Thank you for your tireless efforts to care for our members and the people in our communities during this global pandemic. Our employees continue to work remotely and remain highly focused on planning and readiness to ensure we provide seamless service to you, our members and customers.
Expedited claims payment
We have expedited claims payment to seven days on average.
CMS suspending sequestration payment adjustment
As part of the Coronavirus Aid, Relief and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) is suspending the 2% sequestration payment adjustment for Medicare claims for dates of service from May 1 to December 31, 2020. Therefore, we are suspending the sequestration payment adjustment for our Medicare Advantage claims with dates of service during this time period.
CMS applying a 20% increase to the MS-DRG weight for discharges of an individual diagnosed with COVID-19
As part of the CARES Act, CMS is applying a 20% increase to the Medicare Severity Diagnosis Related Group (MS-DRG) weight for discharges of an individual diagnosed with COVID-19 for discharges beginning on or after January 27, 2020. Therefore, we are applying this increase for our Medicare Advantage claims for discharges beginning on this date.
Medical record requests
If your office is unable to send requested medical records to us via fax or mail, view these steps to submit medical records (PDF) for provider appeals and clinical audits using a secure file transfer protocol (SFTP) site.
For provider appeals, you can also use the SFTP site to upload your appeal request and supporting documentation.
Temporary providers and expedited credentialing
During this health emergency, we are allowing an exception to our Locum tenens policy and expediting credentialing to help meet emerging demands for health care providers and to ensure that our members have access to care.
We are making the following exceptions to our Locum tenens policy to allow a provider to identify and authorize care for his or her patients by another provider, during this pandemic:
- The use of a locum tenens provider by a participating provider has been expanded to 180 days during this emergency.
A locum tenens can have a valid license in a different state than the one in which they are practicing in.
If your practice has been directly impacted by COVID-19, please:
- Complete the credentialing application.
- Contact Provider Relations to request expedited credentialing.
Note: This process does not apply to routine requests.
View information below regarding temporary updates to telehealth.
In Washington state, contact Washington State Department of Health communicable disease epidemiology staff at (206) 418-5500. Coordinate testing with Washington State Department of Health for individuals who meet the person under investigation criteria.
Congress just passed new legislation to provide help during this crisis. Include below is information on new and expanded resources to assist you as both a provider and a small business employer.
New grants for frontline support
A new Public Health and Social Services Emergency Fund includes an initial $100 billion for unreimbursed health care-related expenses or lost revenues that are attributable to COVID-19, as well as for personal protective equipment.
More details will be released soon by the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services (HHS).
HHS is expected to review applications and make payments on a rolling basis, and the application process likely will require a statement of need and a valid tax identification number (TIN).
Tax relief for wages and benefits
Under the new law, physician group practices, clinics and even non-profit community health centers may be able to take advantage of tax credits.
Businesses forced to suspend operations or that have seen gross receipts fall by 50% from the previous year are eligible. Many practices are seeing a loss of revenue as appointments are delayed or even canceled due to concerns around COVID-19.
View the IRS Coronavirus Tax Relief page or speak with your accountant or financial advisor for more information and to see whether your practice or center is eligible.
Businesses with fewer than 500 employees (including sole proprietors, independent contractors and anyone otherwise self-employed) can apply for “paycheck protection” loans to meet payroll and cover certain other expenses like rent and utilities.
If employers maintain their payroll, borrowers can apply for loan forgiveness (PDF). This provision is retroactive to February 15, 2020, to help bring workers who may have already been laid off back onto payrolls.
The new loans are available through private financial institutions (i.e., banks, credit unions) that participate in the U.S. Small Business Administration’s (SBA’s) lending network.
For more information, refer to the following resources:
- CDC COVID-19
- WHO COVID-19
- CDC travel notice
- Pulsara – Free, HIPAA-compliant, video-enabled platform
- Healthwise Coronavirus Resource Center – Information to share with patients
- CMS Answers to Frequently Asked Questions to Assist Medicare Providers
Palliative care resources