COVID-19 UPDATES FOR VIVIDA PROVIDERS
During the current state of emergency related to COVID-19, Vivida Health is waiving co-payments for all services.
Early Prescription Refills
Vivida Health has lifted all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. The edits prohibiting early prescription refills will remain lifted for 60 days, in accordance with the Governor’s Executive Order #2020-52. This does not apply to controlled substances.
This coding information is from the AHCA alert issued on 3/18/2020- Telemedicine Guidance for Medical and Behavioral Health Providers and 3/20/2020- Telemedicine Guidance for Therapy Services and Early Intervention Services.
Practitioners: The Agency covers physician, physician extenders (advanced practice registered nurses and physician assistants), and clinic providers (county health departments, federally qualified health centers, and rural health clinics) through telemedicine. Covered medical services include evaluation, diagnostic, and treatment recommendations for services included on the Agency’s practitioner fee schedule to the extent telemedicine is designated in the American Medical Association’s Current Procedural Terminology (i.e., national coding standards). All service components included in the procedure code must be completed in order to be reimbursed. The Agency reimburses services using telemedicine at the same rate detailed on the practitioner fee schedule. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.
Link to AHCA fee schedule: https://ahca.myflorida.com/Medicaid/review/Fee_Schedules.shtml
For certain evaluation and management services provided during the state of emergency period, the Agency is expanding telehealth to include store-and-forward and remote patient monitoring modalities rendered by licensed physicians and physician extenders (including those operating within a clinic) functioning within their scope of practice. The Agency will reimburse each service once per day per recipient, as medically necessary.
Updated Telemedicine Services and Codes:
|Telephone Communications-existing patients||99441
|Telephone Communications-New Patients||99441CG
Florida Medicaid will reimburse for evaluation, diagnostic, and treatment recommendations for services included on the respective therapy services fee schedule to the extent services can be delivered in a manner that is consistent with the standard of care and all service components designated in the American Medical Association’s Current Procedural Terminology and the Florida Medicaid coverage policy is provided. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.
Early Intervention Services
Florida Medicaid will reimburse for the delivery of early intervention sessions via telemedicine when performed by an eligible EIS provider (as defined in the Medicaid coverage policy) to provide family training designed to support the caregiver in the delivery of care. The provider must guide the caregiver in the implementation of certain components of the recipient’s individualized family support plan to promote carryover of treatment gains. Providers are required to ensure caregivers can perform the tasks. Services are covered, as described below:
|Service||Procedure Code||Modifier Required||Limits|
|Early Intervention Individual Session: Family Training||T1027 SC||GT||Four 15 minute units per day|
Provider Telemedicine Requirements (Applies to Therapy and EIS Providers) Providers using telemedicine as a modality to deliver services must comply with the following:
Additional EIS Provider Telemedicine Requirements Early intervention service providers using telemedicine as a modality to deliver services must also comply with the following:
Centers for Medicare and Medicaid Services issued a set of blanket waivers that states may utilize in response to COVID-19. The Agency for Health Care Administration has received authority for many of these waivers related to health care facilities and licensure requirements. The Agency is actively working to receive the federal authority needed for many of the items listed in this alert related to the Medicaid program. The Agency will be issuing subsequent guidance related to additional flexibilities or service enhancements that will be enacted to ensure there is no disruption in care for Medicaid recipients in the event of workforce shortages or limitations in recipients seeking care in provider.
At Vivida Health we are updating policy and procedures to meet the State guidance and to support our providers. Our website and resources are routinely updated with information available for your review. The following information will help guide you through revised credentialing, administrative, claims and support services policies. We are available to assist you regarding these changes by calling us at 1-844-243-5131 available Monday – Friday 8a – 7p EST. You may also call your provider relations specialist directly or email email@example.com with any questions.
Submission instructions for providers
Includes provider enrollment requirements and waiver of non-applicable provider credentialing requirements Provider enrollment and waiver of non-applicable provider credentialing requirements: To ensure adequacy of providers for treatment of members diagnosed with COVID-19 and under the Agency for Health Care Administration’s directive, Vivida Health will cover medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The provisional provider enrollment form is http://www.mymedicaid-florida.com
Minimum documentation requirements for managed care plan decision making
As your health plan partner and under the Agency for Health Care Administration’s directive, Vivida Health will not deny medically necessary services for lack of initial or ongoing prior authorization from skilled nursing facilities, long term acute care hospitals, hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services, and durable medical equipment and supplies. For members diagnosed with COVID-19, Vivida Health will not deny medically necessary services to evaluate and treat members diagnosed with COVID-19 for lack of prior authorization. Vivida Health will waive limits on medically necessary services for these members or members that require services to keep them safely at home. Medical records may be requested for medical necessity review. We will continue to update our policies based on evolving events and AHCA guidance.
Claim Submission Requirements
Claim submission requirements remain largely the same with added diagnosis and laboratory testing codes available for COVID-19 related care as well as modifiers for telemedicine. Please check this website for updates on additional information as the situation develops.
COVID-19 diagnosis codes
When submitting COVID-19 related claims, follow the appropriate CDC guidance on diagnosis coding for the date of service. The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report until a new code becomes effective April 1, 2020.
Interim code guidelines
Lab providers should use the newly created HCPCS codes when billing for COVID-19 testing. CMS created the following HCPCS codes for testing performed on or after Feb. 4, 2020:
HCPCS U0001: This code is used for the laboratory test developed by the CDC.
HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC.
Non-Urgent and Non-Emergent Services including Elective Procedures
In the State of Florida’s ongoing efforts to take necessary and appropriate actions to ensure the 2019 novel coronavirus (COVID-19) remains controlled and that there are essential resources (e.g., personal protective equipment, hospital beds, etc.) for use by health care professionals responding to this emergency, Governor Ron DeSantis issued Executive Order 20-72 on March 21, 2020 related to non-elective medical procedures. The executive order prohibits hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices from providing any medically unnecessary, non-urgent, or non-emergent procedure or surgery which, if delayed, will not place the patient’s health at risk. This includes non-essential elective medical procedures during the state of emergency. As a result, procedures that may have already been prior approved by the managed care plan must be postponed. In order to reduce the administrative burden for providers that already obtained approval for procedures postponed as a result of this executive order, the managed care plan will extend the approval period for affected authorizations for at least six months.
Although COVID-19 patients with mild symptoms may be managed in a lower level of care (e.g., home, long-term care facility, etc.), the decision to discharge to another setting must take into consideration the patient or the facility’s ability to adhere to the Centers for Disease Control’s (CDC) infection prevention and control recommendations, as well as the potential risk of secondary transmission to household members or other residents.
CDC – Test-based strategy.