As part of the FFCRA, PPPHCEA, CARES Act, and CRRSA, the U.S. Department of Health and Human Services (HHS), will provide claims reimbursement to health care providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis. A portion of the funding will also be used to reimburse providers for COVID-19 vaccine administration to uninsured individuals.
Health care providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 primary diagnosis on or after February 4, 2020 can request claims reimbursement through the program electronically and will be reimbursed generally at Medicare rates, subject to available funding. Providers can also request reimbursement for COVID-19 vaccine administration.
To participate, providers must attest to the following at registration:
- You have checked for health care coverage eligibility and confirmed that the patient is uninsured. You have verified that the patient does not have coverage through an individual, or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for COVID-19 vaccination, testing and/or care for that patient.
- You will accept defined program reimbursement as payment in full.
- You agree not to balance bill the patient.
Reimbursement under this program will be made for qualifying testing for COVID-19, for treatment services with a primary COVID-19 diagnosis, and for qualifying COVID-19 vaccine administration fees, as determined by HRSA (subject to adjustment as may be necessary), which include the following:
- Specimen collection, diagnostic and antibody testing.
- Testing-related visits including in the following settings: office, urgent care, emergency room or telehealth.
- Treatment: office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), rehabilitation care, home health, durable medical equipment (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment.
- Administration fees related to FDA-licensed or authorized vaccines.
Claims will be subject to Medicare timely filing requirements.
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary.
- Hospice services.
- Outpatient prescription drugs.
Steps will involve:
Enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims, and receiving payment via direct deposit.
- Enrolling as a Participating Provider
To begin, visit https://coviduninsuredclaim.linkhealth.com/get-started.html and either sign in using your One Healthcare ID, or register for and ID if you don’t have one yet. Note, you only have to setup one Login as the program administrator for each TIN. The administrator can setup the roster of all providers associated with the given TIN.
- Checking Patient Eligibility
As part of this step, if you have direct contact with the patient, you should make best efforts to confirm that the patient was uninsured at the time the services were provided. If you do not have direct patient contact, you may rely on the attestation of the ordering health care provider that the patient’s health coverage status is uninsured.
- Submitting Patient Information
Patient data can be uploaded either one at a time, or via a batch file in a CSV format. Patient will then be assigned a Temporary Member ID which must be put on their record in your Practice Management system so it appears on the Claim.
- Submitting Claims
By setting up an insurance code for “COVID19 HRSA Uninsured Testing and Treatment Fun” using Payor ID 95964 (which maps to CPID 8748 for Change Healthcare), charges can be entered for a given patient and electronically billed via 837 files to this carrier using the normal electronic billing steps.
- Receiving Payment via Direct Deposit
Practices will need to setup a login with Optum Pay Automated Clearinghouse for Direct Deposit of these funds. Begin this process here – https://myservices.optumhealthpaymentservices.com/registrationSignIn.do
Once claims are processed, you will be able to download an 835 Remittance file from Optum Pay directly, which can then be utilized by your practice management system. (Note for Benchmark System users – you may have to contact Support to have them turn on the 835 manual upload feature prior to using for the first time.)
All of this information can be found here: https://www.hrsa.gov/CovidUninsuredClaim