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

Frequently asked questions

Read current answers below and check back regularly for updates. 

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.

Massachusetts Contact Tracing Collaborative

FDA guidance for COVID-19 testing

Visit our coronavirus hub to see resources for My Care Family 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. To learn more about the Massachusetts vaccine distribution plan and timeline, please visit Mass.gov.

Code

Description

Effective

Comment

 

91300

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

12/11/2020

Pfizer vaccine BioNTech Covid-19

0001A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose

12/11/2020

Report for the administration of Pfizer vaccine 91300, first dose

0002A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose

12/11/2020

Report for the administration of Pfizer vaccine 91300, second dose

0003A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; third dose

8/12/2021

Report for the administration of Pfizer vaccine 91300, third dose

0004A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose

9/22/2021

Report for the administration of Pfizer vaccine 91300, booster dose

91301

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

12/18/2020

Moderna vaccine Covid-19

0011A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose

12/18/2020

Report for the administration of Moderna vaccine 91301, first dose

0012A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

12/18/2020

Report for the administration of Moderna vaccine 91301, second dose

0013A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose

8/12/2021

Report for the administration of Moderna vaccine 91301, third dose

91303

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

2/27/2021

Johnson and Johnson vaccine Covid-19

0031A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, single dose

2/27/2021

Report for the administration of Johnson and Johnson vaccine 91303.

0034A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; booster dose

10/20/2021

Report for the administration of Johnson and Johnson booster dose 91303.

91306

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use

10/20/21

Moderna Low Dose

0064A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, booster dose

10/20/2021

Admin Moderna Low Dose, Report for the administration of 91306

91307

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use

10/29/2021

Pfizer-BioNTech pediatric vaccine

0071A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose

10/29/2021

Report for the administration of Pfizer vaccine 91307 first dose

0072A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose

10/29/2021

Report for the administration of Pfizer vaccine 91307, second dose

 

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COVID-19 testing and treatment

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. Testing is also covered when a person has been identified as a close contact or has had a known or suspected exposure to COVID-19 by a provider or public health entity. Testing is not covered for employment screening - including pre-employment or return to work, public, student, and travel screenings.

Test Site Resources:

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
  • Z86.16 and Z09: Personal history of COVID-19 and encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm (billed together). Effective for dates of service 1/1/2021 and forward.

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.

AllWays Health Partners aligns with MassHealth guidelines for our My Care Family plans. The following specimen collection and lab codes have been published in MassHealth bulletins. For more detail visit the MassHealth site

mh-code-updates-010521-1

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 to CDC and FDA websites for further guidance.

Quarantine will be covered by AllWays Health Partners in accordance with MassHealth bulletins and transmittals.  Members who cannot be safely discharged due to COVID-19 exposure, risk or infection may be admitted under quarantine status even if they no longer require inpatient level of care.

Providers contracted with AllWays Health Partners who provide care to My Care Family members must refer to MassHealth bulletins and transmittals for guidance on billing for telemedicine services.

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. 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.

AllWays Health Partners is covering home- or residence-based monitoring of members with a confirmed or suspected COVID-19 diagnosis when these patients may not require emergency department or hospital care but do require continued close monitoring.

Covered services include:

  • Physician services
  • Daily multi-disciplinary team review
  • Care coordination

Providers initiate the provision of COVID-19 RPM bundled services by billing the code 99423 with modifier U9 on the first day the provider renders COVID-19 RPM bundled services. If necessary, providers may bill this code again after seven days (including the date on which the provider billed 99423-U9).

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Relaxing prior authorization and referral requirements

Quick Reference Guide for Prior Authorization (PA) Lift Requirements to address Capacity and Staffing Issues (Effective 11/17/2021)
AllWays Health Partners standard prior authorization and notification requirements will continue for out of network Inpatient, as well as outpatient services (in network and out of network) as noted in grids below.

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

COVID-19 related admissions do not require Prior Authorization.

Service

Commercial Fully Insured/GIC ASO PA lift Effective Date

Requirements

Inpatient admission (acute and scheduled surgery) at In Network Hospital
COVID-19 and Non-COVID-19 related

11/17/2021 to 02/15/2022
  • 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

COVID-19 and Non-COVID-19 related

11/17/2021 to 02/5/2022
  • 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 business as usual.

Out of Network and Outpatient Services

9/1/2021

AllWays Health Partners’ standard prior authorization and notification requirements will continue for out of network Inpatient, as well as outpatient services (in network and out of network).

 

Quick Reference Guide regarding COVID-19 Public Health Emergency Requirements (Updated 11/17/2021)

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

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 and as noted above in the requirements due to Capacity/Staffing Issue.

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. 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

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.

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Telemedicine and other technology

To help prevent the spread of the coronavirus and support our provider partners during the public health emergency, AllWays Health Partners has expanded the scope of allowed telemedicine services and provider specialties. For more information including reimbursement details, please refer to our COVID-19 public health emergency telemedicine policy.

We have also partnered with Microsoft to offer AllWays on Teams, a free virtual visit platform for network providers. Learn more and register for AllWays on Teams here.

AllWays Health Partners follows MassHealth guidelines for billing telemedicine using place of service 02. However, to be paid at the in-person rate during the state of emergency, providers must also add the appropriate modifier (GT or 95) to the E/M code. You can find details 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.

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 Teams to offer 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.

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.

Yes, MassHealth has released this information sheet to help providers educate members about the free and low-cost telephone and internet services that are available during the COVID-19 crisis. 

You can find more resources for My Care Family members on our coronavirus resource hub for patients. 

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Medications

  • Several drugs and therapies have received FDA or emergency use approval (EUA) for treatment of COVID-19 and post-exposure prophylaxis (PEP) for qualifying patients.
  • The following medications are covered without prior authorization for outpatient treatment of COVID-19. Coverage applies to the cost of administration as the medication is being provided by the government.
  • Sotrovimab and tocilizumab won't be purchased and distributed for free by the federal government. You may purchase these products through typical purchasing channels.

Code

Description

Effective

Q0240

Injection, casirivimab and imdevimab, 600 mg

7/30/2021

 

 

 

M0240

Intravenous infusion or subcutaneous injection, casirivimab and imdevimab, includes infusion or injection and post administration monitoring, subsequent repeat doses

7/30/2021

*M0241

Intravenous infusion or subcutaneous injection, casirivimab and imdevimab, includes infusion or injection, and post administration monitoring in the home or residence. This includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses

7/30/2021

Q0243

Injection, casirivimab and imdevimab, 2400 mg

11/21/2021

Q0244

Injection, casirivimab and imdevimab, 1200 mg

6/30/2021

M0243

Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring

11/21/2021

*M0244

Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

5/6/2021

Q0245

Injection, bamlanivimab and etesevimab, 2100 mg

2/9/2021

M0245

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

2/9/2021

*M0246

Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

5/6/2021

Q0247

Injection, sotrovimab, 500 mg

5/26/2021

M0247

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring

5/26/2021

*M0248

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

5/26/2021

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

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

*Only covered for My Care Family Plans. Not covered for commercial fully insured and ASO self-insured plans.

AllWays Health Partners is in alignment with MassHealth Managed Care Entity Bulletin 41, which took effect on 9/14/2020. Sublocade will continue to be available without prior authorization. Unless noted below, other changes made during the public health emergency have reverted to standard MassHealth and AllWays Health Partners policy.

Beginning on 3/13/20, AllWays Health Partners is allowing MassHealth members up to a 90-day supply of maintenance prescription medications per MassHealth regulations. This will enable pharmacists to override this requirement at the point of service.

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.

Yes, to ensure that our members have access to necessary medications, we will reimburse all pharmacies for mail order during the COVID-19 public health emergency.

Yes, to help keep members and providers safe, AllWays Health Partners has waived signature requirements for all medications during the COVID-19 public health emergency.

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.

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Enrollment and credentialing

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.

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 public health emergency telemedicine policy for details.

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

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. For additional information about the provider portal, or to validate if your account has provider enrollment access, please email prweb@allwayshealth.org.  

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.

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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.

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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).

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.

Quick links

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