Ongoing support for you and your patients in the fight against COVID-19

As COVID-19 cases rise in our communities, we want to remind you about temporary changes we made earlier in 2020 to support you and your patients. Most changes remain in effect. See the complete list of temporary changes.

Check our news for updates as we get closer to 2021.

Get your patients with chronic conditions the prescriptions they need

To ensure members have access to medications they need, we continue to allow early refills for chronic condition medications.Members are encouraged to get a 90-day supply and use mail-order services. Free home delivery from many pharmacies remains available. As a reminder, many of our Medicare Advantage plans include a $0 copay for a 90-day supply of Tier 1 and Tier 2 drugs, when using mail order through ESI.

We're continuing to extend pharmacy prior authorizations expiring through the end of the year by 90 days from the approval date2.

Prior authorization extensions remain in effect

We're continuing to extend authorizations for elective procedures delayed by COVID-19 for members who have continuous enrollment in their plan at the time of service. Authorizations will be extended for six months and are being processed within 14 days. Urgent inpatient admissions and post-acute care requests are processed in 24 to 48 hours. And as always, facilities have 90 days to submit a retro authorization. Get authorization information related to COVID-19.

Appropriate transitions of care

Skilled nursing care and home health is approved for members when the member’s condition requires the level of care and monitoring of skilled nursing or at-home care. Learn more about transitions of care related to COVID-19.

Remember to follow coding and billing guidelines

To help your patients have $0 cost share for COVID-19 testing and treatment:

  • Use ICD-10 code U07.1 for patients with a COVID-19 diagnosis so your patient doesn’t have cost-sharing for COVID-19 treatment.
  • Add the CR or CS modifier for visits that result in a COVID-19 test being ordered. Facilities should add condition code DR.

See all the guidelines for billing and coding.

 

1As allowed by state laws and the member’s benefits.
2Excludes prior authorizations with intentionally short durations, such as high-cost, short-term drugs.