Coronavirus Information for Providers

Family and Friends

Coronavirus Information

HealthTeam Advantage is closely monitoring COVID-19 (Coronavirus) to ensure we continue providing the best care and service to our members, provider partners, and employees. We rely on the guidance from our medical directors, our parent company, Cone Health, the Centers for Disease Control and Prevention, and the NC Department of Health and Human Services.

Updates for our PPO and HMO Products 

The following is effective March 16–June 30, 2020. At that time, we will re-evaluate and communicate with our network.

COVID-19

Testing

Service Codes:

U0001 (CDC test) allowable of $35.91

U0002 (non-CDC test) allowable of $51.31

87635 (CPT for non-CDC test – confirmed that Quest and LabCorp will be using) allowable of $51.31

Modifiers Required: NONE

Date of Service: ANY until further notice

Place of Service: ANY

Member liability: ZERO

Telehealth

Coverage

Expanded**

Service Codes:

Click here for the expanded covered codes.

Place of Service: 02 (The location where health services and health-related services are provided or received, through a telecommunication system.)

Modifiers required: NONE

Date of Service: 3/16/2020 through 6/30/2020 (may be extended)

Member liability: ZERO

Methodology: Video and audio capabilities preferred (Skype and FaceTime accepted). Telephonic accepted if video unavailable.

* Wellness visits should include all required elements with the exception of a few components unobtainable through video services.

** This is in addition to our MDLive benefit which is available to our members free of charge via https://mdlive.com/hta

Part D Network pharmacies can bypass the refill too soon edit by entering a submission clarification code (SCC) of 13 (i.e. override code). The SCC=13 is an override due to a state of emergency. By entering the code, the member is able to get the medication and the plan is able to do reporting on the number of prescriptions processed via the emergency declaration. The member will still be responsible for the applicable cost-share. In addition, many network pharmacies (i.e. Walgreens) are providing free delivery to their customers. Members will need to check with their pharmacy to see if home delivery is available.

The pharmacies were notified via a fax blast about the implementation of the override code. However, if a pharmacy processes a claim early, they will see the message below when the claim rejects:

ANDA;T2;RTS — Rx:  7581097 DT: 23-JAN-2020

DS:  90 RD: 23-MAR-2020; IF A PUBLIC HEALTH

EMERGENCY, USE THE SCC OF 13 TO OVERRIDE

THE 79 REJECT.

Claims Submission

and

Contact Information

PPO Payer ID: 88250 (T9808 members)

HMO Payer ID: 88350 (C9808 members)

Mailing address: PO BOX 94270

Lubbock, TX 79493

Phone: 844-806-8217 option 2

Email: htaclaims@healthteamadvantage.com

Provider Concierge

Contact

Information

Phone: 855-218-3334

Email: providerconcierge@healthteamadvantage.com

HealthTeam Advantage is committed to the health and safety of our beneficiaries that we serve together. As we make updates, we will communicate the information as soon as the information becomes available. As always, we appreciate the care and support you offer our members.

Our Commitment to You

HealthTeam Advantage remains committed to the health and safety of our members and providers. We recognize the strain COVID-19 has put on all aspects of the healthcare system and we’re making your claims payments faster. We are committed to releasing claim payment within seven (7) days of the processing.

Once we are through the declared public health emergency, we will return to our standard payment release schedule of 20 days. If you have any questions or concerns, please contact your dedicated Provider Concierge at 855-218-3334 or providerconcierge@healthteamadvantage.com.

Suspension of 2% Medicare Sequestration

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a bill designed to provide financial support and resources to individuals and businesses affected by COVID-19 pandemic, was signed into law on March 27, 2020. Under the Act, the 2% sequestration of Medicare payments is suspended effective May 1, 2020 through December 31, 2020.

HealthTeam Advantage will follow CMS regulations and suspend the sequestration as outlined.