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A letter from our CEO
COVID-19: Taking action
Dear Valued Partner:
We share the same goal: to help people get and stay healthy. We’re your partners in health care, and we act to serve you and the millions of patients who rely on us for their health care needs.
In response to the rapidly evolving COVID-19 outbreak, CVS Health® and Aetna® are here to support you with timely answers and information. Through CVS Health and Aetna’s combined resources and your partnership, we can best support your Aetna patients’ health and well-being, ensure their access to medication and remove barriers to care.
We’re here to help you help your patients, and we recently announced these resources and enhancements, when applicable. Please note that the following specifically apply to Aetna Better Health® of Maryland’s health plan:
If you request testing related to COVID-19, there will be no cost sharing for your Aetna Better Health of Maryland patient.
Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.
We’re waiving early refill limits on 30-day prescription maintenance medications for all Aetna Better Health of Maryland members with pharmacy benefits administered through CVS Caremark®.
Aetna Better Health of Maryland members may request early refills on 30-day prescription maintenance medications and request 90-day refills of maintenance medications for all pharmacy benefits administered through CVS Caremark (retail and mail order).
Through existing care management programs, Aetna Better Health of Maryland will proactively reach out to your patients who are most at risk for COVID-19.
We continue to work closely with state regulators to coordinate additional guidance for your Aetna Better Health of Maryland patients. Please refer to the FAQs below for additional important information.
As the situation continues to evolve, I want to reaffirm that helping your patients achieve their health goals remains our top priority. Thank you for your continued partnership.
Best regards,
Angelo Edge
CEO, Aetna Better Health of Maryland
COVID-19 FAQs for network providers
General
You can access both state and federal websites to get the latest updates on COVID-19, including:
The Maryland Department of Health’s COVID-19 website
The Maryland state government website
The Centers for Disease Control and Prevention’s COVID-19 page
The Centers for Medicare & Medicaid Services’ current emergencies page
The Centers for Disease Control and Prevention (CDC) recommends that anyone with symptoms of COVID-19 who has been in close contact with a person known to have COVID-19 or who lives in or has recently traveled from an area with the ongoing spread of COVID-19 (such as a CDC-designated “Level 2” or “Level 3” advisory area) should contact their health care provider and be tested.
Yes, the Centers for Disease Control and Prevention recommends that nonurgent medical procedures and elective surgeries be delayed to prioritize urgent and emergency visits. This can help protect staff, preserve personal protective equipment and patient care supplies, and expand available hospital capacity.
We request that you make us aware of changes that will impact access and availability of care and services during the COVID-19 pandemic.
You may email Provider Relations with a link to your website that outlines your changes.
You may also contact us at 1-866-827-2710 (TTY: 711) or email your Aetna Better Health Provider Relations manager.
During the COVID-19 state of emergency, we ask that our providers and vendors continue to adhere to HIPAA, state regulations and your internal policies and procedures to maintain the confidentiality of patient information.
Through existing care management programs, Aetna will proactively reach out to members who are most at risk for COVID-19. Care managers will walk members through what they can do to protect themselves, where to get information on the virus and where to go to get tested.
Telehealth
In response to COVID-19, our enterprise partner Akorbi is now offering prescheduled video interpretation as an alternative to face-to-face appointments.
Yes, these services are covered.
Temporary telehealth expansion
Governor Hogan and Secretary Neall have permitted critical temporary expansions of Medicaid telehealth services to connect Medicaid participants with needed care during the state of emergency.
Providers who are not able to meet in person with a participant should make every effort to use the following technology, in order of priority:
- Traditional telehealth that meets all formal requirements is strongly preferred.
- These services remain unaffected by the measures in this guidance.
- If Medicaid participants are unable to access originating sites possessing fully qualified technology (ability to pan/focus camera, multiple views, etc.), this emergency policy will permit the use of notebook computers, smartphones or audio-only phones.
Please review the guidance issued by the Maryland Department of Health for more information about telehealth requirements during the state of emergency, including issuing prior authorizations and rendering covered services within the provider scope of practice:
Follow-up Guidance on Temporary Telehealth Services (PDF)
The Maryland Department of Health has released the following codes:
Telehealth service delivery type
Two-way audio-visual technology-assisted communication
CPT code
Traditional code for the covered service
Modifier
GT modifier
Place of service
11 (office)
Telehealth service delivery type
Audio-only communication
CPT codes
99211, 99212 or 99213
Modifier
UB modifier
Place of service
11 (office)
No, there is no rate difference in the Aetna Better Health of Maryland fee schedule between services provided “in person” and services offered via telehealth and/or telephonically.
Yes, FQHCs can offer services via telehealth. You can learn more about telehealth in our manual.
Telehealth service delivery type
Two-way audio-visual technology-assisted communication
CPT code
Traditional code for the covered service
Modifier
GT modifier
Place of service
11 (office)
Telehealth service delivery type
Audio-only communication
CPT codes
99211, 99212 or 99213
Modifier
UB modifier
Place of service
11 (office)
The Maryland Department of Health Medicaid Program has issued guidance to address questions regarding how hospitals should submit claims for services delivered via telehealth.
Rates and billing
Yes. The test will not require prior authorization and will be paid at 100% of Medicaid:
HCPCS code
U0001
Description
Reimbursement for using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Panel
Reimbursement
$35.92
HCPCS code
U0002
Description
Reimbursement for 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV testing using any technique multiple types, subtypes (includes all targets)
Reimbursement
$51.33
These codes will be added to our auto-pay list.
The Centers for Disease Control and Prevention (CDC) will implement the new specific ICD-10-CM code for COVID-19, U07.1, on April 1, 2020. Please visit the CDC’s website for additional information. We will implement this code upon release.
Nutritional counseling services are only covered for Medicaid participants under the age of 21 unless the participant is enrolled in the Rare and Expensive Case Management (REM) Program. During the state of emergency, nutritional counseling services that may be appropriate can be provided via telehealth.
Services delivered via telehealth using two-way audio-visual technology-assisted communication should be billed using the “-GT” modifier. None of the services listed below require prior authorization from Maryland Medicaid.
Procedure code
97802
Description
Nutrition Assessment and intervention
Maximum number of units
4
Maximum payment
$30.03
Procedure code
97803
Description
Nutrition Re-assessment and intervention
Maximum number of units
4
Maximum payment
$26.35
Procedure code
97804
Description
Group Nutrition Service
Maximum number of units
1
Maximum payment
$13.55
For these services, audio-only or telephonic services would not be reimbursable.
For guidance regarding flexibilities in delivering telehealth services during the COVID-19 state of emergency, please see the following pages:
Under coverage via Aetna Better Health of Maryland, members do not have copays.
The Maryland Department of Health issued guidance regarding the provision of nonemergency medical transportation (NEMT). To the extent that local health departments can operate NEMT programs remotely, all dialysis, radiation, chemotherapy, physical therapy, substance use disorder, counseling or other recurring transportation services will continue to be provided as scheduled. All other transports to nonurgent services will be postponed, and other normal routine visits will not be scheduled until April 6, 2020, at the earliest. If an appointment cannot be postponed or a clinician calls to request the patient be present for services, the transport request will be honored.
Aetna Better Health also offers nonemergency transportation services. Please contact us at 1-866 827-2710 (TTY: 711) for more information.
The Maryland Department of Health Medicaid Program has recently updated the billing codes for its telehealth program for certain provider types. Dentistry rendered via telehealth, also known as teledentistry, is included. The department will conduct a review of codes that may be appropriate for teledentistry after the end of the state of emergency.
Please contact Aetna Better Health’s dental provider:
- Online at the Avesis website
- By phone at 1-855-214-6777 (TTY: 711)
Aetna Better Health’s vision provider is Superior Vision. They have limited their hours of operation during the state of emergency. Please contact them for more information.
Visit the Superior Vision website.
We will send medical record requests, and providers should mail or fax the records as requested.
Quality of care concerns are investigated through medical record review only. Aetna Better Health of Maryland never sends staff on-site to investigate the quality of care concerns.
Site visits conducted for credentialing purposes or as a result of an environmental complaint are on hold at this time.
Aetna Better Health of Maryland continues to gather and review medical records for HEDIS. The requirements for HEDIS have not changed. Medical records can be faxed or mailed as usual. If a provider prefers, staff will still come and pick up records at the provider’s office, but an on-site visit is not required. All records can be faxed or mailed to Aetna Better Health of Maryland.
During the state of emergency, the Maryland Department of Health will temporarily relax certain Medicaid provider enrollment requirements. These temporary measures are efforts to reduce administrative strain and allow providers to focus on patient care. These measures end when the governor’s state of emergency ends.
Licensure requirements
1. Non-suspension of licenses about to expire
Maryland Medical Assistance Program (Maryland Medicaid) is temporarily not enforcing the COMAR 10.09.36.02 requirement to “be licensed and legally authorized to practice or deliver services in the state in which the service is provided.” The program will not suspend any Medicaid providers whose licenses are set to expire until the state of emergency ends. Maryland Medicaid has reactivated provider licenses with end of February expiration dates that had not been updated in the electronic Provider Revalidation and Enrollment Portal (ePREP). Maryland Medicaid will require an updated and active license on file for all providers after the state of emergency ends.
2. Enroll providers with expired licenses or licenses from out of state
Maryland Medicaid will not enforce the COMAR 10.09.36.02 requirement to have an active license on file to receive payment for services during the state of emergency. Maryland Medicaid will permit enrollment for an individual who has an expired Maryland license or out-of-state license, as long as there is no apparent board sanction. Maryland Medicaid requests that providers continue to submit any license updates via ePREP during the state of emergency. Maryland Medicaid will require an updated and active license on file for all providers after the state of emergency ends.
Other provider enrollment flexibilities
The Maryland Medicaid program has postponed two additional provider enrollment requirements in order to fully align with the executive order or to further expedite provider enrollment.
1.Postpone provider revalidation application requirements
Maryland Medicaid will suspend revalidation requirements per 42 CFR § 455.414, beginning March 2020 until the state of emergency ends. Maryland Medicaid will continue provider revalidations when the state of emergency ends.
2. Not requiring site visits prior to enrollment
Maryland Medicaid will not require pre-enrollment site visits for “moderate” or “high” risk providers per 42 CFR § 455.432. The Maryland Department of Health will conduct post-enrollment site visits for these providers after the state of emergency ends.
If you have any questions about this communication, please email Medicaid provider enrollment. Or call 410-767-5340 and a member of the Medicaid provider enrollment team will get back to you as soon as possible.
During the state of emergency, Aetna Better Health will work with providers to ensure the prior authorization and concurrent review will be allowed for flexibility and will be timely. This may include expediting processing of new prior authorizations requests. We will continue offering providers peer-to-peer conversations about prior authorization requests and denials.
The Medicaid DME/DMS/Oxygen Approved List of Items will be updated to double the limits for DMS items to permit a 60-day supply to be delivered in a single claim.
When DME is lost, destroyed, irreparably damaged or otherwise rendered unusable, DME providers have the flexibility to waive replacement requirements such that the face-to-face requirement, a new physician's order and new medically necessary documentation will not be not required. DME that must be replaced for these reasons and will cost $1,000 or more will continue to be subject to prior authorization by Telligen.
DME providers should use the -RA modifier when submitting claims for replacement DME. DME providers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DME was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.
Pharmacy services
Members are allowed to receive a one-time early refill of up to a 30-day supply for all medications. Aetna Better Health of Maryland will also allow members to fill up to a 90-day supply for all maintenance medications, except specialty medications. Access to the 90-day supply applies to patients who are getting medications filled at a retail pharmacy or through their mail-order pharmacy benefit. Members may continue to obtain their specialty medications through CVS Specialty® pharmacy where up to a 30-day supply will be mailed to the member’s home or provider’s office at no additional charge to the member.
Appointment availability notification
We are happy to help educate your Aetna Better Health of Maryland patients if they contact us for information.
Download appointment availability form (PDF)
Important provider notices
We want to help keep you informed about the health plan and other news that's useful to you.
Please check back periodically for important notices and updates to the Aetna Better Health of Maryland plan.