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California Health & Wellness Alerts for Providers

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.

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COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19

COVID-19 alerts


COVID-19 Vaccine FAQs

What you need to know about the vaccines
 

Vaccine FAQs

Communications & Resources

Stay informed on the latest news and help for you and your patients

Resource FAQs

COVID-19 Trainings & Webinars

Notices about COVID-19-related trainings and webinar sessions

COVID-19 Training

COVID-19 General Information

What's covered, how to bill for treatment, telehealth guidance, and more

General FAQs


Historical Information

COVID-19 content that may be retired or no longer relevant to the public health emergency

Retired FAQs

Updated October 4, 2021

Information throughout the FAQs has been updated to reflect current guidance and information, including the following sections:

COVID-19 Vaccine FAQs

COVID-19 Vaccines (updated)

COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19

  Added 8/19/21

The California Department of Public Health (CDPH) has made changes to requirements already in effect for indoor mega events in the Beyond the Blueprint Framework.

Proof of vaccination or a negative COVID-19 test is required within 72 hours before a large indoor event starts when there are 1,000 or more participants or spectators. This drops the requirement down from the 5,000 participants or more for indoor events previously in effect.

Self-attestation is no longer accepted

Verification of being vaccinated or a pre-entry negative test for COVID-19 is required.

How long does the requirement last

This change is in effect from September 20, 2021 until November 1, 2021.

More information about COVID-19 and vaccinations

  Added 6/8/21

The Emergency Broadband Benefit (EBB) Program is a Federal Communications Commission program. During the COVID-19 pandemic, it gives a temporary discount on monthly internet bills to help families stay connected to jobs, critical care, virtual classrooms, and more.

The Department of Health Care Services would like you to share the following information.

Benefits offered through EBB

All Medi-Cal recipients are eligible, and it will not affect their health coverage. The benefits include:

  • Up to $50 per month to help cover internet costs.
  • One-time discount of up to $100 for a laptop, tablet or desktop computer. Check this list of internet providers offering connected devices in California.

Act fast – apply online

The program will last until funds run out or up to six months after the end of the COVID-19 pandemic, whichever is sooner. Our members should apply online immediately through Get Emergency Broadband or by mail to Emergency Broadband Support Center, P.O. Box 7081, London, Kentucky 40742.

Others who may qualify

Additionally, you are eligible if one person in your home meets any of the following requirements:

  • Loss of income from job loss since February 29, 2020, and the total household income is less than $99,000 annually, or
  • Receive food assistance through the Supplemental Nutrition Assistance Program (SNAP) formerly known as Food Stamps, or
  • Receive Supplemental Security Income (SSI) payments, or
  • Receive Medicaid, or
  • Receive Veterans Pension and Survivors Benefit.

Questions?

Read more information about the EBB program and the documents needed to apply at Get Emergency Broadband.

  Added 5/21/21

The California Medical Association (CMA) is providing onboarding support to providers of pediatric services, individual practitioners and small group practices who have asked California's third-party administrator (TPA) about joining the network but are not contracted for that network.

CMA will contact you directly

The TPA provided CMA with a list of the pediatric practitioners, individual practitioners and small group practices who showed interest in joining the network. CMA will work directly with identified providers to discuss the steps needed to apply for eligibility to receive and administer COVID-19 vaccines within your scope of practice.

Resources

View a webinar about How to Enroll in the California COVID-19 Vaccination Program.

If you are currently enrolled or in the process of enrolling in the California COVID-19 Vaccination Program, there is more program-related resources and communications you can access.

Questions?

Please contact the CMA at vaccinenetwork@cmadocs.org or call their Member Resource Center at 800-786-4262.

The "Let's Get to ImmUnity" campaign will address questions, concerns with COVID-19 vaccinations specific to the Black and African American communities

The California Department of Public Health (CDPH) is rolling out a tailored outreach for Black and African American communities across the state. This latest element of the "Let's Get to ImmUnity" public education campaign is part of the state's overall Vaccinate ALL 58 effort.

Engaging people where they live to raise awareness about COVID-19 vaccines

In addition to traditional communications, the campaign will meet people where they are via community engagement efforts throughout the state. These efforts will begin in Oakland. The campaign will partner with small businesses and community leaders serving the local Black and African American community. The goal is to increase awareness about the safety and efficacy of the vaccines and mobilize community members to get vaccinated.

Support for equitable vaccine administration across the state

Community engagement efforts will expand to Black and African American communities across the state as the campaign continues and will remain focused on increasing vaccine equity. The "Let's Get to ImmUnity" campaign is placing additional focus on geographic areas in the bottom quarter of the Healthy Places Index (HPI), mirroring the state's announcement last month to increase vaccine supply in these communities. The public education campaign is an important part in the state's five-part plan for equitable vaccine administration.

Stay informed about the latest COVID-19 information from CDPH.

In January 2021, the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations (HHS/OIG/OI) issued a health care fraud alert, regarding COVID-19 vaccines. This alert describes how scammers are perpetrating COVID-19-related schemes to beneficiaries, including those enrolled in Medicare. Schemes include telemarketing calls, social media platforms and door-to-door visits. Also, fraudsters are offering COVID-19 tests, HHS grants and prescription cards in exchange for personal details.

Scammers can use personal information collected through these schemes to fraudulently bill federal health care programs and commit medical identity thefts. The services offered are unapproved and illegitimate and may cause harm to the beneficiaries.

Please visit the health care fraud alert for a list of common schemes, and report any suspected COVID-19 health care fraud online or by calling 1-800-HHS-TIPS (800-447-8477).

COVID-19 Trainings and Webinars

Notices about COVID-19-related trainings and webinar sessions

  Added 9/29/21

Please join members of the University of California San Francisco (UCSF) STOP COVID-19 CA team for a webinar discussing their newest Practice and Policy Brief, Understanding Why More Black, Latinx, and Samoan Young Adults Aren't Getting Vaccinated.

When

Thursday, September 30, 2021 at 12:00 PM Pacific time

How to join

Join the webinar:

Or One tap mobile:

  • US: +16692192599,,96232453082#,,,,*764665#  or +16699006833,,96232453082#,,,,*764665#

Or by phone:

Dial (for higher quality, dial a number based on your current location):

Or an H.323/SIP room system:

  • H.323:
    162.255.37.11 (US West)
    162.255.36.11 (US East)
    115.114.131.7 (India Mumbai)
    115.114.115.7 (India Hyderabad)

    Meeting ID: 962 3245 3082

    Passcode: 764665

  • SIP: 96232453082@zoomcrc.com

    Passcode: 764665

The webinar will be recorded. A link will be provided to the recording after the event.

COVID-19 Vaccine FAQs

What you need to know about the vaccines

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 play an integral role with COVID-19 vaccinations. 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. Program enrollment is currently focused on small physician practices who routinely vaccinate their patients as well as providers that are prioritized for vaccine allocation by local health departments.

Step 1: Get your IIS ID

Enroll in your local registry to receive your Immunization Information System (IIS) ID for enrollment in CalVax. County specific information is below.

Step 2: Enroll in myCAvax

Refer to the FAQ document (PDF) on the myCAvax name change for more information. Sign in for myCAvax with the same sign-on information you entered for 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 that can help you share clear and accurate information about the COVID-19 vaccines and address common questions from patients can be found in the Health Care Professionals: Preparing for COVID-19 Vaccination from the Centers for Disease Control and Prevention (CDC).

Who is eligible for the COVID-19 vaccine?

Every Californian ages 12 and up is eligible for the COVID-19 vaccine.

Refer to Vaccinate All 58 for information about the vaccine, incentive programs, how the vaccine works, vaccination progress data, questions and answers, and more.

You can also refer to the CDPH website for updated COVID-19 vaccine eligibility guidelines.

Has the FDA approved any of the emergency use COVID-19 vaccines?

On August 23, 2021, the U.S. Food and Drug Administration (FDA) issued a news release that announced the approval of the Pfizer-BioNTech COVID-19 Vaccine for people ages 16 and older.

The vaccine continues to be available under the Emergency Use Authorization (EUA) for individuals:

  • Ages 12 through 15.
  • A third dose for those who are immunocompromised.

What is the latest update about COVID-19 booster shots and additional doses?

The booster or additional dose of the COVID-19 vaccine will be available at no cost to members. It will follow the same guidance as the initial two doses. For more information, see “How will the COVID-19 vaccine be covered for members?” further down in this section.

Booster shot

The CDPH and the CDC released recommendations on September 24, 2021 about the Pfizer-BioNtech COVID-19 booster shot to help increase protection.

You should receive a booster dose of Pfizer at least six months after your second dose if you are:

You may receive a booster dose of Pfizer at least six months after your second dose based on individual benefits and risks if you are:

  • Ages 18-49 with underlying medical conditions.
  • Ages 18–64 at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting.

Additional doses

Additional doses of the Pfizer-BioNTech COVID-19 Vaccine or the Moderna COVID-19 Vaccine are available for individuals with compromised immune systems. This incudes solid organ transplant recipients or those diagnosed with conditions that are considered equivalent level of immunocompromised.

The CDPH and the Western States Scientific Safety Review Workgroup have conducted an additional review. They recommend providers boost immunity for the immunocompromised to ensure extra protection from COVID-19.

For more Information, visit:

Can kids get the COVID-19 vaccine?

Pediatric distribution

On May 10, 2021, the FDA issued a news release that amends the EUA for the Pfizer/BioNTech COVID-19 vaccine to include adolescents ages 12 through 15. The FDA assures the public and medical community that the available data meets their rigorous standards to support the emergency use of this vaccine for these ages. (Note: The EAU was originally issued on December 11, 2020 for administration in people ages 16 and older.)

The FDA also updated their Fact Sheets for HealthCare Providers Administering the Vaccine (PDF) and for Recipients and Caregivers (PDF) with information about the use of the Pfizer/BioNTech COVID-19 vaccine in adolescents, including the benefits and risks.

The Moderna COVID-19 vaccine and Johnson & Johnson/Janssen vaccines are available to people ages 18 and older.

Co-administer vaccines during pediatric well-child visits

Providers are encouraged to use the Pfizer/BioNTech COVID-19 vaccine visit to meet the well-child visit requirement. The Centers for Disease Control & Prevention (CDC) updated their recommendations (PDF) that co-administration of the COVID-19 vaccine with other vaccines is no longer discouraged.

  • COVID-19 vaccines and other vaccines may now be administered without regard to timing.
  • Simultaneous administration of COVID-19 vaccines and other vaccines can be done on the same day, as well as co-administration within 14 days.

This important step ensures adolescents ages 12 and older who see their physician for a COVID-19 vaccine are able to catch-up on other immunizations they may have missed during the pandemic.

  Added 10/4/21

Are the COVID-19 vaccines safe for pregnant or lactating people?

On September 29, 2021, the CDC issued a health advisory recommending COVID-19 vaccination among people who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future.

As of September 18, 2021, only 31.0% of pregnant people were fully vaccinated before or during their pregnancy. (See Vaccinations Among Pregnant People.)

The CDC strongly urges COVID-19 vaccination either before or during pregnancy as soon as possible. The benefits of vaccination outweigh known or potential risks, such as:

  • Severe illness and death.
  • An increased risk for adverse pregnancy and neonatal outcomes (including preterm birth and admission of their neonate(s) to an intensive care unit).
  • Stillbirth.

Recommendations on where to start

Your efforts should specifically:

  • Address populations with lower vaccination coverage.
  • Use approaches to reduce racial and ethnic disparities, such as tailored, culturally responsive, and linguistically appropriate communication of vaccination benefits.
  • Have pregnant people continue to follow all recommended prevention measures.
  • Advise pregnant people to seek care immediately for any symptoms of COVID-19.

Where can people get information about vaccine availability – My Turn?

If you are not providing the COVID-19 vaccine to your patients, refer them to Find out if it's your turn.

You can also refer patients to their county public health department. A listing of local health departments by county is available through CDPH.

Patients may also call 211 or 311 for information about the COVID-19 vaccines. These are non-emergency numbers that are state- and city-supported and can help direct callers to COVID-19 vaccine services in their area.

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, however, they will not be billable or payable 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
0003A
(eff. August 12, 2021)
ADM SARSCOV2 VAC
30MCG/0.3ML 3RD
Pfizer Pfizer-BioNTech COVID-19 Vaccine Administration – Third 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
0013A
(eff. August 12, 2021)
ADM SARSCOV2 VAC
100MCG/0.5ML 3RD
Moderna Moderna COVID-19 Vaccine Administration – Second Dose
91303 SARSCOV2 VAC AD26 .5ML IM Janssen Janssen COVID-19 Vaccine
0031A ADM SARSCOV2 VAC AD26 .5ML Janssen Janssen COVID-19 Vaccine Administration

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.

How can I help prepare for the COVID-19 vaccine?

  • CMS toolkits – Providers can use this set of toolkits to help administer the vaccine.
  • CMA toolkit - Physician practices can use the California Medical Association toolkit for answers to their frequently asked questions such as vaccine priority, vaccine administrators and addressing patient concerns.
  • CDC toolkit - The COVID-19 Vaccination Communication Toolkit is designed to help medical centers, clinics, pharmacies and clinicians to promote vaccination among healthcare provider staff. These materials can help educate and build confidence in COVID-19 vaccination, raise awareness about the benefits of vaccination, and address common questions and concerns.
  • 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 are offered at no cost to members. In addition:

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 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 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.

Providers are a key part in the adoption and administration of the COVID-19 vaccines to the American public. Patients look to their health care professionals for medical guidance and assurance. As your partners in health care, we want to share some tips for effectively setting expectations and addressing questions from your patients.

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 want to be vaccinated but may not know what to expect

  • Consider providing the following general information to patients about the timeline for COVID-19 vaccines.
  • Encourage patients to continue taking steps to protect themselves from COVID-19.

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.
  • If you have received a COVID-19 vaccine, talk about it with them.
  • 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.

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.
  • Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.

New mask guidelines for vaccinated vs unvaccinated people

The Centers for Disease Control & Prevention (CDC) released a chart and guidance about using masks for activities and other precautions by setting or situation. It shows the different recommendations for vaccinated and unvaccinated people. This chart may help when you talk with your patients about the benefits of getting a COVID-19 vaccine.

Resources to help you build vaccines confidence with your patients

Answering patient questions about the vaccine

Your patients will likely have a lot of questions about the vaccine, and as their health care provider, they will turn to you for answers. Refer members to the COVID-19 Resource Center to view product and audience-specific frequently asked questions about the vaccines and more.

COVID-19 General Information

What's covered, how to bill for treatment, telehealth guidance, and more

Where can I obtain general information and guidance on COVID-19?

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 coronavirus disease 2019 (COVID-19) and care for your patients.

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.
  • Get more information about variants to COVID-19, such as the Delta variant.
  • Become familiar with post-COVID conditions (also called long COVID) that can have different types and combinations of health problems for different lengths of time.
  • 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.
  • Refer to the California Department of Public Health (CDPH) for recent guidance on resuming preventive care.

Take Action:

  1. Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
  2. 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.
  3. Visit the California Department of Public Health (CDPH) for information about COVID-19 and the latest guidance from public health officials.

What other information and guidance on COVID-19 is available?

  • 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 and Support 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.
  • Visit the California Medical Association (CMA) website to view videos from a 12-part webinar series, Telehealth Series for Small and Medium Sized Practices, that cover all aspects of implementing telehealth in a medical practice. Topics reviewed include selecting a platform, reimbursement rules, and more.

On April 21, 2021, HHS Secretary Xavier Becerra renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through July 20, 2021.

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.

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 independent practice associations (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 Telehealth Platforms for Providers section 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:

  • Performed in an operating room or while the patient is under anesthesia.
  • Require direct visualization or instrumentation of bodily structures.
  • Involve sampling of tissue or insertion/removal of medical device.
  • 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 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.

Providers can also refer to Telehealth Platforms for Providers for 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.

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.

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) or independent practice associations (IPAs) 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:

  • LabCorp - Physicians who send laboratory testing to LabCorp, will require an active account. Please contact LabCorp at 1-800-859-6046 and speak to a customer service representative to set up account.
  • Quest Diagnostics - website or call 1-866-697-8378. Providers can open an account.
  • BioReference - Providers do not need to sign up. Tests can be sent through courier or FedEx depending on your area. Providers can open an account or contact BioReference via telephone at 1-833-684-0508 or 1-800-229-5227.
  • Twenty-two public health labs in California are testing samples for COVID-19. Providers can refer members for testing to their county's public health department. Additional information can also be found at the California Department of Public Health.
  • Providers can confirm with community hospitals to determine if they are offering testing for COVID-19.

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?

CDPH has issued updated testing guidance to follow starting June 15, 2021. Diagnostic testing should be considered for all individuals with symptoms or exposure to COVID-19. Health plans are required to cover testing pursuant to federal requirements.

Key points of guidance:

  • Fully vaccinated individuals do not need to undergo diagnostic screening testing in non-health care workplace settings.
  • If 70% of staff and residents are fully vaccinated, the staff does not need to undergo diagnostic screening testing in:
    • Long-term care facilities – skilled nursing facilities and adult and senior care facilities
    • Hospitals

For more details, refer to the CDPH updated guidelines.

Additional resources for testing guidelines:

  • Refer to the Centers for Disease Control and Prevention (CDC) updated guidelines for testing patients suspected of having the COVID-19 infection.
    • Providers are also encouraged to visit the CDC website for the most current COVID-19 guidance.
  • Testing locations and guidance can be found on the Vaccinate ALL 58 site.

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 March 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 April 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 87635 but for being performed with these high throughput technologies.
  • HCPC U0004 - (effective April 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 May 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 June 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 June 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 September 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 September 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 October 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 October 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 October 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 October 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 October 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 June 25, 2020) Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed.
  • CPT 86408 (effective August 10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen.
  • CPT 86409 (effective August 10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer.
  • CPT 86413 (effective September 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.

  • Z11.52 (effective January 1, 2021) – Encounter for screening for COVID-19.
  • Z20.822 (effective January 1, 2021) – Contact with and (suspected) exposure to COVID-19.
  • Z20.828 (through December 31, 2020) – 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.

Are there changes to the appeal process for Medi-Cal members during the public health emergency (PHE)?

Through the duration of the PHE, whenever a member’s appeal involves the termination, suspension or reduction of previously authorized services, Health Net must provide Aid Paid Pending (APP) when an appeal and state fair hearing is filed timely. Health Net is not allowed to seek reimbursement or payment for the additional days of services furnished during this period.

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

For admissions and/or dates of service prior to June 1, 2021, 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. After June 1, 2021, normal prior authorization guidelines will apply.

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

  • U07.1: 2019-nCoV - Confirmed by lab testing (effective April 1, 2020)
  • M35.81: Multisystem Inflammatory Syndrome (MIS) (effective January 1, 2021)
  • B97.29: Confirmed cases - other coronavirus as the cause of diseases classified elsewhere (prior to April 1, 2020)

Does CHWP cover monoclonal antibody infusion treatment for COVID-19?

For dates of service prior to June 1, 2021, COVID-19 monoclonal antibody treatments available under an FDA Emergency Use Authorization (EUA) are covered benefits with no cost share or prior authorization required. The medications are available from the federal government at no cost to providers. After June 1, 2021, normal cost shares and prior authorization guidelines, if any, will apply.

The following codes have been published, however, they are not billable or payable until after the specific treatment received official EUA approval. As of April 16, 2021, the FDA revoked its EUA for Eli Lilly's bamlanivimab when administered alone. Learn more on the FDA's web page.

Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name
Q0239* bamlanivimab-xxxx
(FDA's EUA ended April 16, 2021)
Eli Lilly Injection, bamlanivimab, 700 mg
M0239 bamlanivimab-xxxx infusion
(FDA's EUA ended April 16, 2021)
Eli Lilly Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Q0240
(eff. July 30, 2021)
Casirivi and imdevi 600mg Regeneron Injection, casirivimab and imdevimab, 600 mg
M0240
(eff. July 30, 2021)
Casiri and imdev repeat Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
M0241
(eff. July 30, 2021)
Casiri and imdev repeat hm Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence. This includes a beneficiary's home, subsequent repeat doses
Q0243* casirivimab and imdevimab Regeneron Injection, casirivimab and imdevimab, 2400 mg
Q0244
(eff. June 3, 2021)
casirivimab and imdevimab Regeneron Injection, casirivimab and imdevimab, 1200 mg
M0243 casirivi and imdevi infusion Regeneron Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring
M0244
(eff May 6, 2021)
casirivi and imdevi infusion home Regeneron Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence
Q0245* bamlanivimab and etesevimab

Eli Lilly

Injection, bamlanivimab and etesevimab, 2100 mg
M0245 bamlan and etesev infusion Eli Lilly Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
M0246 bamlan and etesev infusion home Eli Lilly Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence
Q0247
(eff. May 26 2021)
Sotrovimab GSK Injection, sotrovimab, 500 mg
M0247
(eff. May 26 2021)
Sotrovimab infusion GSK Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
M0248
(eff. May 26 2021)
Sotrovimab inf, home admin GSK Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence
Q0249
(eff. June 24, 2021)
Tocilizumab for COVID-19 Genentech Injection, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg
M0249
(eff. June 24, 2021)
Adm Tocilizu COVID-19 1st Genentech Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose
M0250
(eff. June 24, 2021)
Adm Tocilizu COVID-19 2nd Genentech Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose

*medication code not payable

Per DHCS clarification, the infusion administration is not carved out of the managed Medi-Cal program. The medication and infusion's administration fee is billable to the appropriate payor based on CHWP's existing division of financial responsibility with the capitated physician group/IPA. Medication that is available free from the federal government is not reimbursable.

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 practice 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.

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.

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 California Health & Wellness Alerts: COVID-19 to view regular updates.

Communications and Resources

Stay informed on the latest COVID-19 news and help for you and your patients

  • 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 (PDF), distributed on October 2, 2020.
  • Your patients can get a ride to their COVID-19 vaccine. ModivCare offers transportation for members to a health care office or facility, hospital, or pharmacy. Contact information is provided. There is a list of some services associated with transportation that require 24 to 48 hours advance notice. Learn more in the flyer, distributed on March 1, 2021.
  • Some drugstores and pharmacies are offering COVID-19 vaccines. Patients can make an appointment directly with the pharmacy online or by phone once they are eligible. Patients are scheduled for their second dose when they get their first dose. Learn more in the flyer (PDF) distributed on March 1, 2021.
  • COVID-19 information and tools are now in one location. Visit the COVID-19 Resource Center at CAhealthwellness.com/COVID19. This is a central hub for all provider and member COVID-19-related questions, answers and resources. Refer to the flyer (PDF), distributed on March 22, to find out more.
  • COVID-19 vaccination outreach was initiated April 6, 2021 to help schedule COVID-19 vaccine appointments, We are contacting patients through text, email, phone and interactive voice response. On April 19, 2021, we partnered with ConsejoSano to send culturally relevant two-way text messaging and outbound phone calls in 27 different languages to high-risk members. The messages are about COVID-19 vaccines and related information as well as how to schedule a vaccine appointment. Refer to the flyer (PDF) which was distributed on April 7, 2021.
  • The California Medical Association (CMA) will provide onboarding support to select providers and groups who have shown interest in joining the network but who are not yet contracted. If you are interested in joining California's COVID-19 vaccine network, refer to the flyer (PDF) distributed on June 7, 2021.
  • The time span for the prior authorization extension will remain at six months for requests instead of reverting to three months due to new COVID-19 cases rising in California. The extension was to end on August 19, 2021. There is no new expiration date at this time. Refer to provider update 21-628m which was posted in the Provider Library on August 31, 2021.

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-19 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 (PDF) to assist with providing immediate and long-term care for patients resulting from the COVID-19 crisis.

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, 8:00 a.m. to 6:00 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 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 visit myStrength.
  • 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
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.
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.
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.
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.
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.
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.

Historical Information

COVID-19 content that may be retired or no longer relevant to the public health emergency

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 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.

  • 20-666, Help Your Patients Feel Safe and Learn How We've Done the Same (August 27, 2020)
  • 20-932, Give Timely Flu Shots to Help Keep Members Healthy (November 16, 2020)
  • 21-137, When Can Your Patients Get Their COVID-19 Vaccine? (February 8, 2021)
  • 21-266, Updates to COVID-19 Vaccine Eligibility Requirements (March 30, 2021)

March 5, 2020

What you need to know about COVID-19 (updated, March 20, 2020)

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.