Health Insurers Response
Many health insurance issuers and group health plan administrators have announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost-sharing that would otherwise apply to the tests.
States are the primary regulators of health coverage and are issuing emergency rules to authorize or require coverage for telehealth or COVID-19 care. Nevertheless, you may still need to contact the patient's insurer to determine specific benefits and coverage policies because these details may vary by state and by plan. Effective Oct. 1, many private health insurers are no longer fully covering telehealth visits not related to COVID-19, as they had earlier in the pandemic. Patients should be made aware that they may be liable for their copay, coinsurance or deductible prior to a virtual visit.
The Centers for Medicare & Medicaid Services (CMS) has authorized Medicare Advantage (MA) plans to provide additional coverage and benefits during the state of emergency. There are more than 3,000 MA plans, and even more commercial policies (since large employers establish their own self-funded benefits). However, each company provides some guidance for the insurance it sells or the health plans it administers. America's Health Insurance Plans (AHIP) has compiled a list of health plan emergency coverage and telehealth policies, including policies applying to commercial and MA plans.
On Feb. 26, 2021, CMS, the Department of Labor, and the Department of the Treasury released guidance making clear that private group health plans and issuers cannot use medical screening criteria to deny COVID-19 diagnostic test for covered individuals who are asymptomatic and have no known or suspected exposure to COVID-19. Test must be covered without cost sharing, prior authorization or other medical management requirements. For more information, visit FAQs about families first coronavirus response act and coronavirus aid, relief, and economic security act implementation.
National Committee for Quality Assurance (NCQA)
Find the NCQA changes accreditation.
For activities where challenges to timeliness may occur, NCQA is making the following changes, effective immediately:
- Extending the grace period two (2) months to allow 16 months for annual requirements such as analysis, member communications and delegation oversight.
- Removing files from the March-September time frame from credentialing, utilization management denial/appeal and complex case management file reviews. Organizations should remove these files from the universe and document the disaster management plans that were implemented from March-September for credentialing, utilization management and case management. After this time period when credentialing activities resume in accordance with NCQA requirements, the organization may extend:
- The practitioner and provider re-credentialing cycle two (2) months, to 38 months.
- Provisional credentialing status from 60 days to 180 days.
To see if a plan you work with is accredited by NCQA, you can check the report card page and search by plan name. Note that vision plans are under the "Other Health Care Organizations" button at the top of the page.
Utilization Review Accreditation Commission (URAC)
The URAC also "will continue to make adjustments to [its] processes as guidance and recommendations are posted by the Centers of Disease Control and Prevention." Find how URAC is responding to COVID-19 as well as the most current information.
- Allow organization to accept or transfer credentialing an application that is signed and dated up to 210 days (changed from 180 days).
- Allow primary or secondary source verification information collected eight (8) months prior to submission or transfer to be accepted (changed from six (6) months).
- Allow organizations that delegate credentialing to reschedule provider site visits at a later date.
- Increase the period for organizations to complete participating provider re-credentialing from 36 months by an additional 90 days.
To see if a plan you work with is accredited by URAC, you can use this directory search.
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