California Health & Wellness Alerts for Providers
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.
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 billing information and other guidance. This section shall be updated as new information and guidance becomes available; however providers should continue to refer to the Department of Healthcare Services (DHCS) website for the most up to date information.
Updated 5/20/20 - The following sections were added and/or updated with additional guidance and information:
- DHCS Resources for Providing Care during COVID-19 (updated)
CHWP recognizes the incredible challenges to our health care delivery teams under these unprecedented COVID-19 circumstances. We want to thank you for your important contributions to the health of individuals and communities across California.
Please consider dropping in to our new Resilience Thursday gatherings. The goal is to create a quiet, protected online space for reflection, rejuvenation and connection with others, facilitated by health psychologist, Jeffrey Ring. To accommodate your schedules, several times and days are offered. Providers can drop in for one or more sessions as needed. We look forward to seeing you there!
Drop-in Session Details:
- When: May 7th, 14th and 21st
- Times: 8 a.m., 12:30 p.m. and 4:30 p.m. (Pacific time) for 30-minute sessions
- Join Session
- Use password: 042020
About our Facilitator
Dr. Jeffrey Ring is a health psychologist and Principal Consultant at Health Management Associates where he works on projects related to health equity, medical education, integrated whole-person care and medical leadership. As a health psychologist, he has served as the Director of Behavioral Sciences and Cultural Medicine at the Family Medicine Residency Program at White Memorial Medical Center in East Los Angeles where he taught mind-body medicine and doctor-patient communication. Dr. Ring has extensive clinical experience with health practitioner resilience and vitality through teaching, consultation and retreats. In 2016, Dr. Ring taught mindfulness in Spanish to approximately 1400 farm and agricultural workers in the Central Valley region of California.
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.
Will 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 all 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.
- 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 is diligently working to offer expanded access to telehealth services through third parties. We will provide updated information on vendor arrangements once available.
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:
- Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19) (PDF)
- California Department of Health Care Services | Medi-Cal & Telehealth
- California Department of Health Care Services | COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications
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 telehealth vendors are available for providers?
CHWP is contracted with two telehealth vendors, Babylon Health and Teladoc, to deliver virtual care to our members so that they may avoid public spaces without foregoing needed care. Through the increased use of virtual care, we can also help limit traffic to clinical inpatient and outpatient settings, preserving the capacity of our health care system for those in greatest need.
We encourage our providers to consider contracting with one of our vendor partners if you do not already have a telehealth solution in place that meets your needs. Participation in a formal telehealth platform serves both to protect patient privacy through secure connections, as well as give providers training on best practices related to delivering care remotely.
Please contact Babylon and Teladoc directly to begin the contracting process:
|Vendor||Telephone||Email or Website||Webinar|
|Babylonfirstname.lastname@example.org||Providers interested in contracting with Babylon Health are encouraged to access an on-demand introductory webinar to obtain additional information.|
|Teledoc||1-800-835-2362, option 4||www.teladoc.com/providers/contact/||N/A|
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.
|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 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:
- HCPCS U0001 – For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
- HCPCS 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.
- HCPCS 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.
- HCPCS 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.
Authorization requirements will be waived for any claim that is received with these specified codes.
Providers may bill the above codes regardless of provider type or contracting status.
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):
- Special coding advice during COVID-19 public health emergency (PDF)
- CPT reporting for COVID-19 Testing (PDF)
What is the deadline to file claims?
The deadline to file claims 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:
- 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 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?
Refer to the Centers for Disease Control and Prevention (CDC) for updated guidelines for testing patients suspected of having the COVID-19 infection.
On March 19, 2020, the state of California launched a coronavirus awareness website. This site provides the following testing recommendations:
- California is expanding the coronavirus testing capacity daily.
- Currently, testing is being prioritized for people who:
- Have the coronavirus symptoms AND
- Have one of these risk factors:
- Have had contact with a person who has tested positive for COVID-19, OR
- Are health care providers or work with vulnerable populations (such as a long term care facility), OR
- Traveled to an affected country in the past 14 days, OR
- Are over age 60, have a compromised immune system or have serious chronic medical conditions
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?
- 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:
- Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
- 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 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.
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, 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, 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:
- Contact your CHWP provider network regional representative immediately
- 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.
- 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 the latest information and guidance on COVID-19?
To obtain the latest updates and guidance on assisting patients and when to take action, visit cahealthwellness.com/providers.html where you will see a link to California Health & Wellness Alerts: COVID-19 in the orange bar. You can also visit the websites below for more information about COVID-19 and the latest guidance from public health officials:
- UpToDate – Once on this site, you can also refer to Patient education: Coronavirus disease 2019 (COVID-19) (The Basics) or Society guideline links: Coronavirus disease 2019 (COVID-19) topics under Related Topics
- California Department of Public Health
- Centers for Disease Control and Prevention
- World Health Organization
Does the Department of Healthcare Services (DHCS) have any resources available for providing care during COVID-19 that are specific to asthma management, managing diabetes, prenatal and postpartum care, and well visits and immunizations?
For additional information on asthma management, managing diabetes, prenatal and postpartum care, and well visits and immunizations during the COVID-19 crisis, providers are encouraged to reference the following resources distributed by the DHCS to managed care plans (MCPs):
- All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities recommend delaying elective inpatient and outpatient surgical and procedural cases. The delay of elective surgeries or other non-urgent procedures during this time is allowed and is recommended by CMS. 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 the TELEHEALTH section 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.
Provider News and Announcements
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.