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COVID-19 Provider Newsletter | Issue 1

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In an effort to keep you up-to-date during this time, the Alliance is publishing a COVID-19 e-newsletter for our providers.

We are open for business!

Although the Alliance is working in a different way to maximize social distancing, we continue to maintain business operations and support members and providers.

Our mission is to ensure our more than 320,000 members in Monterey, Santa Cruz and Merced counties continue to access needed health care, and one way we meet this objective is by ensuring we are there to support our provider network. Our commitment to members and providers will not waver during this public health crisis. However, to help reduce exposure to the illness and to maintain social distancing requirements, the public areas and member service counters for the Central California Alliance for Health are currently closed.

We have transitioned to full-time work from home for employees currently set up to work remotely. This approach has well prepared us to seamlessly support business operations and provide member and provider support in times of crisis. In addition, the Alliance has a business continuity plan in place to maintain business operations and continue providing core services.

The Alliance understands that providers are extremely busy as they focus on providing patient care. In order to support our providers in prioritizing member access to care and to follow social distancing guidelines, we have suspended in-person provider visits until further notice. All interactions and provider follow-up discussions will occur by phone, email and webinar. All provider relations efforts will focus on supporting our providers in the most efficient way possible during this time.

Questions? Reach out to a Provider Relations Representative at 800-700-3874, ext. 5504.

View our latest press release for more information.

New telehealth guidance

The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) have issued new guidance regarding the provision of telehealth services during the COVID-19 pandemic. In order to support social distancing and ensure the safety of members and providers, Alliance providers must take steps to allow members to obtain health care via telehealth when medically appropriate to do so.

 

Telephonic or video visits: Any clinician eligible to bill for office visits may conduct a telephone or video visit with a patient in lieu of an office visit by way of a HIPAA-compliant platform that supports provider to patient communication for patient care. Such visits must last at least five minutes, must be documented in the patient’s medical record and are subject to oral or written consent by the patient. Per DHCS guidance, FQHCs and RHCs may count video visits and telephone visits the same as in-office visits for the purpose of prospective payment.

 

Required Codes for Telehealth Services

  • Existing face-to-face codes apply when a Medi-Cal provider/clinician is billing the Alliance for video/telephonic visits. Example codes for the PCP Setting: 99201-99204, 99212-99214
  • The CPT or HCPCS code(s) must be billed using:
    • Place of Service Code “02”
  • Use appropriate telehealth modifiers
    • Synchronous, interactive audio and telecommunications systems: Modifier 95
    • Asynchronous store and forward telecommunications systems: Modifier GQ

Please note: Not all services are appropriate for telehealth (for example, benefits or services that require direct visualization or instrumentation of bodily structures). The Alliance will communicate any new or additional guidance to allowable telehealth services as it becomes available.

Alliance Provider Services and Claims staff are available to assist with questions. Speak to a Provider Relations Representative by calling 800-700-3874, ext. 5504.

For more information, view our flyer, Guidance on Telehealth Services .

Pharmacy and prescription updates

  • Members may be reminded that they can receive a 90-day supply, including free standard delivery, for most prescription medications mailed to them through MedImpact Direct. To set up mail order for medications, they may visit www.medimpactdirect.com or call 855-873-8739.To find an in-network pharmacy, use MedImpact’s online pharmacy directory .
  • Walgreens and CVS pharmacies are offering free delivery on all eligible medications. Members should talk to their pharmacist or call their local Walgreens or CVS for more information.
  • The Alliance has added a few options to our pharmacy network:Alisal Pharmacy/Alisal LTC Pharmacy
    323 N. Sanborn Rd
    Salinas, CA 93905
    Phone: 831-424-7321
    Fax: 831-424-0197
    www.alisalrx.com

    Soledad Pharmacy and Wellness Center
    537 Front St.
    Soledad, CA 93960
    Phone: 831-677-6100

    SortPak – mail order pharmacy, can arrange delivery to a member’s home
    124 South Glendale Ave.
    Glendale, CA 91205
    Phone: 877-570-7787
    Fax: 877-475-2382
    E-scribe NCPDP/NABP: 0524733
    www.sortpak.com

    For more information please review the Alliance Pharmacy page.

  • No available data for treating COVID-19 with hydroxychloroquine or chloroquine

    There is no currently available data from randomized controlled trials to inform clinical guidance on the use, dosing or duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection. Additionally, there is no available data from randomized controlled trials in humans to support recommending any investigational therapeutics for patients with confirmed or suspected COVID-19 at this time. At present, clinical management includes infection prevention and control measures and supportive care.

    Sources:

    CDC “Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)”

    CDC “Information for Clinicians on Therapeutic Options for COVID-19 Patients”

  • Formulary alternatives for generic albuterol HFA inhalers

    There is a known shortage of albuterol HFA inhalers (generic ProAir, Ventolin, Proventil). In response to the shortage, brand ProAir, Ventolin and Proventil HFA inhalers can be dispensed without prior authorization. In addition, levalbuterol HFA inhaler (generic Xopenex) and albuterol nebulized solutions are on formulary and do not require prior authorization.