients?

CHWP offers many solutions to enhance access to care for your patients. These solutions supplement, but do not replace, the personal care you provide to your patients. Examples include:

  • The Nurse Advice Line – Available to members 24 hours a day at 1-800-893-5597 (TTY 711).
  • myStrength (tailored wellness resources to help members with mental health challenges). If a member needs emergent or routine treatment services, call MHN at 1-888-327-0010 or mystrength.com.
  • Aunt Bertha – A free online search service, allows members to find free and low cost social services.

Does CHWP have a list of recommended telehealth platforms for providers?

CHWP has researched a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

CHWP is not affiliated with, and does not endorse, any of the solution platforms represented below. CHWP has reviewed these platforms and summarized their capabilities on behalf of our providers, but we do not have any direct experience with any of these platforms and we cannot guarantee their performance. Your decision to utilize any of these platforms is based on your individual sole discretion as it relates to the needs of your individual practice.

Below is a summary of telehealth platforms you may find helpful in selecting a solution that best meets your practice needs.

Name Description Contact
Amwell Amwell's Private Practice platform is available to California physicians at a discounted rate for the next 12 months. This telehealth solution can be branded for each practice and enables physicians to see their own patients and operate under their own payer contracts. Practice management capabilities include a branded telehealth practice with clinical workflows, online physician enrollment and scheduling appointments with your patients, collecting patient payments at the time of visit, and reporting and visit summaries to assist with clinical documentation. business.amwell.com
Doxy.me See your patients from anywhere via a personalized virtual exam room. Click doxy.me/YourDrsName to join them for a video call. You do not need to download software or create an account. Use a browser on a computer or mobile device with a camera and microphone. Practice management capabilities include in-session, live chat-box with current patient and/or next patient(s) in queue, and patient check-in. www.doxy.me
VSee Secure, low-bandwidth HD video. Encrypted with military-grade 256-bit AES encryption. VSee Messenger allows providers to securely video chat with patients in their homes. In-session snapshots can be securely sent through individual or group chats. Practice management capabilities include real-time screen share, live annotation, mark-up lab results, CT scans, e-documents, and electronic health record (EHR) integration. www.vsee.com
eVisit A user-friendly exam room equips providers with the tools needed to chart, prescribe and take notes. eVisit commits telehealth expertise and technology to fight against COVID-19 with VirtualED™ – a COVID-19-specific workflow that can be implemented quickly at no cost until July 31, 2020. Practice management capabilities include seamless EHR integration, custom patient eligibility and claims solutions. Specializes in increasing provider telehealth footprint to better meet the unique needs of the market. Improves outcomes and revenue with minimal overhead. www.evisit.com
Innovaccer COVID-19 management supports automated assessments, remote patient monitoring, education, and treatment. Practice management capabilities include leveraging artificial intelligence to eliminate coding gaps to drive quality performance, a data activation platform that promotes value-based care, and a private virtual examination room with secure audio/visual features to allow for the seamless and effortless rendering of care to patients. www.innovaccer.com
Updox Includes a dedicated virtual exam room to triage COVID-19 patients. No need to download software or create an account. Just use a browser on a computer or mobile device with a camera and microphone. Patients do not need to be pre-registered. Practice management capabilities include document completion, appointment scheduling, and appointment reminders via email and SMS. www.updox.com

 

What additional telehealth options are available to my patients?

CHWP offers additional telehealth services to enhance access to care for your patients. These services supplement, but do not replace, the personal care you provide to your patients. CHWP is contracted with Babylon Health.

What support will Babylon Health provide to me if my patients use them?

Babylon Health supports the primary care physician (PCP) and their relationship with their patient. Babylon services include:

  • Visit summaries sent to the PCP for close communication and continuity of care.
  • Referring patients back to the assigned PCP for follow up appointments.
  • Prescribing of non-scheduled, non-lifestyle medications.
  • Ordering of and follow up on basic ancillary testing for immediate treatment of the medical condition.
  • Direct communication back to the member's PCP about clinical assessments that include a recommendation for a referral for advanced imaging, such as CT, MRI or referral to a specialist.
    • The PCP, who best knows the member and their clinical needs, then decides whether such referral is required and, if so, directs the patient to the most appropriate resource.
  • Availability of the member's medical records through the Babylon Health app.

What billing codes should be used to bill for COVID-19 testing?

Starting April 1st, 2020, fee-for-service providers performing the COVID-19 test can begin billing CHWP for services that are CHWP's responsibility for payment that occurred after February 4, 2020, using the following newly created HCPCS and CPT codes:

Specimen Collection

  • HCPC G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source.
  • HCPC G2024 - Specimen collection for severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.
  • HCPC C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]).
  • CPTs 99000, 99001, or 99211 when billed with a COVID-19 related diagnosis code.

Active Virus Testing

  • HCPC U0001 - For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPC U0002 - For all other commercially available tests: 2019-nCoV Real-Time RT-PCR Diagnostic Panel. (It is not yet clear if the Centers for Medicare & Medicaid Services (CMS) will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.)
  • CPT 87635(effective 3/13/2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. The industry standard for reporting of novel coronavirus tests across the nation’s health care system.
  • HCPC U0003 (effective 4/14/2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. U0003 should identify tests that would otherwise be identified by CPT code U0001 but for being performed with these high throughput technologies.
  • HCPC U0004 (effective 4/14/2020): 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
  • CPT 0202U (effective 5/20/2020): Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 0223U (effective 6/25/2020) Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 87426 (effective 6/25/2020) Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).
  • CPT 0225U (effective 9/8/2020) Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected.
  • HCPC 0226U (effective 9/8/2020) Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum.
  • CPT 0240U (effective 10/6/2020) Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 0241U (effective 10/6/2020) Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 87636 (effective 10/6/2020) Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.
  • CPT 87637 (effective 10/6/2020) Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
  • CPT 87811 (effective 10/6/2020) Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Effective for dates of service April 10, 2020, and continuing during the course of this declaration of emergency, CHWP benefit plans cover medically necessary FDA approved serologic (antibody) testing ordered by physicians or other authorized health care providers, using AMA approved CPT codes and based on CDC guidance for appropriate use of FDA approved or authorized (Emergency Use Authorization, EUA) antibody tests. Additional clinical guidelines for serologic testing coverage may be communicated at a later date.

Fee-for-service (FFS) providers performing medically necessary FDA approved COVID-19 antibody tests can bill CHWP for services that are CHWP’s responsibility for payment, using the following CPT codes:

  • CPT 86318 (Medi-Cal only) Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (eg, reagent strip); (EXISTING PARENT CODE NOT SPECIFIC TO COVID 19)
  • CPT 86328 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), (Coronavirus disease [COVID-19]), (For severe acute respiratory syndrome, coronavirus 2 [SARS-CoV-2] [Coronavirus, disease {COVID-19}] antibody testing using multiple-step method, use 86769)
  • CPT 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using single step method, use 86328)
  • CPT 0224U (effective 6/25/2020) Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed.
  • CPT 86408 (effective 8/10/2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen.
  • CPT 86409 (effective 8/10/2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer.
  • CPT 86413 (effective 9/8/2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.

CDC Antibody Testing Guidance

Authorization requirements will be waived for any claim that is received with these specified codes.

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

For complete and up-to-date diagnosis coding for COVID-19, visit the CDC National Center for Health Statistics website.

The following diagnosis codes can be used to bill for screening and testing services related to COVID-19.

  • Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases.
  • Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out.

Is there more information available on COVID-19 billing?

For additional information on coding, refer to the following links from the American Medical Association (AMA):

What is the deadline to file claims?

The deadline to file Medi-Cal claims for dates of service March 5, 2020 through the end of the public emergency period, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines or the timeline in your CHWP Provider Participation Agreement (PPA). This also applies to Medi-Cal late filing penalties.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and CHWP's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is CHWP requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

CHWP is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Participating Physician Groups (PPGs) delegated by CHWP to authorize services related to COVID-19 screening and testing are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Where is COVID-19 testing available?

LabCorp, Quest Diagnostics™ and Bio Reference and several commercial and hospital based laboratories are currently offering testing for COVID-19. Providers are encouraged to visit the following sites for more information on registration and specimen collection requirements:

Testing can be ordered only by physicians or other authorized health care providers.

  • Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

The Lab Patient Service Centers will not be collecting specimens for COVID-19 testing. DO NOT refer patients to Lab Patient Service Centers. Please contact specific labs for instructions for specimen collection and transport, and to obtain specimen collection supplies.

What are the screening and testing guidelines for COVID-19?

Refer to the Centers for Disease Control and Prevention (CDC) for updated guidelines for testing patients suspected of having the COVID-19 infection.

The state of California launched a coronavirus awareness website. This site provides the following testing recommendations (as of 9/30/2020). Providers are encouraged to reference the CDC website for the most current guidance.

First priority

  • Hospitalized patients with COVID-19 symptoms
  • Those identified through an outbreak or contact tracing investigation

Second priority

  • All other individuals with COVID-19 symptoms
  • Close contacts of confirmed cases
  • People without symptoms, but who are:
    • Residents in group living facilities
    • Healthcare workers who care for COVID-19 patients
    • Workers in group living facilities and in-home support services
    • Workers in the emergency service sector who have frequent interactions with the public or people with COVID-19. This includes first responders and other public service departments.
    • Workers in correctional facilities
    • Hospital admission and discharge patients

Third priority

  • People without symptoms, but who are:
    • Essential workers
    • Education workers who have frequent interactions with students or the public

Fourth priority

  • People without symptoms, but who are:
    • At risk of infection
    • Being tested by their employer

Is CHWP waiving prior authorizations for COVID-19 related treatments?

CHWP and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medi-Cal members. Inpatient admission notification is still required as soon as possible to CHWP and the member’s assigned delegated participating physician group (PPG) or IPA, if available.

What COVID-19 ICD-10 diagnoses codes are approved for use in treatment?

  • B97.29: Confirmed cases – other coronavirus as the cause of diseases classified elsewhere (prior to 4/1/20)
  • U07.1: 2019-nCoV – Confirmed by lab testing (effective 4/1/20)

What resources are available for providers to request and/or order Personal Protective Equipment (PPE)?

We understand that access to necessary PPE and other important supplies during the COVID-19 crisis has been challenging. If you need access to appropriate PPE and/or other supplies to provide care to your patients, we encourage you to reach out to the following resources for assistance.

Designated Local Public Health Department by County

Resource requests for health care providers and facilities are handled through the designated Public Health Department for your county.

New requests are:

  1. Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
  2. Upon receipt by the RDMHC, the request is then sent to the California Department of Public Health (CDPH) Medical and Health Coordination Center (MHCC) for proper tracking and fulfillment by both the State Operations Center (SOC) and the Emergency Medical Services Agency (EMSA).

Facilities currently facing a shortage of respirators, N95 masks or other supplies, should contact their MHOAC.

Direct Relief®

Direct Relief provides clinics and health care centers throughout the United States and globally with access to no-cost pharmaceuticals, medical supplies and other resources to care for the world's most vulnerable people.

Learn more about Direct Relief and how to become a network partner.

Western Drug Medical Supply

Western Drug Medical Supply is a leading provider of home medical equipment and supplies in Southern California. They have a large volume of masks procured and have volunteered to donate to providers located in Southern California who need them. Providers should reach out to Western Drug directly or at 1-800-891-3661.

How do Community-Based Adult Services (CBAS) centers continue adult services during the COVID-19 outbreak?

The Department of Health Care Services (DHCS) has released guidance via All Plan Letter (APL) 20-007 that outlines ways CBAS centers may continue to provide services to CBAS participants now remaining at home.

Providers should refer to the Provider Update 20-362 (PDF), titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak distributed on April 17, 2020, for additional information.

What steps are certified CBAS providers required to take for approval to participate in CBAS Temporary Alternative Services (TAS)?

The California Department of Aging (CDA) CBAS Branch has issued All Center Letter (ACL) 20-07 that outlines the requirements for CBAS TAS and the steps that certified CBAS providers must take for approval to participate in CBAS TAS.

Providers should refer to the Provider Update 20-362 (PDF), titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak distributed on April 17, 2020, for additional information.

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member’s identification (ID) card.

CHWP encourages participating provider groups. (PPGs) to educate contracted providers on disaster-responsive, trauma-informed care. This education or training should include the crucial roles of:

  • Ensuring physical and emotional safety of patients
  • Building trust between providers and patients
  • Recognizing and responding to the signs and symptoms of stress on physical and mental health
  • Promoting patient-centered, evidence-based care
  • Ensuring provider and patient collaboration in treatment planning
  • Sensitivity to the racial, ethnic, cultural, and gender identity of patients
  • Supporting provider resilience

PPGs should ensure their providers and care management teams learn the signs of and assess for stress-related morbidity, and create responsive treatment plans, including supplementing usual care with measures that help regulate the stress response system, such as:

  • Supportive relationships
  • Age-appropriate, healthy nutrition
  • Sufficient, high-quality sleep
  • Mindfulness and meditation
  • Adequate physical activity
  • Mental health care

Additional resources on how to mitigate the stress-related health outcomes anticipated with the COVID-19 emergency can be found at ACEs Aware.

Adverse Childhood Experiences (ACEs) resources and information for Medi-Cal can be found at California Department of Health Care Services | ​​​​​​​​Trauma Screenings and Trauma-Informed Care Provider Trainings.

What if my office or facility is impacted by COVID-19?

If your office or facility is impacted by COVID-19 and this affects your ability or capacity to provide services and access to members, please contact your provider network regional representative immediately. If you are affiliated with a participating physician group (PPG) or independent physician association (IPA), please contact your PPG of IPA immediately. CHWP contracted PPGs must notify their CHWP designated network representative of any changes in access to their provider panel.

As a reminder, providers are responsible to provide coverage to their patients, and to communicate this to patients via appropriate signage, messaging, and communications. We encourage the use of telehealth services to promote physical distancing while supporting the needs of your patients, whenever possible. The use of urgent care or emergency room/department services to provide routine coverage for your office is not appropriate, unless the use of emergency room/department services are medically necessary.

If you close your office, or if you switch to only providing virtual appointments, take the following action:

  1. Contact your CHWP provider network regional representative immediately
  2. Notify your patients who have upcoming appointments about your office changes and provide documentation of how your patients were notified to your CHWP designated network representative.
  3. Inform your patients about available coverage options for your office, including voicemail instructions and/or message for patients, posters and member outreach.

Where can I obtain general information and guidance on 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, and the total impact of the illness. New information, obtained daily, will further inform the risk assessment, treatment options and next steps. We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance:

  • Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.
  • Be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
  • Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients 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 health care 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.

Take Action:

  1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  2. Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
  3. 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.
  4. Refer to the CDC and the World Health Organization (WHO) for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
  5. Be familiar with the intended scope of available testing and recommendations from the U.S. Food & Drug Administration (FDA).
  6. Visit the California Department of Public Health (CDPH) for information about COVID-19 and the latest guidance from public health officials.

Provider Alerts:

You can also visit the provider alerts page at California Health & Wellness Alerts for Providers.

Does the Department of Healthcare Services (DHCS) have any resources available for providing care during COVID-19?

Providers are encouraged to reference the following resources distributed by the DHCS to managed care plans (MCPs) to assist with providing care during the COVID-10 crisis:

What resources are available from DHCS to assist with the COVID-19 epidemic's immediate and long-term impacts on the mental health?

Providers can refer to the DHCS notice on suicide and prevention screening and resources to assist with providing immediate and long-term care for patients resulting from the COVID-19 crisis.

DHCS notice on suicide and prevention screening and resources (PDF)

  • All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities may recommend delaying elective inpatient and outpatient surgical and procedural cases. The referring or treating provider must have determined and noted in the relevant record that when considering COVID-19 implications during this public health emergency period, a longer waiting time will not have a detrimental impact on the health of the member.
  • Telehealth services during this emergency period may be used to determine medical necessity for someone to come into the office, emergency room or urgent care center. Refer to Telehealth Guidance above for more information.
  • For Medi-Cal, where mailing hard-copy notices to members and providers as required by law is delayed due to personnel shortages and/or safety precautions enacted, please contact the member or provider electronically or by telephone. If the provider or IPA, as the case may be, does not have personnel available to mail hard-copy information, it is sufficient to communicate with members and providers electronically and/or by telephone, so long as a log or record of such communications is maintained.
  • Health care workers, including those supporting health care operations, are considered essential workers and are exempt from the "stay at home," "shelter in place," and "shelter at home" recommendations and orders recently announced.
  • San Joaquin County providers can refer to the San Joaquin County Public Health Office (PHO) Isolation and Quarantine Orders for community members diagnosed with or suspected of having COVID-19.
  • The California Medical Association (CMA) is hosting a 12-part webinar series over six months that covers all aspects of implementing telehealth in a medical practice. Practices will learn about selecting a platform, reimbursement rules and patient interactions. Providers can register for the webinar series.

    Previous webinars from the series are available for download.
  • Learn more about resources and educational materials providers and their staffs can use to help their patients feel safe when seeking medical care during the COVID-19 pandemic in provider update 20-666, Help Your Patients Feel Safe and Learn How We've Done the Same, distributed on August 27, 2020. Also included is information communicated by CHWP to your CHWP patients, our members, during the crisis.
  • During the COVID-19 state of emergency, the Hospital Notification Unit (HNU) 800 number is temporarily suspended. During this time, contracted hospitals, skilled nursing facilities, long-term care facilities, and long-term acute care hospitals should submit inpatient authorization requests by fax to 1-855-556-7907. Status for inpatient authorization requests can be obtained by calling the Provider Services Center at 1-877-658-0305. More information is available in provider update 20-716, Hospital Notification Unit 800 Number Temporarily Suspended, distributed on October 2, 2020.
  • Give timely flu shots to help keep members healthy! The flu vaccine is critical to keeping the most vulnerable patients from having the flu and COVID-19 at the same time. Encouraging the flu vaccine among members can also help conserve health care system resources during the COVID-19 crisis and reduce the prevalence of illness caused by the flu, thereby reducing outpatient visits or hospital admissions.

    Refer to the provider update 20-932 (PDF), distributed on November 16, 2020, for information about flu vaccine coverage, recommendations for giving the vaccine at appointments or referring members to an appropriate resource to access the vaccine, and how to be reimbursed for vaccine administration. Information is also included to inform delegated IPAs of their responsibilities concerning flu vaccine coverage and requirements to ensure members have access to the flu vaccine.

3/5/20

What you need to know about COVID-19 (updated, 3/20/20)

Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. Though the risk of getting COVID-19 in the U.S. is low, learn how you can help keep yourself and others healthy.