Anthem will update FAQs as more information becomes available. Providers should visit the Provider News homepage for the latest information from Anthem about COVID-19.

 

Anthem is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.

 

To help address care providers’ questions, Anthem has developed the following updates and frequently asked questions.

 

Contents:

Update Summary

Frequently Asked Questions:

  • Anthem’s actions
  • COVID-19 Testing
  • Virtual, telehealth and telephonic care
  • Coding, billing, and claims
  • Other

 

Update Summary

 

COVID-19 testing and visits associated with COVID-19 testing

Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed.  Tests samples may be obtained in many settings including a doctor’s office, urgent care, ER or even drive-thru testing once available.  While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help you get to a provider who can do so. The waivers apply to members who have individual, employer-sponsored, Medicare and Medicaid plans. 

 

Telehealth (video + audio):

For 90 days effective March 17, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits, including visits for mental health or substance use disorders, for our fully insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

 

Telephonic-only care

For 90 days effective March 19, 2020, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only.  Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Self-insured plan sponsors may opt out of this program.

 

Prescription Coverage

Anthem’s affiliated health plans are also providing coverage for members to have an extra 30-day supply of medication on hand. And, we are encouraging that when member plans allow that they switch from 30-day home delivery to 90-day home delivery.

 

Frequently asked questions

 

Anthem’s Actions

 

What is Anthem doing to prepare?

Anthem’s affiliated health plans are committed to help provide increased access to care, while eliminating costs and help alleviate the added stress on individuals, families and the nation’s healthcare system.

 

These actions are intended to support the protective measures taken across the country to help prevent the spread of COVID-19 and are central to the commitment of Anthem’s affiliated health plans to remove barriers for their members and support communities through this unprecedented time. 

 

Anthem’s affiliated health plans are committed to help our members gain timely access to care and services in a way that places the least burden on the healthcare system. Our actions should reduce barriers to seeing a doctor, getting tested and maintaining adherence to medications for long-term health issues.

 

How is Anthem monitoring COVID-19?

Anthem is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders.

 

Anthem has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics, and will be ready to deploy the plan if necessary.

 

Anthem’s enterprise wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and Anthem’s Virtual Command Center for Emergency Management command, control and communication.

 

In addition, Anthem has established a team of experts to monitor, assess and help facilitate timely mitigation and response where it has influence as appropriate for the evolving novel coronavirus threat.

 

In case of mass epidemic, how can you ensure that your contracted providers can still provide services?

Anthem is committed to working with and supporting its contracted providers. Our benefits already state that if members do not have appropriate access to network doctors that we will authorize coverage for out-of-network doctors as medically necessary.

 

In addition, Anthem’s telehealth provider, LiveHealth Online, is another safe and effective way for members to see a doctor to receive health guidance related to COVID-19 from their home via mobile device or a computer with a webcam. 

 

COVID-19 Testing

 

Will Anthem waive member cost shares For COVID-19 testing and visits associated with COVID-19 testing?

Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test are waived. Tests samples may be obtained in many settings including a doctor’s office, urgent care, ER or even drive-thru testing once available.  While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help you get to a provider who can do so. The waivers apply to members who have individual, employer-sponsored, Medicare and Medicaid plans. 

 

How is Anthem reimbursing participating hospitals that perform COVID-19 diagnostic testing in an emergency room or inpatient setting?

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of member cost share amounts waived by Anthem.  As we announced on March 6, Anthem will waive cost shares for members of our fully-insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test. 

 

How is Anthem reimbursing participating hospitals which are performing COVID-19 diagnostic testing in a drive thru testing setting?

Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, Anthem will recognize the codes 87635 and U0002, and will reimburse drive thru COVID-19 tests according to the lab fee schedule inclusive of member cost-share amounts waived by Anthem.  Participating hospitals without lab fee schedules will follow the same lab testing reimbursement as defined in their facility agreement with Anthem inclusive of member cost share amounts waived by Anthem.  As we announced on March 6, Anthem will waive cost shares for members of our fully insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test.

 

Does Anthem require a prior authorization on the focused test used to diagnose COVID-19?

No, prior authorization is not required for diagnostic services related to COVID-19 testing.

 

Does Anthem require use of a contracted provider for the COVID-19 lab test in order for waiver of the member’s cost share to apply?

Anthem will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers.  This is applicable for our employer-sponsored, individual, Medicare and Medicaid plan members. 

 

Virtual, telehealth and telephonic care

 

What services are appropriate to provide via telehealth?

  • Anthem covers telehealth (i.e., video + audio) services for providers who have access to those platforms/capabilities today.
  • Effective March 17, 2020, Anthem’s affiliated health plans will waive member cost share for telehealth (video + audio) visits, including visits for mental health or substance abuse disorders, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans where permissible for 90 days. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

 

Will Anthem cover telephone- only services in addition to telehealth via video + audio?

Anthem does not cover telephone-only services today (with limited state exceptions) but we are providing this coverage for 90 days effective March 19, 2020, to reflect the concerns we have heard from providers about the need to support continuity of care for Plan members during extended periods of social distancing. Anthem will cover telephone-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law. Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Self-insured plan sponsors may opt out of this program.

 

What member cost-shares will be waived by Anthem’s affiliated health plans for virtual care through internet video + audio or telephonic-only care?

Effective March 17, 2020, Anthem’s affiliated health plans will waive member cost share for telehealth (video + audio) visits, including visits for behavioral health, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans where permissible for 90 days. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

 

Effective March 19, 2020, Anthem will cover telephone-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law for 90 days. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law. Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Self-insured plan sponsors may opt out of this program.

 

Is Anthem’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telehealth?

As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability and stands ready to have doctors available to see the increase in patients, while maintaining reasonable wait times.

 

What codes would be appropriate to consider for a telehealth visit with a patient who wants to receive health guidance related to COVID-19?

Submit Telehealth with the CPT code for the service rendered, place of service (POS) 02, and append either modifier “95” or “GT”.

 

What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies?

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for physical, occupational and speech therapies for visits coded for an evaluation. Anthem would recognize physical therapy evaluation codes (97161, 97162, 97163, 97164), occupational therapy evaluation codes (97165, 97166, 97167, 97168) and speech therapy evaluation codes (92521, 92522, 92523, 92524) with modifiers 95 or GT. Treatment related codes require face-to-face and hands on interaction and therefore are not appropriate for telehealth visits. Treatment codes not appropriate for telehealth visits include: 97010-97028, 97032-97039, 97110-97150, 97530-97546, 92507, 92508.

 

What is the best way that providers can get information to Anthem’s members on Anthem’s alternative virtual care offerings?

Anthem.com and Anthem’s member facing blog (https://www.anthem.com/blog/member-news/how-to-protect/) are great resources for members with questions and are being updated regularly.

 

Anthem members have access to telehealth 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or by downloading the LiveHealth Online app from the App Store or Google Play.

 

Anthem members also can call the Anthem 24/7 NurseLine at the number listed on their Anthem ID card to speak with a registered nurse about health questions.

 

Coding, billing, and claims

 

Does Anthem have recommendations for reporting, testing and specimen collection?

The CDC updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information from the CDC:  https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html   

 

What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19?

The CDC has provided coding guidelines related to COVID-19: https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf   

 

Is Anthem waiving member cost-shares when a member needs treatment from a doctor or a hospital related to COVID-19?

No. The waiver of member cost shares is for the COVID-19 test and visits to get the COVID-19 test.  This waiver does not apply to treatment.

 

However, keep in mind telehealth visits for any covered treatment do not require member cost sharing for 90 days.  See other FAQs for details.

 

Does Anthem expect any slowdown with claim adjudication because of COVID-19? 

We are not seeing any impacts to claims payment processing at this time. 

 

Other

 

Are you aware of any limitations in coverage for treatment of an illness/virus/disease that is part of an epidemic?

Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from an epidemic.



If you have any questions, please contact the Provider Service number on the back of the member’s ID card, or your Provider Solutions contact on our Escalation Contact List.



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