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Read a thank you message to MassHealth providers from Amanda Cassel Kraft, Acting Medicaid Director

CARES Act Provider Relief Fund: For Providers

September 13 is the deadline for providers to access federal funding for COVID 19 impacts. If you have already received funds, you may be eligible for more. Learn more and apply.

 

Frequently asked questions

Read current answers below and check back regularly for updates. 

COVID-19 testing and treatment

Our coverage policies for COVID-19 testing and treatment are based on public health recommendations and industry guidelines and are informed by the best data and medical evidence available.

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

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

mass-health-code-updates-1027

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 state of 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 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.

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, we are suspending referral requirements for all lines of business during the Massachusetts public health 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, 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 state of 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.

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 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.

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.

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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Home visits

AllWays Health Partners covers home visits for My Care Family members. 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.

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Medications

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

AllWays Health Partners aligns with the MassHealth directives for pharmacy coverage. We’re making medications more accessible to My Care Family members by:

  • Covering brand name and generic albuterol products due to concerns about shortages
  • Removing prior authorization requirements from the following categories as clinically appropriate:
    • Inhaled aminoglycoside agents
    • Oral and injectable antibiotics
    • Oral and injectable antifungals
    • Oral and inhaled respiratory agents
  • Implementing the SCC13 override code (emergency disaster code) to allow pharmacists to bypass prior authorizations and step therapy for the categories listed above
  • Removing the prior authorization for Sublocade

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.

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.

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. In addition, we will follow guidance from MassHealth.

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.

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

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

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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 state of 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.

AllWays Health Partners will be applying the appropriate rate increases to designated services according to MassHealth Bulletin 24. Per MassHealth requirements, this rate increase will end for dates of service after 7/31/2020 except for the rate adjustment for DRG-specific acute hospital services, which is slated to continue through the end of the Massachusetts state of emergency.

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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

Visit our coronavirus hub to see resources for My Care Family members. 

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.

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