Coronavirus Information for Providers
GHP has taken action
- Cost-sharing for testing: We have waived cost-sharing for all COVID-19 testing at an approved laboratory location for all GHP members who meet the CDC guidelines for testing. Self-insured/TPA groups can opt-out of this program.
- GHP Family and GHP Kids cost-sharing: We have waived cost-sharing for testing and treatment services related to COVID-19 for GHP Family (Medicaid) and GHP Kids (CHIP) members, in accordance with the PA Department of Human Services.
- PROMISe ID service location requirement: GHP has suspended the PROMISe ID service location requirement on GHP Family and GHP Kids claims for dates of service March 15, 2020 and after. More information below.
- Prior authorization: Prior authorization will not be a barrier for any COVID-19 related testing or treatment. GHP will not subject COVID-19 related testing or treatment to prior authorization.
- Prescription refills: We have relaxed refill quantity and frequency restrictions to offer 90-day maintenance medication prescriptions for Commercial and Geisinger Gold (Medicare) members and allowing members to refill their prescriptions early. This applies to controlled substances but does not apply to prescriptions that contain opioids outside of certain conditions.
- Home prescription delivery: We have relaxed restrictions on home prescription delivery. We’re also encouraging eligible members to use the CareSite mail order pharmacy.
- Telehealth: We have waived cost-sharing for telehealth services through June 15, 2020. Learn more on how GHP is addressing telehealth services below.
- If you have any questions or concerns about COVID-19, visit the CDC website for current news, testing information and prevention guidelines.
- Geisinger's Coronavirus Resource Center has updated information for patients and GHP members.
- If your GHP patient has questions about their coverage, they should call the customer service phone number on the back of their member ID card.
We understand the important role telehealth services play in keeping both patients and healthcare professionals safe amid the COVID-19 outbreak. Effective immediately through June 15, 2020, GHP will cover telehealth services and member costs will be waived for telehealth visits through:
GHP’s Teladoc service offerings
We are encouraging members to get care through Teladoc in two convenient ways:
- Online: Visit Teladoc.com to download the Teladoc smartphone app. Use the app to create an account, fill out a short medical history questionnaire and schedule an online doctor visit. This is the fastest way to get in touch with a doctor. Teladoc will provide an estimate of when a doctor will contact them.
- By phone: Call 800-Teladoc to request a call from a doctor. Teladoc will provide an estimate of when a doctor will contact them.
Please note: As the coronavirus outbreak evolves, the need for telehealth care has never been greater. As a result, users may experience extended wait times. The fastest way to connect with a doctor is to use the app or web page.
Learn more about this service at GeisingerHealthPlan.com/Teladoc
In-network provider telehealth services
GHP will cover and waive member cost sharing for any in-network providers who offer telehealth and virtual care services that allow members to avoid unnecessary trips to the office. This includes telehealth services for any physical or behavioral health diagnosis, virtual screenings for COVID-19, and other routine medical needs such as cold, flu, allergy, rash, sinus infection, etc.
Our goal is to ensure members get the care they need—through telehealth or otherwise—and we will continue to work with providers to address concerns about coverage and reimbursement.
Telehealth billing advice
- Providers should bill code G2012 for a brief virtual visit.
- Other codes covered by GHP for virtual visits that are more involved and longer in duration include the following code sets:
- 99421-99423 for physicians
- G2061-G2063 for non-physician providers
We are working closely with the PA Department of Human Services (DHS) to address the needs of GHP Family (Medicaid) and GHP Kids (CHIP) members amid the COVID-19 pandemic. To give healthcare providers maximum flexibility to test for and treat COVID-19, in addition to regular patient care, we are relaxing claim edits related to the PROMISe ID service location registration requirement. This requirement ensures providers are registered for each service location at which they see GHP Family and GHP Kids members. Under normal circumstances, GHP Family and GHP Kids claims submitted by a provider without a service location that can be matched to a location registered for that provider, would be denied.
- Code the reason for encounter and add ICD10 code B97.29: Providers should continue to code the reason for the encounter using current ICD10 diagnosis codes for illnesses such as Pneumonia, Lower Respiratory Infection, etc. and then code B97.29 (Other coronavirus as the cause of diseases classified elsewhere).
- If the provider documents “suspected”, “possible” or “probable” COVID-19, providers should not use B97.29. Instead, providers should assign a code explaining the reason for the encounter such as fever, etc.
- Do not use ICD10 diagnosis code U07.1: The World Health Organization has created a new ICD10 diagnosis (U07.1) for COVID-19. This code will be reviewed in the March 2020 ICD-10 committee meeting with an anticipated effective date of October 1, 2020. Providers should not use this code until after the established effective date.
- Do not use ICD10 diagnosis code B34.2: Providers should not use diagnosis code B34.2, Coronavirus infection, unspecified. The cases have universally been respiratory in nature and the site would not be “unspecified”.
Therapeutic protocols for COVID-19 may include the use of albuterol and a combination of hydroxychloroquine and anti-viral therapy in some cases. We remind prescribers that these medications should be used judiciously. Supplies are limited and it is imperative that reserves are maintained for those patients already on these pharmaceuticals for chronic conditions or those who may benefit from its use.
NPR reports that the National Association of Boards of Pharmacy says six states, so far, have taken steps to limit inappropriate prescriptions for hydroxychloroquine and preserve supplies for patients who take the medicine as approved. Those states are Texas, Louisiana, Ohio, North Carolina, Nevada and Idaho.
Providers should also be vigilant about potential fraud, waste and abuse related to these medications. If fraud, waste or abuse is suspected, you can call GHP’s Fraud and Abuse Hotline at 800- 292-1627 (calls may be made anonymously).