FLASH: COVID-19 Vaccines & Utilization Management Flexibilities During the Public Health Emergency
November 24, 2020COVID-19 Vaccine Distribution
Like others in the healthcare sector all across the country, Health Alliance™ is engaged in planning related to the availability of a COVID-19 vaccination. Based on what we know today, we want to clarify our understanding of billing and payment for the vaccine and its administration outlined in the Interim Final Rule with Comment Period. All information is subject to change based on state and federal regulatory guidance.
Vaccine Reimbursement:
- Initially, the United States federal government will cover the cost of the vaccine.
Vaccine Administration Fee:
- The Centers for Medicare and Medicaid Services will reimburse the vaccine administration costs for any Medicare beneficiary. These claims should be submitted to your local MAC.
- For members of Health Alliance fully-insured group or individual plans, or members of a self-funded group health plan administered by Health Alliance, providers can submit a claim for the vaccine administration directly to Health Alliance, using the appropriate, product-specific administration code.
Health Alliance will cover the cost of the vaccine administration for commercial and self-funded members (with the exception of short-term, limited-duration and grandfathered health plans) at no cost to the member.
Utilization Management COVID-19 Flexibilities
Throughout the pandemic, Health Alliance has worked hard to ensure that we support our providers and ensure our members have access to the safest and most effective care. We are happy to announce that we are reinstating some of the flexibilities related to Utilization Management during this unparalleled Public Health Emergency.
Beginning December 1, 2020, Health Alliance will offer the following through January 31, 2021:
- Waiving of inpatient acute hospital concurrent review, regardless of diagnosis.
- Extending prior authorization for elective surgeries and referrals from 90 days to 180 days.
Continue to notify Health Alliance within 24 hours of a hospital admission. We expect to be notified of all member transfers and discharges. It’s critical that our members receive their benefits of post-acute care management from our care management team.
As a reminder, additional modifications related to Utilization Management during the Public Health Emergency remain active.
As always, please contact your Provider Relations Specialist with any questions, concerns or feedback. We also invite our provider network to visit our COVID-19 webpage for up-to-date information about the illness, our response to it and questions about coverage.