En un esfuerzo por mantenerlo actualizado durante este tiempo, la Alianza publica un boletín electrónico sobre COVID-19 todos los lunes para nuestros proveedores.
Presentar reclamos por citas repetidas
With the increased social distancing efforts in response to COVID-19,
providers have likely had to pivot from primarily face-to-face interactions
to a greater reliance on telehealth by phone or video chat.
One challenge you may be facing is how to submit claims for patients seen twice on the same date of service. This
situation might occur if you’ve triaged a patient over a telehealth
appointment and determined that they need to be seen in the office.
In order to ensure the claim is processed and avoid a denial for the second
appointment, you will need to submit additional documentation with the
claim, outlining the medical justification for two services rendered to the
same provider, for the same patient, on the same date of service. This can
be done by
adding a note in the remarks section of the claim that indicates the
separate times the member was seen
or otherwise indicating the claim is not a duplicate bill.
If you have questions about this process, please direct billing questions
to Claims support staff at 800-700-3874, ext. 5503
New billing codes for testing
As our members continue to be affected by the COVID-19 pandemic, you are
likely busy screening patients and prescribing COVID-19 laboratory testing.
We want you to know that
the Alliance covers both laboratory testing and screening for COVID-19.
To ensure you receive appropriate reimbursement,
you must submit COVID-19 related claims using the procedure codes
outlined in the table below.
Note that these are base rates only. Contracted providers
will be paid in accordance with the fee schedule outlined in their contract. Refer to your Alliance
Provider Agreement to determine specific contracted rates.
The Alliance would like to extend our continued gratitude to all of our
provider offices for the important work you’re doing to keep our community
safe and well.
We encourage you to contact a Provider Relations Representative,
800-700-3874, ext. 5504, with any questions about COVID-19 procedure
codes and reimbursements.
Authorization updates and changes
In order to expedite services to our members during the pandemic, we have implemented authorization updates and changes:
- Authorizations for approvals are extended to the end of 2020.
- Out of Area (OOA) Authorized Referrals (AR) are approved.
- Face-to-face authorization for durable medical equipment (DME) and the Medical Therapy Program (MTP) are waived.
- Face-to-face certifications are not required for any authorizations that typically require them.
- Bipap and Respiratory Assist Devices (RADs) are automatically approved: Sleep tests for RAD/PAP are waived.
- Home sleep center testing is approved.
- Home oxygen requests are automatically approved: Oximetry for home O2 is waived.
- Home ventilators are automatically approved: Ventilator medical necessity documentation is waived.
- Prothrombin time and international normalized ratio (PT/INR) monitoring is automatically approved.
- Manual BP monitors for home monitoring are approved.
- Telehealth requests are approved, and providers may use previously approved authorization requests for telehealth services.
- Home health care (HHC) post-service approval: No authorizations are required to start services.
Reminder on new telehealth guidance
El Departamento de Servicios de Atención Médica (DHCS) y el Departamento de Atención Médica Administrada (DMHC) han emitido nuevas directrices sobre la prestación de servicios de telesalud durante la pandemia de COVID-19. Para apoyar el distanciamiento social y garantizar la seguridad de los miembros y proveedores, los proveedores de Alliance deben tomar medidas para permitir que los miembros obtengan atención médica a través de telesalud cuando sea médicamente apropiado hacerlo.
Visitas telefónicas o por video: Cualquier médico elegible para facturar por visitas al consultorio puede realizar una visita telefónica o por video con un paciente en lugar de una visita al consultorio a través de una plataforma compatible con HIPAA que respalda la comunicación entre el proveedor y el paciente para la atención al paciente. Dichas visitas deben durar al menos cinco minutos, deben estar documentadas en la historia clínica del paciente y están sujetas al consentimiento oral o escrito del paciente. Según las pautas del DHCS, los FQHC y RHC pueden contar las visitas por video y las visitas telefónicas de la misma manera que las visitas al consultorio a efectos de pagos potenciales.
Required Codes for Telehealth Services:
- Los códigos cara a cara existentes se aplican cuando un proveedor/clínico de Medi-Cal factura a Alliance por visitas telefónicas o por video. Códigos de ejemplo para la configuración PCP: 99201-99204, 99212-99214
- Los códigos CPT o HCPCS deben facturarse utilizando:
- Código de lugar de servicio “02”
- Utilice modificadores de telesalud adecuados
- Sincrónico, sistemas interactivos de audio y telecomunicaciones: Modificador 95
- Asincrónico Almacenar y reenviar sistemas de telecomunicaciones: Modificador GQ
Tenga en cuenta: No todos los servicios son apropiados para la telesalud (por ejemplo, beneficios o servicios que requieren visualización o instrumentación directa de estructuras corporales). La Alianza comunicará cualquier orientación nueva o adicional a los servicios de telesalud permitidos a medida que esté disponible.
El personal de Servicios de Proveedores y Reclamos de Alliance está disponible para ayudar con sus preguntas. Hable con un representante de Relaciones con Proveedores llamando al 800-700-3874, ext. 5504.
