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PITTSBURGH- Following Governor Wolf’s third 90-day extension of Pennsylvania’s Proclamation of a Disaster Emergency, UPMC Health Plan today confirmed that it will continue to waive all deductibles, coinsurance and copays for in-network, inpatient COVID-19 treatment for its members enrolled in its Medicare Advantage plans, fully-insured employer group and individual ACA plans, as well as in self-insured employer group plans that opt into this coverage. This policy change is effective immediately and will stay in effect through Feb. 28, 2021 as permitted under state and federal emergency declarations.
“As we await the initial distribution of vaccines in the midst of a significant surge in COVID-19 cases, UPMC Health Plan wants our members to know that we will continue to make access to testing and care easy and affordable,” said Diane Holder, President and CEO of UPMC Health Plan. “By waiving out-of-pocket costs for inpatient COVID-19 treatment, we hope to eliminate one source of stress that our members may have in this time of uncertainty.”
Telehealth services like UPMC AnywhereCare are a convenient and easy way to get a medical evaluation from home or the office if you're experiencing common conditions like cold, sore throat, or think you are experiencing coronavirus symptoms. You can get medical attention quickly and safely at $0 copay when you use UPMC AnywhereCare.
UPMC Health Plan will also continue to waive deductibles, copayments and cost-sharing for all in-network virtual visits (telehealth) with a health care provider, including through UPMC AnywhereCare, until Feb. 28, 2021, as permitted under state and federal emergency declarations. Both before and during the current public health emergency, UPMC Health Plan has covered a wide range of telehealth services for preventive care, acute care and medical condition management-both physical and behavioral. These expanded services give particular focus to critical services and supports, like behavioral health and counseling, that allow patients to access the health care system using a mobile device, computer or telephone.
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Providers are encouraged to confirm member benefits and coverage provided by their health plan at the time of service due to the rapidly changing situation.
- Optum will review claims that may be impacted by cost-sharing waivers and reprocess them automatically. The provider will not need to request a claim adjustment or appeal.
- Due to the rapidly changing environment around patient cost-sharing waivers, providers may want to allow their claim to be fully processed before collecting any patient cost-sharing responsibility.
Optum (behavioral health and EAP) are taking action to ensure health plan members affected by COVID-19 (coronavirus) have the support and resources they need. In order to make it easier for our members to receive appropriate treatment during this challenging time, we are encouraging providers and members to observe social distancing, isolation and quarantine rules as outlined by the CDC. To support this, consistent with an applicable Notice of Enforcement Discretion from the Office for Civil Rights (OCR) at the Department of Health and Human Services (Notice), on a temporary basis, health care providers, qualified and licensed in accordance with applicable regulations, may use audio or video communications technology immediately to deliver telephonic and telehealth care to Optum Behavioral Health plan members in addition to any HIPAA-approved telehealth technology as long as this method will effectively support the behavioral health needs of the individual member. Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) has issued guidance regarding the medical emergency section to 42 CFR Part 2 to ensure that substance use disorder treatment services are uninterrupted during this public health emergency. With respect to the latter, we encourage providers covered by 42 CFR Part 2 to confirm the application of the medical emergency exception, or some other permission, and proceed with the guidance below.
Immediate care options open to all behavioral health providers during the national COVID-19 health crisis:
Telephonic care: For providers who do not have access to HIPAA-approved technology typically required to conduct a video-enabled virtual session, or video chat platforms as listed below, telephonic services can begin immediately. Providers do not need to attest through our virtual visits process to provide telephonic care. Please refer to reimbursement guidelines for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment.
Virtual visits: HIPAA-approved technology can continue to be used by providers to deliver telehealth care to members. For providers who do not have access to HIPAA-approved technology to conduct a virtual video-enabled session, providers can conduct these sessions immediatelyusing any nonpublic-facing remote communications product that is available to communicate with members as listed below in accordance with OCR’s Notice. Although providers are encouraged to use HIPAA-compliant technologies, consistent with OCR’s Notice, as outlined below and follow Optum standard telehealth processes, during the nationwide public health emergency, providers do not need to attest through the Optum virtual visits process to provide telehealth or virtual visit care. (Please note: Providers will not be listed in the virtual visit provider directory until attestation is completed, including the use of HIPAA-compliant technologies.)Please refer to reimbursement guidelines for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment.
Optum has temporarily expanded our policies around telehealth services to make it easier for UnitedHealthcare members to connect with their behavioral health provider during the COVID-19 public health emergency. Optum has waived the Centers for Medicare and Medicaid’s (CMS) originating site restriction and extended the expansion of telehealth access for UnitedHealthcare Medicare Advantage, Medicaid and commercial members in accordance with the timeframes shown below:
Commercial Membership: This policy change is effective through June 30, 2021 for in-network providers. For out-of-network providers, this policy change was applicable through July 24, 2020.
Medicare Advantage Membership: This change in policy is effective as follows:
For in-network providers and out-of-network providers through the national public health emergency period, currently in effect through July 19, 2021.
Medicaid Membership: State Medicaid guidance/mandates apply. If no mandate was issued, the expanded policy was applicable through June 17, 2020.
Upmc Telehealth Copays
Links to other Health Plan COVID-19 sites can be found here.
Is There A Copay For Telehealth
Providers are responsible to provide telehealth services in accordance with OCR's Notice
During the COVID-19 nationwide public health emergency, providers should provide telehealth services in accordance with the OCR Notice. The OCR Notice contains information regarding applications that may be used to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
In addition, providers should continue to:
Upmc Telehealth Copay Card
- Be consistent with directives from the CDC and SAMSHA, health services that are not urgent should be postponed where possible. Providers should weigh potential benefits from rendering needed care against the potential weakened validity and reliability of assessment results if choosing to conduct testing via telehealth or virtual visit care.
- Ensure the integrity of the psychometric properties of the tests or assessment procedures used
- Modifying the test environment as necessary to prevent access to cell phones, the Internet, or coaching from other persons during administration
- Minimizing any potential distractions which could affect performance
- Ensure that additional consideration is given to issues that arise with testing diverse populations that could further lower reliability and validity of scores due to changes in administration procedures and the test environment
- Ensure the quality of the technologies being used and the hardware requirements needed are considered prior to starting testing
- Consideration should be given to the availability of back-up technologies should technical problems be encountered during administration
- Use HIPAA approved telehealth technologies as well as temporarily allowed popular applications that allow for video chats to provide telehealth in accordance with the OCR Notice Notify patients that telehealth applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications
- Ensure that documentation of the following issues is made in the member record:
- Potential difference in obtained scores due to telehealth administration
- Any accommodations or modifications that were made to standard administration procedures
- Potential limitations of all assessment results or conclusions when test norms used for interpretation are not based on a telehealth administration
In order for a virtual visit provider to be listed in our virtual visit provider directory for members, a provider must complete a virtual visit attestation form (see Post-COVID-19 Emergency Period section below). Optum is processing new virtual visit attestations in the order they are received as quickly as possible and once completed, your information will be displayed in our virtual visit provider directory for members, but, during the nationwide public health emergency, virtual care can be provided to a member.
Upmc Telehealth Modifier
Optum is continually monitoring this situation and if any further modifications to our normal processes are necessary to accommodate individuals impacted by COVID-19 we will communicate immediate updates on Provider Express. For the latest information as this situation evolves, we encourage people to stay informed by visiting the CDC website.
Post-COVID-19 Emergency Period
For the past several years, virtual visits (telemental health) for certain outpatient services have been covered under certain behavioral health plans or Employee Assistance Programs (EAP) offered to members. After the COVID-19 emergency period ends, Optum will continue to allow members to receive certain covered services via the telehealth modality. If you would like to continue to provide telemental health services to our members and permanently participate in our virtual visits network, please visit the virtual visits page on Provider Express. There, you will find information about virtual visits and you can complete an attestation to participate in our virtual visits network. If you are already a virtual visits provider or have already completed an attestation, no further action is required.
If you have any questions about Optum’s standard virtual visits program, please contact our Provider Service Line at 1-877-614-0484, or contact your Provider Relations Advocate.