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Coronavirus Updates

March 2020 - Maryland Physicians Care (MPC) has been working in close partnership with Maryland Department of Health (MDH) in addition to other government authorities to serve and protect patients during the COVID-19 outbreak. MPC is dedicated to ensuring that our members and providers have the most up-to-date information to protect themselves and their families from COVID-19. MPC will implement all MDH HealthChoice Program requirements regarding COVID-19. Visit the MDH website for the latest Medicaid information during the COVID-19 outbreak. Check back often for updates.

MDH revised guidelines for FFS nursing home admissions. Currently MPC continues to require notification of transfer from a hospital to nursing facility. Hospitals are not required to obtain Preadmission Screening and Resident Review (PASRR) approval prior to requesting a transfer to a skilled nursing facility, as indicated for certain individuals.

Updated 4/24/20

New testing codes

MPC will accept the additional testing codes recently released and will reimburse in accordance with the MD Medicaid rates:

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

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

G2023: Specimen collection for SARS-CoV-2, any specimen source

G2024: Specimen collection for SARS-C0V-2 from an individual in a SNF or by a laboratory on behalf of a Home Health Agency, any specimen source

MPC will cover COVID-19 testing and screening services to members with no associated member cost share. To ensure that our members receive the care they need as quickly as possible, MPC will not require prior authorization for par and non-par providers.  The Maryland Department of Health (MDH) has issued guidance on the codes and rates for COVID-19 testing.   MPC will accept claims with the following codes to represent COVID-19 testing:

U0001 - 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)

87635 - 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

MPC will pay the MD Medicaid rates for these codes.  Any claims processed prior to MDH establishing its Medicaid rate will be paid at 30% of billed charges and later adjusted accordingly.

MPC covers telemedicine (audio and video) visits per the MDH guidance. Prior authorization is not required for any participating provider. Remote patient monitoring (RPM) still requires prior authorization.

Updated 5/12/20

MDH provided guidance regarding coverage of physician services via audio only telehealth during the COVID-19 State of Emergency.  After review of the guidance, MPC has expanded the codes allowed to be billed using audio only telehealth.

The following CPT codes are billable to MPC for Physician services rendered via audio only telehealth using the UB modifier

  • 99110
  • 99211-15
  • 99391-96

Updated 5/7/20

On May 4, 2020, MDH issued guidance on Well-Child Visits and Preventive Care during the COVID-19 State of Emergency with specifics regarding the types of visits and coding acceptable via audio/video telehealth services.   MPC will be following the MDH guidance regarding the coding and use of telehealth services for Well-Child visits. Please refer to the MDH notice for more information.

On April 27, MDH issued guidance to address questions regarding how hospitals should submit claims for services delivered via telehealth.  MPC will be following the MDH guidance.  Please refer to the MDH notice for more information.

Updated 3/27/20

Therapy Services

On March 27, MDH issued guidance regarding use of telehealth for Physical Therapy, Occupational Therapy, Speech/Language Pathology and Nutrition Counseling during the state of emergency. MPC will cover these services in accordance with MDH guidance. MPC requires the therapy modifier per the communication previously shared.

Per the MDH guidelines, therapy services provided via telehealth will also require the GT modifier in the second modifier position. Prior authorization for therapy services is required for all providers.

Please note that it is the provider’s responsibility to ensure services are delivered via the guidelines established by MDH.

Teledentistry Services

On March 30, MDH released guidance regarding Dentistry services via telehealth during the state of emergency. For MPC members age 21 and over, MPC’s Dental provider, DentaQuest will allow teledentistry services in accordance to the MDH guidelines, as part of MPC’s value added adult benefit coverage.

Updated on 3/25/20

On March 21, MDH issued further guidance to authorize the reimbursement of audio-only health care services for SOMATIC health care providers and to grant further flexibility regarding the use of HIPAA-compliant telehealth technology during the state of emergency. Providers MUST comply with the MDH medical record and member consent documentation requirements found on the MDH website COVID-19 transmittals. MPC will cover audio-only services during the state of emergency in accordance with the MDH guidance. Prior authorization is not required for any licensed physicians and CRNPs. Visit the MDH website for specific guidelines under Provider Updates. MDH will issue future guidance regarding the applicability to other provider types such as therapy providers not currently included in these provisions.

Updated 4/1/20

The ICD-10 code U07.1 for COVID-19 has been configured in MPC’s systems.

MPC will allow a 14 day emergency fill during the state of emergency excluding controlled substance medications.

Medications requiring prior authorization and other restrictions:

 

Medication

Prior Authorization Required

Exceptions

Chloroquine

Yes

Restricted to non-COVID-19 uses, exception existing medication

Hydroxychloroquine

Yes

Restricted to non-COVID-19 uses, exception existing medication

Ribavirin

No

Requires Hep C medication co-dispensing

Darunavir

Yes

Requires HIV diagnosis

MPC allows medication refills after 75% of the days’ supply is used. 

MPC has established clinical criteria for the use of hydroxychloroquine and cholorquine (effective 4.21.2020) which is located https://www.marylandphysicianscare.com/providers/approved-drug-benefits/prior-auth-request.html. See Prior-Authorization Forms for Outpatient Pharmacy Medications Processed Through ESI.

There are no member copays for medications.

Updated 4/29/20

The Maryland Department of Health office of Pharmacy Services Fee-for-Service Medicaid Helpline has transitioned to a voicemail system. When callers dial 1-800-492-5231, option # 3, the system instructs them to leave a voicemail with their name, Medicaid ID number or Provider number, and contact information. Our staff will return their calls. The voicemail option is available Monday through Friday from 8 AM to 5 PM. We expect to see a higher than usual volume of inquiries due to this change.

Currently MPC is not experiencing any operational issues impacting members or providers. There may be opportunities to streamline processes by utilizing electronic systems instead of paper where possible.

Member and Provider Service phone lines are accessible. Provider Relations support remains available via telephone or email. Please visit the website to identify your Provider Relations representative. 

MPC is following standard procedures related to prior authorization and notification for admissions. Please refer to the MPC website for prior authorization process instructions. MPC continues to recommend that requests be faxed in for prior authorization.

MPC / National Imaging Associates (NIA) for high end radiology and select pain management services offers an online tool to facilitate prior authorization for imaging. The site offers various tools to support the process including checking status of authorization. Please visit the site to register.

MPC continues to process claims and provider payments with no interruptions in operations. Electronic submission should be used whenever possible to reduce the need for mailroom services. All standard claim filing guidelines apply. Participation in electronic funds transfer is recommended. Please visit the MPC website for additional information.

Member pre-service appeals:

MPC continues to process member pre-service with no change in process. Member pre-service appeals can be faxed to 866-831-0790. Please refer to the MPC website for additional information. 

Provider claims appeals:

MPC continues to process provider appeals with no change in process. Claims appeals must be submitted in writing with appropriate medical records per the instructions on the MPC website.

A Quick Reference Guide is located on our website with essential phone and fax numbers.

Last updated 4.30.2020.

Please refer to the Centers for Disease Control and Prevention (CDC)’s website for most current guidance.