Colorado COVID-19 Telehealth & Billing Updates

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• Until June 4, 2020, Aetna will waive member cost-sharing for any in-network covered telemedicine visit – regardless of diagnosis – for their Commercial plans.

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• Through September 30, 2020, Aetna is extending all member’s cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their commercial plans.

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• Through September 30, 2020, Aetna will offer zero co-pay primary care and behavioral health telemedicine visits with network providers to all Individual and Group Medicare Advantage members

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• For Medicare Advantage plans, effective May 13, 2020, through September 30, 2020, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason.

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• Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until August 4, 2020. The member cost-share waivers for medical care for Commercial plans will end on June 4, 2020.n
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  • Self-insured programs may opt-out of cost-sharing waivers

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• Through at least June 15, 2020, Anthem’s affiliated health plans will waive member cost-share for telehealth visits, including visits for behavioral health, for insured health plans in Colorado.

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• Cost-sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers.

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• Through at least June 17, 2020, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers.n
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  • Self-insured programs may opt-out of cost-sharing waivers

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• Through July 31, 2020, Cigna will waive customer cost-sharing related to COVID-19 screening, testing, and treatment.

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• Through July 31, 2020, Cigna will waive customer cost-sharing for telehealth screenings for COVID-19.

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• Through July 31, 2020, Cigna will cover usual face-to-face E/M visits via telehealth, but standard cost-share will apply.n
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  • This is applicable for Cigna Commercial, not Cigna MA

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• Humana will extend cost-sharing waivers through the end of the year for individual and group Medicare Advantage members. This waiver applies to audio and video telehealth visits with all participating/in-network providers, including primary care, behavioral health, and other specialist providers.

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• As of May 15, 2020, Humana will resume pre-payment medical record claims review and post-payment medical record claims review. This will be a return to the normal Humana policy.

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• As of May 22, 2020, Humana will reinstate authorizations and referrals for required services for Medicare Advantage, Medicaid, and Commercial lines of business. This will be a return to the normal Humana policy.n
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  • Humana will continue to suspend all medical authorizations and referrals for COVID related diagnosis

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• Medicare (Novitas) will keep COVID-19 related telehealth changes in place for the “duration of the PHE” for services rendered on or after March 1st, 2020.

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• Information from CMS is updated regularly, and timelines will reflect the most recent updates.

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• Health First Colorado (Medicaid) will keep COVID-19 related telehealth changes in place for the duration of the PHE.

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• Services can be provided between a member and a distant site provider when a member is in their home or other location of their choice. Additionally, the distant provider may participate in the telemedicine interaction from any appropriate location.

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• Information from CMS is updated regularly, and timelines will reflect the most recent updates.

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• Through June 18, 2020, RMHP will waive cost-sharing for in-network, non-COVID-19 telehealth visits.

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• Through June 18, 2020, RMHP will reimburse appropriate claims for telehealth services delivered by telephone if delivery is provided through live, interactive audio, and visual transmission.

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• Through June 18, 2020, UnitedHealthcare will reimburse appropriate claims for telehealth for dates of service starting March 18, 2020.

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• Through June 18, 2020, UnitedHealthcare is waiving the CMS originating site for Medicare Advantage, Medicaid, and Individual and Group Market health plan members.

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• Through at least September 30, 2020, UnitedHealthcare will cover the full cost share for Medicare Advantage members for applicable services.

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