Updated Message from BILPHN – Jeff Hulburt, (BILHPN – Chief Business Officer)

Dear Colleagues –

Attached is an updated repository of quick links to health plan and payer communications and policy updates regarding COVID-19. Please note that we are changing to a bi-weekly distribution going forward.

The following health plans and payers released updated information during the weeks ending August 7 and August 14, 2020:

  • Aetna
  • Anthem (BCBS NH)
  • Blue Cross Blue Shield (BCBS)
  • Harvard Pilgrim Health Care (HPHC)
  • Medicaid
  • Medicare
  • Tufts Health Plan
  • UniCare/GIC Commonwealth Indemnity Plan

As information is constantly evolving, we suggest that you review the resources made available via our COVID-19 health plan and payer repository for the latest details.

Additional resources and updates

  1. The Division of Insurance (DOI) has been holding weekly provider calls to assist with questions and concerns relating to the review of all 2020 bulletins issued by the DOI, as well as coverage, reimbursement, and administrative flexibilities during the pandemic. The focus has been on telehealth, COVID-19 testing, waivers of prior authorization and member cost sharing, and prohibiting retroactive medical necessity denials for COVID-19 inpatient admissions.

The DOI and CHIA have scheduled another provider Zoom meeting (meeting ID: 290 289 5643 and password: 501) on Thursday, August 27 from 2 – 3 p.m. to answer any questions.

  1. CMS continues to offer weekly “Office Hours” twice a month on Tuesdays from 5 – 6 p.m. to answer questions related to COVID-19. You can view the full listing of upcoming sessions. The next Office Hours session is Tuesday, August 25 from 5 – 6 p.m. (attendee dial-in: 833-614-0820 and access passcode: 8579003, or via the preferred Audio Webcast link).
  1. UniCare posted updated versions of billing and preauthorization changes on their provider COVID-19 webpage. The changes are now effective for 180 days as of March 1, 2020 (was initially 90 days).
  1. Harvard Pilgrim Health Care published a new Updates for Providers on August 1, 2020. This document now contains a link to the COVID-19 Antibody (Serological) Testing Medical Policy and details on criteria and coverage as well as information on antibody and coronavirus testing, treatment for COVID-19, telemedicine/telehealth, prior authorization policies, reimbursement, and credentialing.
  1. We recently notified you of a Blue Cross Blue Shield of Massachusetts (BCBS) News Alert that announced that effective as of July 14, BCBS will resume the following activities:
  • Retrospective provider audits for:
    o    Professional providers
    o    Inpatient and outpatient facilities
  • Prepayment reviews for forensic claims
  • Any other claim recovery activities

The Massachusetts Health and Hospital Association (MHA) has disputed these activities with the Division of Insurance (DOI) but the DOI did not agree. The MHA has requested additional clarification and reasoning from the DOI and is requesting that providers notify the MHA if audits resume and to include any issues that arise from those audits. Please note that providers should not have any medical necessity denials for COVID-19 admissions.

  1. MassHealth recently released several bulletins that impact providers and hospitals throughout the system. All MassHealth bulletins can be found on their website. Please review these bulletins for additional information.
  • Transmittal Letter TRN-38: MassHealth will reimburse transportation providers for medically necessary, non-emergency wheelchair van transportation for a person under investigation or known to have COVID-19, regardless of whether or not the person being transported has a mobility disability or is using a wheelchair.
  • Managed Care Entity Bulletin 39: Telehealth, durable medical equipment (DME), and home health policies have been updated. As explained in All Provider Bulletin 298, MassHealth is consolidating and restating, with some modifications, MassHealth’s current telehealth policy (as reflected in All Provider Bulletins 289, 291, and 294 and Managed Care Entity Bulletins 21 and 29), and extending that policy through December 31, 2020.

We will continue to provide a bi-weekly email update, and kindly ask you to share these updates and resources with others in your organization.