UniCare is closely monitoring COVID‑19 developments and what it means for our customers and our healthcare provider partners. Our clinical team is actively monitoring state and federal regulations and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.
- Check the COVID-19 Billing Spreadsheet to see how to bill appropriately for telehealth and COVID-19 diagnosis and treatment. Learn more below.
- COVID-19 Preauthorization Changes
UniCare has made the following changes to plan benefits in order to remove barriers to treatment and to help prevent the spread of the virus.
- Telehealth services will continue to be covered, but beginning July 1, 2021, standard office visit copays will apply for non-COVID related services.
- Services for the diagnosis and treatment of COVID‑19, including lab testing, provider visits, and inpatient services are covered with no member cost share (effective March 16, 2020).
- Prior authorization requirements were reinstated as of April 2, 2021 for all services except for those related to COVID-19 treatment.
These changes apply to all providers and members nationwide.
Provider Billing for Services Related to COVID-19
Information about how to appropriately bill for telehealth and COVID‑19 diagnosis and treatment is available in the COVID-19 Billing Spreadsheet.
For all telehealth services, UniCare will allow reimbursement based on the regulations set forth by the Division of Insurance (DOI).
Refer to the COVID-19 Billing Spreadsheet for information on how to bill appropriately for telehealth.
There is no member cost share for the treatment and testing of COVID-19.
Refer to the COVID-19 Billing Spreadsheet for applicable diagnostic codes and other information on how to bill appropriately for these services. If these services are billed with diagnosis codes not related to COVID‑19, standard member cost sharing will apply.
Providers should adhere to the following guidelines when billing for telehealth services or services for the diagnosis and treatment of COVID‑19:
- Use standard Current Procedural Terminology (CPT) codes such as Evaluation and Management (E&M) codes to ensure standard payment rates
- Place of service code 02 is required to indicate telehealth
- Use appropriate modifiers
- When billing with revenue code 780, a CPT code must also be included
- Use identified diagnosis codes for testing and treatment related to COVID‑19
Refer to the COVID-19 Billing Spreadsheet for specific diagnosis codes and additional details about appropriate billing for telehealth and COVID‑19 diagnosis and treatment.
- For an initial appointment with a new patient, the provider must review the patient's relevant medical history and any relevant medical records with the patient before initiating the delivery of any service.
- For existing provider-patient relationships, the provider must review the patient's medical history and any available medical records with the patient during the service.
- Prior to each patient appointment, the provider must ensure that the provider is able to deliver the services to the same standard as in-person care and in compliance with the provider's licensure regulations and requirements, programmatic regulations, and performance specifications related to the service (e.g., accessibility and communication access).
- If the provider cannot meet appropriate standard of care or other requirements for providing requested care via telehealth, then the provider must make this determination prior to the delivery of treatment, notify the patient of this, and advise the patient to instead seek appropriate in-person care.
- To the extent feasible, providers must ensure the same rights to confidentiality and security to a patient as provided in face-to-face services and must inform members of any relevant privacy considerations prior to providing services via telehealth.
- Providers must follow consent and patient information protocols consistent with those followed during in-person visits.
- Providers must inform patients of the location of the provider rendering services via telehealth (i.e., distant site), and obtain the location of the patient (i.e., originating site).
- Providers must inform the patient of how the patient can see a clinician in-person in the event of an emergency or otherwise.
In accordance with Bulletin 2021-03 issued on April 2, 2021 by the Division of Insurance, UniCare has reinstated all prior authorization procedures except when related to treatment of COVID-19.
Consistent with existing policies, the admitting provider must notify UniCare of the admission or service; however, UniCare will not perform reviews for medical necessity. The notification-only requirement enables UniCare to assist members during their care transitions. When no notification is received, UniCare will conduct a retrospective review.
The notification-only requirement applies to the initial request only. Reviews for medical necessity will still be performed upon receipt of continued service requests for these services.
Refer to Massachusetts Rehab Hospitals Contracted with UniCare for a list of contracted inpatient rehab facilities in Massachusetts.
All skilled nursing facilities in Massachusetts are reimbursed at the contracted benefit.
UniCare will reimburse providers for the COVID-19 vaccine administration per CMS guidelines and the Commonwealth of Massachusetts Division of Insurance guidelines. Providers should submit a claim and UniCare will reimburse based on the applicable COVID-19 vaccine administration codes. UniCare is not requiring authorization or referrals for members who receive COVID-19 vaccines.
