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Maryland Providers

COVID-19 information from Wellpoint

Wellpoint is closely monitoring COVID-19 developments and how the novel coronavirus will impact our customers and health care provider partners. Our clinical team is actively monitoring external queries and reports from the CDC and Maryland Department of Health to help us determine what action is necessary on our part.

Summary

COVID-19 testing and visits associated with COVID-19 testing

Wellpoint will cover reasonable member health care costs related to COVID-19. Test samples may be obtained in many settings including a doctor’s office, urgent care, ER or even drive-thru testing once available. While a test sample cannot be obtained through a telehealth visit, the telehealth provider can connect members with testing.

Telehealth

Wellpoint is following the communication on telehealth visits per Maryland Department of Health (MDH).  Visit the Maryland Department of Health to view all MDH telehealth communications.

Prescription coverage

Wellpoint is also providing coverage for members to have an extra 30-day supply of medication on hand. We are encouraging that when member plans allow, they switch from 30-day home delivery to 90-day home delivery.

Frequently asked questions

To help address providers’ questions, Wellpoint has put together a list of frequently asked questions.

Actions taken by Wellpoint

Wellpoint is committed to help provide increased access to care to help alleviate the added stress on individuals, families and the nation’s healthcare system.

These actions are intended to support the protective measures taken across the country to help prevent the spread of COVID-19 and are central to our commitment to remove barriers and support communities through this unprecedented time.

Wellpoint is committed to helping our members gain timely access to care and services in a way that places the least burden on the health care system. Our actions should reduce barriers to seeing a doctor, getting tested and maintaining adherence to medications for long-term health issues.

Wellpoint is monitoring COVID-19 developments and what they mean to those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the CDC to help us determine the actions necessary to support our stakeholders.

Wellpoint has a business continuity plan for serious communicable disease outbreaks. The plan is inclusive of pandemics and will be ready to deploy the plan if necessary.

Our enterprise-wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and the Virtual Command Center for Emergency Management command, control and communication.

In addition, Wellpoint has established a team of experts to monitor, assess and help facilitate timely mitigation and response where it has influence as appropriate for the evolving novel coronavirus threat.

Wellpoint is committed to working with and supporting its contracted providers. Our benefits already state that if members do not have appropriate access to network doctors we will authorize coverage for out-of-network doctors as medically necessary.

Wellpoint is committed to working with and supporting providers. As of March 16, Wellpoint is removing prior authorization requirements for skilled nursing facilities (SNFs) for 90 days to assist hospitals in managing possible capacity issues. SNF providers should continue admission notification to Wellpoint in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments.

In addition, Wellpoint is also extending the length of time a prior authorization is in effect for elective inpatient and outpatient procedures to 90 days. This will help prevent the need for additional outreach to Wellpoint to adjust the date of service covered by the authorization.

COVID-19 testing

Wellpoint will process the claim, as it does, for example, with preventive health services.

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates.

Wellpoint is encouraging providers to bill with codes U0001, U0002, U0003, U0004, 86328, 86769 or 87635 based on the test provided.

Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, Wellpoint will recognize the codes 87635 and U0002, and will reimburse drive thru COVID-19 tests according to the lab fee schedule. Participating hospitals without lab fee schedules will follow the same lab testing reimbursement as defined in their facility agreement with Wellpoint.

No, prior authorization is not required for diagnostic services related to COVID-19 testing.

Virtual, telehealth and telephonic care

Wellpoint covers telehealth services for providers who have access to those platforms or capabilities today and will continue coverage through September 30, 2020.

Wellpoint is following the communication on telehealth visits per Maryland Department of Health (MDH). Visit the COVID-19 Updates section of this page to view all MDH telehealth communications.

Yes. Wellpoint is following the communication on telehealth visits per Maryland Department of Health (MDH). Visit the Visit the COVID-19 Updates section of this page to view all MDH telehealth communications.

Wellpoint is following the communication on telehealth visits per Maryland Department of Health (MDH).  Visit the COVID-19 Updates section of this page to view all MDH telehealth communications.

Wellpoint members also can call the 24/7 Nurse HelpLine at the number listed on their Wellpoint ID card to speak with a registered nurse about health questions.

Coding, billing and claims

The CDC updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information on the CDC website.

We are not seeing any impacts to claims payment processing at this time.

Other

Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from an epidemic.

For providers in bordering states who were previously seeing members in approved locations that met state and/or CMS billing requirements, you may submit your telehealth claim using the primary service address where you would have normally seen the member for the face-to-face visit.

Providers should use the provider's location when determining the appropriate POS code to bill. Permitted places of service from where to deliver services via telehealth include school (03), office (11), inpatient hospital (21), outpatient hospital (22), emergency room (23), nursing facility (32), independent clinic (49), federally qualified health center (FQHC) (50), community mental health center (53), non-residential substance abuse treatment facility (57), end-stage renal disease treatment facility (65), and public health clinic (71).

HealthChoice does not accept or use POS code 02 for telehealth. Providers working from a home office to provide services via telehealth should use POS 11 for office and not POS 12 for home.

Provider tools and resources

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