Health Net Alerts for Providers
Questions and Answers for California Health & Wellness Plan Network Providers
Updated 3/26/20 – The following sections were added and/or updated with additional guidance and information:
- COVID-19 Testing and Screening Billing Information (updated)
- Screening and Testing (updated)
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, 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 for Medi-Cal members, 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).
- 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.
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.
Additional details on telehealth billing and coverage requirements for Medi-Cal products will soon be posted to "California Health & Wellness Alerts: COVID-19," on cahealthwellness.com/providers.html.
What billing codes should be used to bill for COVID-19 testing?
The following guidance can be used to bill for COVID-19 testing.
Starting April 1st, 2020, providers performing the COVID-19 test can begin billing CHWP for services 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 March 13, 2020 (the industry standard for reporting of novel coronavirus tests across the nation's health care system).
Prior authorization requirements will be waived for any claim that is received with these specified codes.
Providers may bill these 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?
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.
NEW 3/26/20 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 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.
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 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.
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.
Providers can also refer members for testing to their county's public health department.
What are the screening and testing guidelines for COVID-19?
NEW 3/26/20 Refer to the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf 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.
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.
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 an IPA, please contact your IPA immediately. CHWP contracted IPAs must notify their CHWP designated network representative of any changes in access to their provider panel.
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
- 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.