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AllWays resources

Information from the CDC

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:


Frequently asked questions

Everything you need to know about caring for our commercial members during the pandemic.
Visit the My Care Family FAQ for information about MassHealth members

Table of Contents


If a topic isn't addressed here, please reference our COVID-19 payment policy or follow our standard policies and procedures as outlined in our medical policies, payment policies, authorization guidelines, provider resources, or your contract. 

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 reference our COVID-19 payment policy for more details

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.

Our COVID-19 vaccination status report can help PCPs identify which of their patients 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

  • Z11.52: Encounter for Screening for Covid-19.
  • Z20.822: Contact with and suspected exposure to Covid-19.

Diagnosis Codes for Treatment of Covid-19

  • U07.1: COVID-19
  • J12.82: Pneumonia due to coronavirus disease 2019
  • M35.89 billed with B94.8/U09.9:
    • M35.89: Other specified systemic involvement of connective tissue
    • B94.8: Sequelae of other specified infectious and parasitic diseases. (for dates of service through 9/30/2021)
    • U09.9: Post COVID-19 condition, unspecified (for dates of service from 10/1/2021 and forward)

 

If Multisystem Inflammatory Syndrome (MIS) develops as a result of a previous COVID-19 infection, assign codes M35.81 billed with B94.8/U09.9

  • M35.81: Multisystem Inflammatory Syndrome
  • B94.8: Sequelae of other specified infectious and parasitic diseases. (for dates of service through 9/30/2021)
  • U09.9: Post COVID-19 condition, unspecified (for dates of service from 10/1/2021 and forward)

 

AllWays Health Partners follows ICD-10-CM Official Guidelines for Coding and Reporting and guidance from the Massachusetts Division of Insurance.

Please reference our comprehensive COVID-19 payment policy for the specimen collection and lab codes that are covered when medically necessary and ordered by a provider. 

 

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

The tables below provide guidance for prior authorization and medical review requirements during the COVID-19 public health emergency and as a result of the Massachusetts Division of Insurance (DOI) capacity/staffing constraint bulletin. 

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

COVID-19 related admissions do not require Prior Authorization.

See updates below regarding Prior Authorization (PA) Lift Requirements to address DOI capacity/staffing constraint bulletin.

In addition, a new prior authorization on previously approved scheduled medical procedures that had been postponed, will not be required, if the procedure occurs within 120 days of February 15, 2022.

Service

Commercial Fully Insured/GIC ASO PA lift Effective Date

Is Prior Authorization (PA)/Notification Required?

Is Review Required?

Requirements

Inpatient admission (acute and scheduled surgery) at In Network Hospital

11/17/2021 to 05/16/2022

Yes

Suspended for Initial Review

Required for Concurrent Review

  • Suspend prior authorization review for In-network Inpatient Scheduled Surgeries and Inpatient Acute hospital admissions.
  • Notification of the admission should be submitted by the provider within 24 hours of admission and updates provided a minimum of every 5 days to support discharge planning.
  • Concurrent review for acute and scheduled surgery admissions at inpatient hospitals will continue to be done business as usual.

Post-Acute care at In Network Inpatient facilities

11/17/2021 to 05/16/2022

Yes

Suspended for Initial Review 

Required for Concurrent Review beginning on day 6 of admission, from 2/15/22-4/16/22 

Concurrent review will resume business as usual on 4/17/22.

  • Suspend prior authorization review for In Network Post-Acute Care, which includes: skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals.
  • Notification of the admission should be submitted by the provider within 24 hours of admission and updates provided a minimum of every 5 days to support discharge planning.
  • Concurrent review for Post-Acute Care admissions will continue to be done as follows: For a period of 60 days (effective 2/15/2022-4/16/2022), Post Acute Care concurrent or retrospective reviews will begin on day 6 following a transfer from an acute care facility or mental health hospital, except for certain instances:
    • Exception to requirement:
      • Instances of fraud
      • When the claim is the subject of legal action
      • If the claim payment was incorrect because the provider was paid, or the insured has already paid for the services identified in the claim
      • If the services identified in the claim were not delivered by the provider
    • Concurrent and retrospective review will resume, business as usual on 4/17/2022, if notification occurred.

Out of Network and Outpatient Services

9/1/2021

Yes

Yes

AllWays Health Partners’ standard prior authorization and notification requirements will continue for out of network inpatient services, and for in-network and out of network outpatient services.

 

Quick Reference Guide regarding COVID-19 Public Health Emergency Requirements

For details, please refer to our COVID-19 public health emergency PA grid.

Service

Commercial / ASO Effective Date

My Care Family Effective Date

Is Prior Authorization (PA)/Notification Required

Is Review Required

Requirements

Inpatient admission
Non-COVID-19 related

4/1/2021

9/1/2021

Yes

Yes

Standard prior authorization and notification requirements have resumed for all Commercial and My Care Family inpatient admissions except those related to COVID-19 and as noted above in the requirements due to Capacity/Staffing Issue.

Inpatient admission
COVID-19 related

4/6/2020

4/6/2020

Yes

Suspended

Suspend prior authorization review for initial and concurrent acute admissions at hospitals, related to COVID-19. Notifications 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

Yes

Yes

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. Exception: see Post-Acute care requirements as noted above in the Capacity/Staffing Issue prior auth and notification requirements.

Post-Acute care
COVID-19 related

3/23/2020

3/23/2020

Yes

Suspended

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 for HMO plans continue to be suspended for all lines of business during the COVID-19 public health emergency. Please note, AllWays continues to require prior authorization for HMO members seeking non-COVID, non-emergent care from a provider who is out-of-network for the member's plan.

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 public health 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

Please reference our COVID-19 payment policy for medications covered under the medical benefit.

For oral medications covered under the retail pharmacy benefit, please refer to the member's pharmacy benefit manager. 

As specific medications are developed to treat COVID-19, AllWays Health Partners follows 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.

AllWays Health Partners is committed to ensuring timely access to critical health care services for COVID-19 for our members. During the COVID-19 public health 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).

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 public health emergency telemedicine policy for details.

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

Administrative information & Hospital at Home

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 public health 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.  

Yes, our Acute Hospital at Home program covers hospital level care provided to acutely ill members that meet Inter Qual criteria. For complete details about this program, read our Hospital at Home FAQ.

Contact us

Mass General Brigham COVID-19 hotline for MGB clinicians and patients: 617-724-7000 

AllWays Health Partners staff is available at 855-444-4647 Monday-Friday (8:00 AM - 5:00 PM EST, closed 12:00 - 12:45 PM).

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.

You can also refer to our Coronavirus Resource Hub.

Massachusetts Contact Tracing Collaborative

FDA guidance for COVID-19 testing

You can also refer to our FAQ for members.