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Frequently asked questions

Everything you need to know about working with us during the pandemic.
Visit the My Care Family FAQ.

Visit our COVID-19 vaccine resource page with easy-to-access information for you and your patients. 

Table of Contents



The Massachusetts State of Emergency ended on June 15, 2021, and we’re currently reviewing policies that were established during this time. We’ll share updates about our policies here, so please continue to check this FAQ.

If a topic isn't addressed here, please follow our standard policies and procedures as outlined in our medical policies, payment policies, authorization guidelines, provider resources, or your contract. 

Please refer to the COVID-19 payment policy for more information about payment during the Massachusetts public health emergency. AllWays Health Partners is in compliance with all relevant Massachusetts regulations related to COVID-19 during the public health emergency.  

General information

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.

You can also refer to our FAQ for members.

Vaccine information

Throughout the COVID-19 pandemic, AllWays Health Partners has ensured timely access to critical health care services for our members. As part of that commitment, AllWays will cover the administration of all COVID-19 vaccines that receive emergency use authorization (EUA) or full approval from the Food and Drug Administration (FDA), at no cost to our members.

Please note that all vaccine providers administering a dose of COVID-19 vaccine in the Commonwealth must report administration to the Massachusetts Immunization Information System within 24 hours.

Throughout the COVID-19 pandemic, AllWays Health Partners has ensured timely access to critical health care services for our members. As part of that commitment, AllWays will cover the administration of all COVID-19 vaccines that receive emergency use authorization (EUA) or full approval from the Food and Drug Administration (FDA), at no cost to our members.

vaccine grid 090921

 

Our COVID-19 vaccination status report can help PCPs identify their patients that have not been vaccinated. This report contains all commercial HMO members on your panel who are partially vaccinated or unvaccinated, and is available on our provider portal. 

You can find the report under the "Reports" tab after logging in to your provider portal account. 

COVID-19 testing and treatment

Read our COVID-19 payment policy.

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.

Testing coverage

In accordance with current CDC and state public health department guidelines, AllWays Health Partners members are covered without cost sharing for COVID-19 testing, when it is medically necessary and ordered by a PCP or treating provider. FDA-approved testing is also covered when a person:

  • Has been identified as a close contact by a public health entity for a known or suspected exposure to COVID-19.
  • Works in an industry with increased exposure to the virus like health care, restaurant, hospitality, and retail industries


Testing is not covered for third party administrative reasons — including but not limited to pre-employment or return to work, public health, return to school, and travel screenings.

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
  • Z11.52: Encounter for screening for Covid-19.  Effective for dates of service 1/1/2021 and forward.
  • Z20.828: Contact with and (suspected) exposure to other viral communicable diseases
  • Z20.822: Contact w/and suspected exposure to covid-19. Effective for dates of service 1/1/2021 and forward.


Diagnosis Codes for Treatment of Covid-19

  • U07.1: 2019-nCoV acute respiratory disease
  • J12.82: Pneumonia due to coronavirus disease 2019. Effective for dates of service 1/1/2021 and forward.
  • B97.21: SARS-associated coronavirus as the cause of diseases classified elsewhere
  • B97.29: Other coronavirus as the cause of diseases classified elsewhere


If Multisystem Inflammatory Syndrome (MIS) develops as a result of a previous COVID-19 infection, assign codes M35.81 and B94.8.

  • M35.81: Multisystem Inflammatory Syndrome. Effective for dates of service 1/1/2021 and forward
  • B94.8: Sequelae of other specified infectious and parasitic diseases


You can find more information in our COVID-19 payment policy.

The following specimen collection and lab codes are covered when medically necessary and ordered by a provider. For more information, check our COVID-19 payment policy.

code-updates-123020

Due to the rapidly evolving nature of Covid-19 testing protocol AllWays Health Partners Clinical leadership continues to track developments regarding COVID-19 antibody testing. Please refer toCDC and FDA websites for further guidance.

Optum is our behavioral health partner. They have detailed COVID-19 information available on both their provider portal and their member portal. Please refer to Optum’s State-Specific Guidance for the most current COVID related updates. In addition, they have a site dedicated to resources for general wellbeing.

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

Relaxing prior authorization and referral requirements

Inpatient elective surgeries and hospital admissions (Updated 9/1/2021)

AllWays Health Partners standard prior authorization and notification requirements have resumed for all Commercial Inpatient admissions except those related to COVID-19, effective 4/1/21. Effective 9/1/21, prior authorization and notification requirements resume for all My Care Family (MVACO) inpatient admissions, except those related to COVID-19. For details, please refer to our COVID-19 public health emergency PA grid.

 

Post-acute care (Updated 9/1/2021)

AllWays Health Partners standard prior authorization and notification requirements will resume for non-COVID related Post-Acute Care, which includes: home health care (for MVACO), skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals.

For COVID related Post-Acute Care, please refer to our COVID-19 public health emergency PA grid.

Please submit notifications in the provider portal per our usual process.

 

Quick PA Reference Guide

Service Commercial / ASO Effective Date My Care Family Effective Date Requirements
Inpatient admission Non-COVID-19 related 4/1/2021 9/1/2021 Standard prior authorization and notification requirements have resumed for all Commercial and My Care Family inpatient admissions except those related to COVID-19
Inpatient admission COVID-19 related 4/6/2020 4/6/2020

Suspend prior authorization review for acute admissions at hospitals, related to COVID-19. Notification of the admission should be submitted by the provider within 48 hours of admission and updates provided a minimum of every 5 days to support discharge planning.

Suspend concurrent review for COVID-19 related acute hospital inpatient services. Notification should be submitted by the provider within 48 hours of admission and updates provided a minimum of every 5 days to support discharge planning.

Post-Acute care Non-COVID-19 related 9/1/2021 9/1/2021 Standard prior authorization and notification requirements have resumed for non-COVID-19 related Post-Acute Care including: home health care (MVACO), skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals.
Post-Acute care COVID-19 related 3/23/2020 3/23/2020

AllWays Health Partners has removed prior authorization requirements for Post-Acute Care, which includes: home health care (MVACO), skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals. Notification from the provider of the admission to and continued stay/services at extended care facility or home health care is required. Skilled nursing and acute rehab will be reviewed for medical necessity after day 7, home health care will be reviewed for medical necessity after day 30.

 

Referral requirements continue to be suspended for all lines of business during the COVID-19 public health emergency.

For details about authorization and referral requirements during the pandemic, please refer to our COVID-19 public health 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.

Telemedicine and other technology

To help prevent the spread of the coronavirus and support our provider partners during the public health emergency, we have expanded the scope of allowed telemedicine services and provider specialties.

In addition, to ensure continued access to care, we have removed cost sharing (copayments, deductibles, or coinsurance) for medically necessary COVID-19 telemedicine visits. As of January 1, 2021, cost sharing has resumed for non-COVID-19-related telemedicine visits with PCPs, specialists, and additional providers, such as urgent and routine care, and outpatient behavioral health services.

AllWays on Teams

AllWays Health Partners offers a free telehealth platform to  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.

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 payment 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.

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.

Medications

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.

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.

AllWays Health Partners is committed to ensuring timely access to critical health care services for COVID-19 for our members. During the COVID-19 state of emergency, we will cover immunizations for members age 3+ at a retail pharmacy, in addition to a provider’s office. As always, we encourage members to consult their primary care provider or pediatrician regarding childhood immunizations.

Please note employers that are self-insured may not offer prescription drug coverage through AllWays Health Partners. Members should check the details of their coverage by contacting their employer, visiting the member portal (allwaysmember.org), or using the AllWays Member app (allwayshealthpartners.org/memberapp).

  • Several drugs have received FDA or emergency use approval (EUA) for treatment of COVID-19 and post-exposure prophylaxis (PEP) for qualifying patients.
  • The following infused medications are covered without prior authorization for outpatient treatment of COVID-19. Coverage applies to the cost of infusion as the medication is being provided by the government

 

Code

Description

Effective

M0243

Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring

11/21/2020

Q0243

Injection, casirivimab and imdevimab, 2400 mg

11/21/2020

M0245

Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

2/9/2021

Q0245

Injection, bamlanivimab and etesevimab, 2100 mg

2/9/2021

M0247

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring

5/26/2021

Q0247

Injection, sotrovimab, 500 mg

5/26/2021

M0249

Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose

6/24/2021

M0250

Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose

6/24/2021

Q0249

Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg

6/24/2021

 

Credentialing and enrollment

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.

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 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.  

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

FDA guidance for COVID-19 testing

You can also refer to our FAQ for members.