Third-Party Payer & MCO Tracking

COVID-19 Third-Party Payer & MCO Tracking

AAHomecare has shared policy recommendations with major third-party payers and MCOs that will allow HME companies to better serve their members/beneficiaries, and continues to follow up with these payers to advocate for these proposals. Several payers have adjusted requirements and guidance related to coverage, respiratory care, authorizations, documentation, delivery, and other related operational practices. These changes are available in spreadsheet form and are also broken out below. We will continue to work with these payers and update these resources to reflect new policy guidance.

See AAHomecare policy recommendations to third-party payers and MCOs for additional details.

Webinar replay: Payers in the Pandemic: Policy Updates from State and Commercial Payers (4/21/2020) – see also related presentation.

Download our Third-Party Payer Tracking Excel spreadsheet here (updated 6/3/2020) or see policy changes and resources broken out by payer below. Important note: the information collected in the spreadsheet and broken out below shown for basic summary and comparison purposes only. Suppliers are advised to check with your payers to confirm this information to make sure it is accurate and up-to-date for purposes of patient treatment and business operation purposes. AAHomecare provides no warranty or guarantee of the accuracy of this information.

Aetna – Anthem multiple states – Anthem NY-Empire NY-Empire – Blue Cross/Blue Shield Association – Carecentrix-Cigna Core Business (updated 6/3) – Carecentrix-Cigna NALC – Carecentrix-Cigna PSG – Carecentrix-Cigna Shared Administration/Alliance – Carecentrix-Florida Blue (updated 6/3) – Carecentrix-Horizon (updated 6/3) – Centene – Excellus BCBS – Humana (updated 6/3) – Molina Healthcare of Michigan – UnitedHealthCare (updated 6/3)

Aetna – Aetna has confirmed to AAHomecare that they will continue their established practice of following Medicare guidelines on all patient care issues – see also their recently updated Oxygen Medical Policy.

Anthem (CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI) - 4/1/2020 Anthem press release – providers should check the Anthem provider site (select your state) for updates to any Medicaid plans for their states that may change the responses.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – None documented
Prior Authorization Flexibilities – Prior authorization requirements are suspended for COVID-19 DME including oxygen supplies, respiratory devices and continuous positive airway pressure (CPAP) devices, non-invasive ventilators and multi-function ventilators for any medical reason as determined by a provider, along with the requirement for authorization to exceed quantity limits on gloves and masks. See state-by-state PA updates for more detail: California – Colorado – Connecticut – Georgia – Indiana – Kentucky – Maine – Missouri – New Hampshire – Nevada – Ohio – Virginia – Wisconsin
Reauthorization – Waived for COVID-19 diagnoses
Respiratory Medical Policy – Coverage of Short-Term home oxygen use for members with COVID-19 related diagnoses
Telehealth – Yes
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Yes

Anthem NY-Empire – providers should check the Anthem provider site (select NY) for updates that may change the responses.

Prior Authorization Flexibilities – Not for DMEPOS – see Anthem NY-Empire update on currently-allowed PA
Reauthorization – Not for DMEPOS
Telehealth – Yes
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Yes

Blue Cross/Blue Shield Association – BCBS COVID-19 Updates

Proof of Delivery Signature Waived – Varies by State
Proof of Delivery Instructions – Varies by State
Prior Authorization Flexibilities – Varies by State
Reauthorization – Varies by State
Respiratory Medical Policy – Varies by State
Face 2 Face Flexibilities – Varies by State
Telehealth – Varies by State
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Yes
Complex Rehab Face 2 Face – Varies by State
Repair Prior Authorizations – Varies by State
Order Quantity Changes – Varies by State
Audit Suspension – Varies by State
Replacement DME for Patients displaced due to Pandemic – Varies by State
PAP Instruction Via Telephone or video messaging – Varies by State

Carecentrix-Cigna Core Business – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Retro authorization for 90 days for Dates of service through 7/31/20 for all Diagnoses. SEE RESPIRATORY MEDICAL POLICY
Respiratory Medical Policy – No Prior auth for respiratory related equipment (oxygen, neb, RAD, vent, suction, pulse ox, cough assist for COVID-19 DX.
Face 2 Face Flexibilities – Waived with documentation issued by physician surrogates or existing orders and results currently available.
CRT Face-2-Face – Replace face to face requirement with physician prescription or tele-evaluation. Providers may conduct a video evaluation by LCMP. Providers may perform home assessment via video or verbal interview.
Order Quantity Changes – Allow 180 day supply shipment and can ship 30 days in advance for specific supply codes.
Replacement DME for Displaced Patients – Yes
PAP Instruction Via Telephone or video messaging – Allowed

Carecentrix-Cigna NALC – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Not allowed
Respiratory Medical Policy – No Prior auth for respiratory related equipment (oxygen, neb, RAD, vent, suction, pulse ox, cough assist for COVID-19 DX.
Face-2-Face Flexibilities – Face-2-Face required
Complex Rehab Face-2-Face – Face-to-Face required
Order Quantity Changes – Not allowed
Replacement DME for Patients displaced due to Pandemic – Not allowed
PAP Instruction Via Telephone or video messaging – Allowed

Carecentrix-Cigna PSG – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Not Allowed
Respiratory Medical Policy – Not Allowed
Face-2-Face Flexibilities – Face-2-Face Required
Complex Rehab Face-2-Face – Face-2-Face Required
Order Quantity Changes – Not allowed
Replacement DME for Patients displaced due to Pandemic – Not allowed
PAP Instruction Via Telephone or video messaging – Allowed

Carecentrix-Cigna Shared Administration/Alliance – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Not allowed
Respiratory Medical Policy – Not allowed
Face-2-Face Flexibilities – Face-to-Face required
Complex Rehab Face-2-Face – Face-to-Face required
Order Quantity Changes – Not allowed
Replacement DME for Patients displaced due to Pandemic– Not allowed
PAP Instruction Via Telephone or video messaging – Allowed

Carecentrix-Florida Blue – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Retro authorization for 90 days for Dates of service through 6/30/20 for all Diagnoses.
Respiratory Medical Policy – No Prior auth for respiratory related equipment (oxygen, neb, RAD, vent, suction, pulse ox, cough assist for COVID-19 DX.
Face 2 Face Flexibilities – Waived with documentation issued by physician surrogates or existing orders and results currently available.
Complex Rehab Face 2 Face – Replace face to face requirement with physician prescription or tele-evaluation. Providers may conduct a video evaluation by LCMP.
Order Quantity Changes – Allow 90 day supply shipment and can ship 30 days in advance for specific supply codes.
Replacement DME for Patients displaced due to Pandemic – Yes
PAP Instruction Via Telephone or video messaging – Allowed

Carecentrix-Horizon – Horizon Oxygen Bulletin-April 2020 – Provider Newsflash-4/22/20 – Provider Newsflash-5/28/20 – note: CCX providers no longer need to look up the latest NewsFlash; please go to your Provider Portal and look under the Support section for updates.

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Document reason for no signature and verify confirmation that patient has received equipment/service.
Prior Authorization Flexibilities – Retro authorization for 90 days for Dates of service through 6/30/20 for all Diagnoses. **SEE RESPIRATORY MEDICAL POLICY
Respiratory Medical Policy – No Prior auth for respiratory related equipment (oxygen, neb, RAD, vent, suction, pulse ox, cough assist for COVID-19 DX. No authorization required for a 30-day supply of oxygen for any patient (any diagnosis) discharged from the ER.
Face 2 Face Flexibilities – Waived with documentation issued by physician surrogates or existing orders and results currently available.
Complex Rehab Face-2-Face – Replace face-to-face requirement with physician prescription or tele-evaluation. Providers may conduct a video evaluation by LCMP. Providers may perform home assessment via video or verbal interview
Order Quantity Changes – Allow 90 day supply shipment and can ship 30 days in advance for specific supply codes.
Replacement DME for Patients displaced due to Pandemic – Yes
PAP Instruction Via Telephone or video messaging – Allowed

Centene – COVID-19 Clinical Policy: Diagnostic Testing Guidelines for 2019-Novel Coronavirus-March 2020

Prior Authorization Flexibilities – Waived for COVID-19 related treatment
Reauthorization – Waived for COVID-19 related diagnoses
Respiratory Medical Policy – Follows State Medicaid or Medicare Policy. Additional Follow Up Needed.
Face 2 Face Flexibilities – Follows State Medicaid or Medicare Policy.
Telehealth – Yes
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Yes

Excellus (BCBS) – FAQs for DME Providers Apr. 2020

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Will relax signature requirements for proof of delivery for any delivery occurring on or after March 20, 2020 until the COVID-19 State of Emergency is lifted.
Prior Authorization Flexibilities – We are following New York State’s guidance related to preauthorization waivers and other administrative relief during the COVID-19 State of Emergency. Please refer to the NYS Department of Financial Services Circular Letter No. 8 for additional details
Reauthorization – We are following New York State’s guidance related to preauthorization waivers and other administrative relief during the COVID-19 State of Emergency. Please refer to the NYS Department of Financial Services Circular Letter No. 8 for additional details.
Respiratory Medical Policy – We will cover short-term oxygen for in-home use for our members when it meets the medical necessity criteria for the member’s care. Please include documentation in the patient’s medical record to support medical necessity, including the diagnosis and any additional information, such as “oxygen saturation is less than 88%.”
Face 2 Face Flexibilities – During the State of Emergency, New York State has relaxed its requirements related to telehealth services provided to those with Medicaid coverage and will allow a new patient visit to be performed via telephone only.
Telehealth – During the State of Emergency, New York State has relaxed its requirements related to telehealth services provided to those with Medicaid coverage and will allow a new patient visit to be performed via telephone only.
Order Quantity Changes – We are following New York State’s guidance related to preauthorization waivers and other administrative relief during the COVID-19 State of Emergency. Please refer to the NYS Department of Financial Services Circular Letter No. 8 for additional details.
Audit Suspension – We have extended audit appeal time frames from 30 days to 90 days during the State of Emergency. For any other contingencies in place during the State of Emergency, we are we are following New York state guidance. Please refer to the NYS Department of Financial Services Circular Letter No. 8 for additional details.
NYS Department of Financial Services Circular Letter No. 8

Humana – COVID-19 Provider Website – 4/2/20 Press Release – 5/15/20 Update on Authorizations

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – None documented
Prior Authorization Flexibilities – Waived for COVID related diagnoses; authorization requirements for other items reinstated May 22, with exception of state mandates suspending authorizations/referrals in effect.
Reauthorization – Waived for COVID related diagnoses
Respiratory Medical Policy – Coverage of Short-Term home oxygen use for members with COVID-19 related diagnoses
Face 2 Face Flexibilities – Via Telehealth
Telehealth – Yes
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Yes
Order Quantity Changes – Not addressed
Audit Suspension – Yes

Molina Healthcare of Michigan – COVID-19 Update

Prior Authorization Flexibilities – Following MDHHS guidance: Waiving quantity limits, PA, and documentation requirements for respiratory equipment and medical supplies (see MDHHS guidance)
Reauthorization – Following MDHHS guidance: Waiving quantity limits, PA, and documentation requirements for respiratory equipment and medical supplies (see MDHHS guidance).
Respiratory Medical Policy – Following MDHHS guidance: Waiving quantity limits, PA, and documentation requirements for respiratory equipment and medical supplies (see MDHHS guidance).
Face 2 Face Flexibilities – Recommend ordering physicians utilize telemedicine to meet Affordable Care Act (ACA) face-to-face requirements (see MDHHS guidance)
Telehealth – MDHHS has issued an updated bulletin to allow telehealth for Medicaid members under certain parameters, including telephone.
Audit Suspension – We are being reasonable with timeframes to return medical records if an audit does occur.
Replacement DME for Patients displaced due to Pandemic – Allowed
Michigan Dept. of Health & Human Services guidance referenced

UnitedHealthCare – COVID-19 Updates

Proof of Delivery Signature Waived – Yes
Proof of Delivery Instructions – Must document date, time, and relationship
Prior Authorization Flexibilities – All currently effective prior authorization requirements and site of service reviews reinstated effective June 1
Reauthorization – F2F required for all auths obtained prior to 10/1/19. Auths obtained 10/1/19 or later is having authorization extended through 9/30/20.
Respiratory Medical Policy – Covid-19 related oxygen requests can be delivered without prior authorization and does not need to meet current clinical criteria.
Face 2 Face Flexibilities – Via Telehealth-See Reauthorization guidelines.
Telehealth – Yes
Waiving Copays for COVID Testing – Yes
Waiving Copays for COVID Treatment – Not for DMEPOS
Complex Rehab Face 2 Face – Vendors can utilize telehealth to minimize in-person contact to meet evaluation requirements.
Repair Prior Authorizations – Waived
Order Quantity Changes – 1st order-30-45 day supply; 2nd order additional 15-day supply; remaining orders-manage frequency to maintain sufficient product but not to exceed 45 days on hand. Supply limits still apply.
Audit Suspension – No

Updated 6/3/2020 – we will continue update the page as appropriate.