Will Vibra Health Plan cover COVID-19 diagnostic testing?
Yes. Vibra Health Plan policies include coverage for COVID-19 diagnostic testing.
We are also waiving prior authorizations for diagnostic tests and related services consistent with CDC guidance. Please verify eligibility prior to providing services.
Will Vibra Health Plan waive member cost share for inpatient services related to COVID-19?
Vibra Health Plan continues to make it easier for members to get in-network treatment for care they need during the COVID-19 pandemic. As an additional step in that effort, effective April 1 through July 31, 2020, Vibra Health Plan is waiving members’ cost share (copayments, coinsurance, and deductible) for in-network, inpatient hospital treatment for COVID-19. Inpatient hospital treatment for COVID-19 includes care from short-term acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and inpatient mental health care given in a psychiatric hospital or psychiatric unit within a hospital.
If the patient is seen by a provider for an office visit and during the visit, the provider orders the test for COVID-19, are both services waived of copays?
Vibra Health Plan is waiving member cost share (copay, coinsurance, and deductible) for the COVID-19 diagnostic testing consistent with statutory requirements. Per recently enacted additional statutory requirements, we are also waiving member cost share for the visit that resulted in a COVID-19 test whether in an office, emergency room, telehealth, or urgent care. Providers will receive the full allowed amount from Vibra Health Plan, and therefore the Provider must refund any deductibles or co-payments that were inadvertently collected from the member.
What codes should we use to bill diagnostic testing for COVID-19?
CMS has developed two Healthcare Common Procedure Coding System (HCPCS) codes that the Medicare claims processing systems will be able to accept starting on April 1, 2020, for dates of service on or after February 4, 2020. Vibra Health Plan is ready to accept these codes.
- U0001 - used to bill for tests, tracks new cases of the virus, and is to be used specifically for CDC testing laboratories to test patients for SARS-CoV-2.
- U0002 - allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers.
- 87635 - similar to U0002, the American Medical Association (AMA) created this new Category I code effective 3/13/20 for reporting the novel coronavirus tests: 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.
- U0003 - 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. (test dates on or after 4/14)
- U0004 - 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. (test dates on or after 4/14)
In addition, there are two new codes that have been issued for COVID-19 specimen collection. Vibra Health Plan in the process of implementing these codes as well as a Medicare set payment for them.
- G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
- G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
When submitting diagnostic tests to Vibra Health Plan, please use the newly-created codes.
What are the reimbursement rates for diagnostic testing?
- U0001 = $35.92 (test dates on or after 2/4)
- U0002 = $51.33 (test dates on or after 2/4)
- 87635 = $51.33 (test dates on or after 3/13)
- U0003 = $100.00 (test dates on or after 4/14)
- U0004 = $100.00 (test dates on or after 4/14)
- G2023 = $23.46 (test dates on or after 3/1)
- G2024 = $25.46 (test dates on or after 3/1)
Will Vibra Health Plan cover telehealth visits?
Yes. Vibra Health Plan covers telehealth visits with in-network providers.
Will Vibra Health Plan cover the member cost share for telehealth benefits?
We are covering the member cost share (co-pays, co-insurance and deductibles) for telehealth visits that occurred through April 15th with in-network providers.
We are encouraging our members to use telehealth services to help reduce exposure in healthcare settings as well as prevent community spread. We are waiving member cost share (copay, deductible, and coinsurance) for medically necessary telehealth (phone or video conference) visits with in-network healthcare providers through April 15. Providers will receive the full allowed amount from Vibra Health Plan, and therefore the Provider must refund any deductibles or co-payments that were inadvertently collected from the member.
Please verify a member’s eligibility and benefits before providing telehealth services.
How do providers become participating with Vibra Health Plan’s Amwell app?
Our telehealth vendor, Amwell, is only able to add providers who offer urgent medical services at this time. (Urgent medical providers include internists, general practitioners, family practitioners, pediatricians, emergency medicine.)
However, you don’t need to be a part of the Vibra Health Plan’s app to provide telehealth services. Telehealth services can also be made available directly by provider whether via phone or via video conference, as long as they are medically necessary, provided by an in-network provider and in accordance with the member’s benefits.
Providers interested in providing telehealth services via the Vibra Health plans telehealth app should visit the Amwell for Providers website.
Where can I find more information regarding Vibra Health Plan and COVID-19?
If you have additional questions, contact your Provider Relations Consultant or email us.
CMS is waiving the three night acute care stay requirement for SNF coverage due to the state of emergency declaration. Will Vibra Health Plan follow this guideline?
Vibra Health Plan does not require a three-night acute stay prior to a SNF admission for Medicare Advantage products.
How do providers bill for telehealth services?
Given the current COVID-19 situation, Vibra Health Plan is temporarily allowing providers to bill and receive reimbursement consistent with an in-person visit. This change applies beginning March 6, 2020 through the end of the public health emergency.
To facilitate reimbursement, providers must:
- Identify the place of service (POS) they would bill had the visit occurred as a face-to-face visit.
- Providers should not use “02” as POS.
- They must also identify that it was a telehealth service by including Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System).
Will telehealth services be eligible for coverage for Vibra Health Plan members who have not previously had telehealth benefits?
Yes. All Vibra Health Plan members have telehealth benefits through 2020, and we will continue to follow CMS guidelines for coverage of telehealth services.
Will telehealth services be eligible for coverage for Vibra Health Plan members when performed by providers that are not contracted with Vibra Health Plan?
Telehealth services are covered only when delivered by a Vibra Health Plan provider.
Will Vibra Health Plan be adjusting the length of time a preauthorization is valid before it expires?
To relieve some of the burden on our providers and our members during this health crisis:
- For services that may be delayed due to COVID-19, new preauthorizations will be valid for at least six months.
- For services that are likely to be impacted by the pandemic, such as: OP surgery, IP electives, DME etc., we have extended existing preauthorizations by six months.
If you experience a problem with preauthorization timeframes, please call the preauthorization line, and we can adjust end dates as needed.
How will other preauthorizations apply during the COVID-19 emergency?
Preauthorizations related to COVID-19 diagnostic tests:
- Covid-19 tests: no preauthorization is required
- Laboratory tests - CBC and electrolytes: no preauthorization is required
- Chest X-rays: no preauthorization is required
- CT scan chest: preauthorization is waived
Preauthorization will be waived for most services with diagnosis codes on the CDC COVID-19 recommended list. Exclusions include: medical specialty injectable, genetic testing, transplant, reconstructive/cosmetic surgeries, MSK, NIA (with exception of CT scan chest).
How is Vibra Health Plan handling providers adding additional staff and/or redeployment of existing resources that may be necessary to handle added patient volumes?
Vibra Health Plan recognizes that, during the COVID-19 crisis, additional staffing and/or redeployment of existing resources may be necessary to handle added patient volumes.
Until further notice, Vibra Health Plan will allow providers to use the Locum Tenens billing guidelines for either:
- Using a substitute physician who is not contracted with Vibra Health Plan for reciprocal billing arrangements (i.e., Locum Tenens) when a patient’s regular physician is unable to provide services.
- Using a substitute physician who is contracted with Vibra Health Plan but is providing services in another location not currently loaded into our claims adjudication system.
The Healthcare Common Procedure Coding System (HCPCS) code modifier Q6 (services furnished under a fee-for- time compensation arrangement) is required on all claims during this time when using the Locum Tenens process outlined above.
In addition, Vibra Health Plan will also allow contracted providers to bill with the current provider record on file, instead of the actual place of service rendered, if this reduces the billing providers’ administrative burden.
Is Vibra Health Plan covering Medicare Annual Wellness exams through telemedicine? Example: Codes G0438 and G0439.
Vibra Health Plan will recognize the most current published Centers for Medicare and Medicaid Services (CMS) list of covered services, excluding provider consultation services.
Which Applied Behavioral Analysis (ABA) services will be eligible for reimbursement under our Network Reimbursement Policy for Telehealth Services?
At this time the following ABA services will be considered covered services when performed telephonically:
For Clinicians, as defined in the Medicare Telemedicine Health Care Provider Fact Sheet, what services will be covered under the Network Reimbursement Policy for Telehealth Services?
The following codes represent services that are considered covered under the telehealth reimbursement policy for Clinicians:
View the CMS fact sheet here.
During this health emergency, will Vibra Health Plan give facilities (other than Hospitals as defined above) extra time to submit claims and adjustments?
Yes. For encounters that occur between March 1, 2020 and June 1, 2020, facility providers, not included in the definition of Hospital above, that submit UB-04 claims for outpatient services will have 270 days from the date of service or discharge to submit a claim or adjustment.
Timing: Claims and Appeals
During this health emergency, will Vibra Health Plan give providers extra time to appeal medical necessity reviews?
For medical necessity claim denials, VHP accepts disputes submitted within 365 days of the denial.
For medical necessity UM denials submitted on behalf of the member, VHP is waiving timeliness altogether during this health emergency.
How is Vibra Health Plan helping members have enough medication on hand during this health emergency?
As part of Vibra Health Plan’s efforts to address the COVID-19 spread, we have waived early refill limits on prescription drugs. This means members can get refills sooner and have an extra supply of their medication on hand. Their plan may also provide them the option of 90-day home delivery.
Are all prescriptions available for early refill?
A member may not be eligible to receive an early refill if the drug has a quantity level limit (QLL), or they already received an early refill. They should call Member Services at the number on the back of their ID card to inquire.
Do we need to renew members’ prior authorizations for medications during this health emergency?
Existing prior authorizations for medications that were set to expire from March 3 to April 30, 2020 have been extended to August 31, 2020. Prior authorizations that were set to expire in May 2020 have been extended to September 30, 2020.
Updated October 1, 2020