Coronavirus Information and Resources
CareSource has provided links to your state’s Department of Health, and we encourage you to monitor your state’s guidance.
CareSource’s response to COVID-19 may vary by plan and state requirements. Please check your plan’s updates page frequently for specific guidance from CareSource.
CareSource has developed resources to help you with your telehealth practice. Access the resources below for telehealth-related guidance.
|WEST VIRGINIA MARKETPLACE|
|West Virginia Department of Health & Human Resources|
Updates & Announcements
|COVID-19: Anti-Stockpiling Quantity Limits – UPDATE||05/07/2020|
|COVID-19: Prior Authorization Guidance||05/01/2020|
|COVID-19: Anti-Stockpiling Quantity Limits – This notification has been revised. See notification dated 05/07/2020.||04/24/2020|
|COVID-19: Temporary Expansion for Molecular Diagnostic Testing for Influenza Virus Infection and Streptococcus A and B||04/16/2020|
|COVID-19: CDC Health Alert on Chloroquine||04/07/2020|
|COVID-19: Temporary Telehealth Services||03/27/2020|
|Protecting Members and Reducing the Spread of COVID-19||03/25/2020|
CareSource monitors state and federal guidance on COVID-19, and we recognize that rules related to services, coverage and requirements may change quickly as the situation evolves. We will continue to update information for our provider partners.
Requirements may vary by plan. Please check your Updates & Announcements page frequently for specific plan guidance.
Access & Availability
CareSource encourages members to seek care first with their primary care provider. In the event that a member needs to see an out-of-network provider during this time, we have standards to ensure continuity of care:
- Referrals – CareSource does not require referrals; therefore, members will not experience a barrier to referral restrictions during this time.
- Credentialing process – CareSource is closely monitoring guidance from National Committee for Quality Assurance (NCQA) for any credentialing process changes.
- State licensure – Providers are required to be licensed in the state where services are performed, based upon state law.
CareSource has business continuity plans in place to protect our members from disruptions in service. We are in communication with state and local health departments to ensure we are prepared to maintain full operations across the organization. In addition, we are working with our vendor partners to ensure they have adequate business continuity plans in place. We are following all Centers for Disease Control and Prevention (CDC) guidance and protocols to prevent workplace exposures to COVID-19.
We do not anticipate any disruption in claims or prior authorization processing. We will communicate any updates to providers should processing delays occur.
For COVID-19 coding information, providers should reference the Centers for Medicare & Medicaid Services (CMS) and the State Department of Medicaid or Department of Insurance to properly code for COVID-19.
On March 9, 2020, CareSource announced that all members, regardless of their plan, are able to receive COVID-19 testing with no out-of-pocket costs. Specifically, CareSource will partner with laboratories that have successfully verified and are currently using COVID-19 diagnostic tests in accordance with the Centers for Disease Control and Prevention (CDC). Providers are advised to use their judgment to determine whether a COVID-19 test should be ordered for a patient. For the latest news and guidance on the virus testing and treatment, please visit the Centers for Disease Control and Prevention (CDC) website.
CareSource covers COVID-19 testing and treatment services. To ensure accurate reimbursement for covered services, please reference the Centers for Medicare & Medicaid Services (CMS) for guidance.
CareSource is closely monitoring medication and product supplies in conjunction with the need for expedited prior authorizations of medication, where necessary.
Additionally, CareSource is relaxing our refill-too-soon edits for members diagnosed with COVID-19, with compromised immune systems, or those that are quarantined. Pharmacists may override 79 rejects (refill-too-soon rejects) using SCC13. Please use professional judgement when overriding claims due to the COVID-19 pandemic. Overridden claims will be monitored for fraud, waste and abuse.
In light of COVID-19, CareSource implemented new or modified quantity limits on select medications to prevent unnecessary stockpiling and protect medication access for our members. The updated full quantity limit is listed in the May 7, 2020 COVID-19: Anti-Stockpiling Quantity Limits network notification.
We will also authorize a 90-day supply of maintenance medications, with the exception of controlled substances, as necessary. Providers should call the Express Scripts Help Desk for guidance.
CareSource covers prescriptions delivered or mailed to patients’ homes. CareSource waives patient signature requirements during the pandemic. Pharmacists may enter “COVID-19” in place of patients’ signatures.
In the event that a drug shortage occurs, CareSource will work with our members and network pharmacies to ensure members have access to the medications required. In the event that an in-network pharmacy is unable to provide the necessary medication(s), CareSource will work with members to obtain necessary medications, including at an out-of-network pharmacy, if necessary.
No prior authorization is required to order COVID-19 testing. CareSource aligns our prior authorization requirements with federal and state guidance. Please continue checking your state website for the most up-to-date guidance on prior authorizations.
CareSource currently covers telehealth services to ensure our members can have access to health care services, particularly in situations where reducing the risk of infection and spread of disease is of utmost importance.
Members should contact their primary care provider to see if their provider offers telehealth visits and learn how to access these services directly from their providers. For the most up-to-date information, CareSource encourages members to contact their provider directly to find what telehealth services are available to them.
CareSource partners with MyIdealDOCTOR™ to provide telehealth services for medical purposes, not behavioral health services. MyIdealDOCTOR is available for members starting at two years of age. The services allow members to see a board-certified physician anywhere, anytime using their phone, mobile app or computer.
Members can contact MyIdealDOCTOR by:
- Visiting the MyIdealDOCTOR website
- Calling 1-855-879-4332
- Downloading the app on a smartphone
For behavioral health services, we encourage members to speak with their behavioral health provider about telehealth options.
CareSource24®, CareSource’s 24/7/365 Nurse Advice line, provides members with unlimited access to talk with a caring and experienced staff of registered nurses about symptoms or health questions. CareSource patients can find the CareSource24 phone number on their member ID card.
Members can reach CareSource24 at: 1-866-206-0701 (TTY: 1-800-982-8771 or 711)
CareSource aligns our telehealth prior authorization requirements with federal and state guidance. CareSource will process telehealth claims and cover services in accordance with federal and state guidelines.
Generally, all claims will be processed in accordance with billing guidelines outlined in the Centers for Medicare & Medicaid Services’ (CMS) fact sheet, as well as with state guidance.
Other Specific Telehealth Guidance
- Out-of-pocket costs – CareSource is waiving all cost sharing for telehealth services for COVID-19-related testing, screening and treatment.
- Reimbursement – Telehealth visits are considered the same as in-person visits and are paid at the same rate as regular visits.
- Phone and text visits – Telehealth is still defined the direct delivery of health care services to a patient via synchronous, interactive, real-time electronic communication comprising both audio and video elements. All claims will be processed in accordance with billing guidelines as outlined in the Centers for Medicare & Medicaid Services’ (CMS) fact sheet, as well as with state guidance.
- Timely payment – As new guidance is released related to COVID-19, CareSource will make every effort to add/configure new codes and process claims in a timely fashion. If a denial occurs prior to configuration, we will process the claim proactively. There is no need for a provider to take any action.
- Covered channels of communication – Under the Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, 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. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers. Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products.
- Site of service – Generally, there are not limitations on the site where patients or providers can be located when telemedicine services are delivered.
- Originating site requirements – There is no obligation for a member to travel to an originating site nor to have a prior relationship in order for a telehealth visit to be covered.
- Technological requirements – Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. Providers are to exercise professional judgment in the use of telehealth examinations.
- Provider types – Any service that can appropriately be provided via telehealth technologies that is a covered service under the benefit plan will be covered. All services rendered must be within the provider’s applicable licensure and scope of practice.
- Behavioral health services – Behavioral health is not covered by MyIdealDOCTOR. CareSource covers a variety of behavioral health telemedicine services, including:
- Psychotherapy services (Individual, Group, Family)
- Counseling (Individual, Group, Family)
- Assessment and Screening for Mental Health and Substance Use Disorders
- Psychiatric consultation, including medical management services
We encourage members to contact their behavioral health provider to see if providers are offering telehealth visits and to learn how to access these services directly with their provider. If a member is unable to access services through their current provider, or does not have a current provider, they can contact a community behavioral health center (CBHC) in their area. Members can locate a behavioral health provider using CareSource’s Find a Doc tool.
- Recovery support services – CareSource has directed members to resources to stay connected to peer services, including virtual support groups that are available online:
- SAMHSA National Helpline, 12-Step Support, Alcoholics Anonymous, Narcotics Anonymous, Smart Recovery, Al-Anon, online mobile apps
- Other services covered – (mental health and substance use disorder, occupational and physical therapy, speech pathology, annual well visits, home health referrals) – These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits. All services rendered must be within the provider’s applicable licensure and scope of practice.
Behavioral health is not covered by MyIdealDOCTOR.
CareSource utilizes laboratories that have successfully verified and are currently using COVID-19 diagnostic tests in accordance with the Centers for Disease Control and Prevention (CDC). Please visit the Centers for Disease Control and Prevention (CDC) and your state health department website for guidance on testing.
In the event an immunization becomes available, CareSource will cover COVID-19 vaccinations at no cost-sharing for all covered members.