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Frequently asked questions

AllWays Health Partners is working to expedite access to critical care during the COVID-19 state of emergency. The questions and answers below detail the changes to date, including:

  • AllWays on Teams free telemedicine app for network providers
  • Removing cost-sharing for medically necessary testing and treatment for COVID-19
  • Expanding access to telemedicine services for providers and members
  • Implementing an expedited credentialing process

We will continue to review and update our COVID-19 information as new guidance becomes available, so please check this page regularly.

 

Table of Contents

COVID-19 testing and treatment

 For the duration of the public health emergency, we have removed copayments, deductibles, or coinsurance for medically necessary COVID-19 testing and treatment. This applies to inpatient and outpatient services at in- or out-of-network providers, including urgent care centers, emergency departments, hospitals, and other facilities.

These changes are in accordance with guidelines from the Centers for Disease Control (CDC) and the Massachusetts Department of Public Health. Please note that employers offering self-insured plans may have different cost sharing for these services. Members can log into the member portal or call the customer service number on the back of their card for information about their plan benefits.

Diagnosis Codes for Evaluation for suspected Covid-19

  • Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out
  • Z11.59: Encounter for screening for other viral diseases  
  • Z20.828: Contact with and (suspected) exposure to other viral communicable diseases


Diagnosis Codes for Treatment of Covid-19

  • U07.1: 2019-nCoV acute respiratory disease
  • B97.21: SARS-associated coronavirus as the cause of diseases classified elsewhere
  • B97.29: Other coronavirus as the cause of diseases classified elsewhere

Please refer to the table below for code details regarding laboratory tests for COVID-19.

code-updates-0515

 

Please see the Medication section below.

Optum is our behavioral health partner. They have detailed COVID-19 information available on both their provider portal and their member portal. In addition, they have a site dedicated to resources for general wellbeing.  

During the state of emergency, you can check this list to locate in-network skilled nursing facilities (SNFs), rehab facilities, and in-patient acute care centers.

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Relaxing prior authorization requirements

During the pandemic, we have lifted many prior authorization requirements to reduce administrative burden on providers and increase access to care, 

For details about authorization and referral requirements, please refer to our COVID-19 state of emergency PA grid.

Post-acute care (March 23 – June 23, 2020)

For a 90-day period (March 23 – June 23, 2020), AllWays Health Partners has removed prior authorization requirements for post-acute care including: home health care, skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals. However, you must notify AllWays Health Partners when a patient is admitted to an extended stay facility or receiving home health care within 48 hours of the admission. Please submit notifications in the provider portal per our usual process.

For skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals: you must submit notification of continued stay on day 7.

For home health care: you must submit notification of continued stay on day 30.

This applies to all lines of business.

In-patient elective surgeries and hospital admissions (April 6, 2020 – June 6, 2020)

AllWays Health Partners is suspending prior authorization review for scheduled in-patient elective surgeries or admissions at hospitals. The provider should notify us within 48 hours of admission and submit an update a minimum of every 5 days to support discharge planning. AllWays Health Partners retains the ability to conduct retrospective review.

Yes, AllWays Health Partners is suspending concurrent and retrospective review for hospital inpatient services. The provider should notify us within 48 hours of admission. AllWays Health Partners retains the ability to conduct retrospective review. This applies to fully insured Commercial plans.

Yes, we are suspending referral requirements for all lines of business during the COVID-19 state of emergency.

For details about authorization and referral requirements during the pandemic, please refer to our COVID-19 state of emergency PA grid. 

If you need to change the service location for an authorization, please follow standard procedure. The new location must enter a prior authorization request in our provider portal. If possible, the new location should include the previous authorization number.

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Telemedicine and other technology

To help prevent the spread of the coronavirus and support our provider partners during state-of-emergency, we have:

  • Expanded the scope of allowed telemedicine services and provider specialties
  • Removed all cost-sharing for telemedicine

There are two scenarios for billing clinically appropriate, medically necessary telemedicine:

  • For well visits and existing or new patient visits, use the appropriate E/M codes (service must meet E/M coding guidelines) with modifiers GT or 95 and place of service 02
  • For all other services, bill telemedicine using telephonic or digital codes with place of service code 02

You can find complete information in our COVID-19 state of emergency telemedicine policy.

We have expanded access to telemedicine services during the COVID-19 epidemic. 

For more information, please refer to our COVID-19 state of emergency telemedicine policy.

Yes, our network providers have expressed a need for a fast, HIPAA-compliant telemedicine solution to help them care for patients during the COVID-19 crisis. In response, AllWays Health Partners is working with Microsoft to offer AllWays on Teams, a virtual visit platform for all providers in our network. You can learn more and register here.

Providers are not required to use AllWays on Teams. This service is designed to support providers who do not have existing technology for virtual visits. AllWays Health Partners reimburses for telemedicine on any HIPAA-compliant platform.

 

Please note that Partners HealthCare providers should contact their site representatives with virtual care questions and for access to clinical tools.

If a preventive visit has been rendered and billed via telehealth, AllWays Health Partners does not reimburse separately for a follow-up preventive visit in your office. Vaccinations and vaccine administration are separately reimbursable.

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Home visits

AllWays Health Partners covers home visits. Please reference our Evaluation and Management Services guidelines for information on coding and payment.

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Medications

We are temporarily relaxing some of our drug policies to ensure that members can access prescription medications during the crisis.

Yes, most pharmacy or medical specialty drug prior authorizations due to expire between 3/23 – 6/30 will be extended for an additional 90 days. Some exclusions apply. Please note that self-insured accounts may opt out of this extension.

Beginning on 3/13, AllWays Health Partners is lifting the early refill rules on all medications. This includes allowing early refills for up to a 30-day supply of non-maintenance prescription medications and up to a 90-day supply of maintenance prescription medications.

This will enable pharmacists to override this requirement at the point of service. This applies to all lines of business and to all medications except narcotics. We will allow early refills of specialty pharmacy, and this will be limited to a 30-day supply.

If any specific medications are developed to treat COVID-19, AllWays Health Partners would expect to follow any Federal and/or State guidance for how it would be made available and for any applicable cost sharing requirements. There are currently some medications being utilized that are on our existing formulary without a prior authorization. Non-formulary prescriptions can be reviewed within 24 hours in cases of exigent circumstances. Please note COVID-19 on the request.

We anticipate that once a COVID-19 vaccine is available, it will be available through all established channels, including primary care, minute clinics, urgent care, specialty care offices, and pharmacies. Approved vaccines are preventive services per the Affordable Care Act.

As of April 6, hydroxychloroquine and chloroquine will be limited to a 14-day supply within 60 days. Additional quantities or refills will require an authorization.

If your patient has been taking these medications in the past for health conditions such as rheumatoid arthritis and lupus, they can continue to fill their prescriptions. Anyone who has filled a supply of 30 days or more within the past 180 days will be allowed to bypass the 14-day restriction and fill up to a 90-day supply. Members starting new prescriptions for more than 14 days will require an authorization.

This applies to all plans that include prescription drug coverage through AllWays Health Partners and all lines of business.

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Credentialing and enrollment

We are working to support your medical practice with expedited credentialing when necessary. 

If you have an immediate need to credential or enroll a provider, please indicate that on your request. In addition, please indicate if this is a permanent or temporary placement at your practice.

Prior to submitting any request to enroll or credential a medical provider, please check your rosters via the AllWays Health Partners provider portal to validate current provider enrollments to your group billing NPI.  

Providers who have already been credentialed by AllWays Health Partners will not require any additional credentialing to provide services at a new location, however, they will need to be enrolled. To enroll a new provider to your group billing NPI:

Behavioral health providers should refer to the information on the Optum provider portal.

There are no additional credentialing or enrollment submissions required for a medical provider that is enrolled in the AllWays Health Partners network to provide telemedicine services. Please refer to our COVID-19 state of emergency telemedicine policy for details.

Behavioral health providers should refer to the information on the Optum provider portal.

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Administrative information

AllWays Health Partners is adhering to standard turnaround times and prompt pay standards for all claims processing.  Standard claim editing applies and some claims may pend for manual review.  Manually reviewed claims are also subject to standard turnaround times.

AllWays Health Partners will evaluate extending the time frame for commercial member and provider appeals that are received after the standard 180 days when those appeals are related to a COVID-19 diagnosis. 

AllWays Health Partners is paying in accordance with DOI guidelines during the state of emergency. Providers are not permitted to balance bill members for any costs above the DOI-mandated rates. This applies to fully insured and most self-insured commercial plans.

Click here to find instructions on submitting out-of-network claims to AllWays Health Partners.  

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Need the FAQ for our My Care Family plans?

Read the FAQ

Telemedicine billing information

VIDEO: View the webinar recording

Read the 5/01 webinar Q&A

Read our COVID-19 state of emergency telemedicine policy

Contact us

Partners Health Care COVID-19 hotline for Partners clinicians and patients: 617-724-7000 

AllWays Health Partners staff is available at 855-444-4647 Monday-Friday (8:30 AM - 5:00 PM EST).

For urgent prior authorization requests outside of regular business hours (including weekends and holidays), please contact at 1-855-444-4647 and follow the prompts.

Where can I get updates on coronavirus?

The best source for credible news on COVID-19 is the CDC (Centers for Disease Control and Prevention). You can check their website to find the latest updates and recommendations, including resources like:

The Massachusetts Department of Public Health is also a helpful resource for more of the latest updates.

Massachusetts Contact Tracing Collaborative

List of COVID-19 testing sites in Massachusetts

Interactive map of Massachusetts testing sites

FDA guidance for COVID-19 testing

You can also refer to our FAQ for members.

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AllWays Health Partners includes AllWays Health Partners, Inc, and AllWays Health Partners Insurance Company