Provider Coronavirus Information

• Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.
• Instruct symptomatic patients with travel history to China or other infected areas to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
• Health care personnel encountering symptomatic patients with travel history to China or other infected areas should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
• Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
• Monitor and manage ill and exposed healthcare personnel.
• Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible. 

1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.
3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.

Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

• Care Coordination will continue operations via telephone and email.
• Authorizations and concurrent review will continue business as usual.
• Our Provider and Member Services Call Center continues to operate at normal business hours and our Provider Self-Service Portal remains available to providers 24/7.
• Claims processing and payment remains uninterrupted. We always encourage providers to enroll in Electronic Remittance Advices (ERA) and Electronic Fund Transfer (EFT).
• All cost share (co-pay, coinsurance, and deductible) will be waived across all products for any claim billed with the new COVID-19 testing codes.
• Western Sky has configured its systems to apply $0 member liability for those claims submitted utilizing these new COVID-19 testing codes.
• In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. 
• Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
• Adjudication of claims is currently planned for the first week of April 2020.  

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.

Any COVID-19 related claims should have the phrase 'COVID-19' in box 23 on both UB and CM1500 forms to facilitate tracking.

WSCC COVID-19 Billing Codes (PDF)

Medicare Member Liability Reinstatment Notice (PDF)

HCPCS and CPT Codes for COVID-19 Testing Services

• Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
  • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
    Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
• All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
• We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
• In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.  
• Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
• We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
• Adjudication of claims is currently planned for the first week of April 2020.

Medicare Reimbursement Rates for COVID-19 Testing Services for All Provider Types*

• We are complying with the rates published on 3/12/20 by CMS:
  • U0001 = $35.91
  • U0002 = $51.31
  • Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.
• Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

COVID-19 Vaccination Billing Guidance

Medicaid Notice of Vaccine Billing Guidelines (PDF)

Medicare Notice of Vaccine Billing Guidelines (PDF)

New Telemedicine Policies Expand Coverage for Healthcare Services

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telemedicine services for all products for the duration of the COVID-19 emergency.  These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

• Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telemedicine* (Medicare Member Liability Reinstatement Effective June 1st, 2021, Provider Notice [PDF])
• Any services that can be delivered virtually will be eligible for telemedicine coverage
• All prior authorization requirements for telemedicine services will be lifted for dates of service from March 17, 2020 through June 30, 2020
• Telemedicine services may be delivered by providers with any connection technology to ensure patient access to care**

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telemedicine/telemedicine related services. 
**Providers should follow state and federal guidelines regarding performance of telemedicine services including permitted modalities.

Providers who have delivered care via telemedicine should reflect it on their claim form by following standard telemedicine billing protocols in their state.