LifeWise Assurance Company Student Insurance Response to COVID-19

  • LifeWise is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak.

    Updates as of April 16, 2020

    LifeWise has created a program to offer advance payments to eligible providers to help provide financial support during this period of revenue shortfall related to reductions in services. The program allocates up to $100 million in advance payments to providers caring for our members every day with the services they most use, including typical office visits to primary care providers, specialists, dentists and behavioral health providers.

    If you have health plan questions not covered in these resources, call Student Insurance’s customer service team at the number on the back of the member ID card, or your provider network team. Every question will be answered as soon as possible. We’ll update this FAQ as additional information is available.

    LifeWise Student Insurance frequently asked questions about COVID-19 health plan coverage

    Is there a special enrollment period allowed for individual plans?

    In response to the potential growth of COVID-19 cases, the Washington Health Benefit Exchange announced a limited-time, special enrollment period for qualified individuals who aren’t insured. Enrollment runs through May 8, 2020, for coverage beginning May 1, 2020, through Washington Healthplanfinder. Individuals can enroll by calling the Customer Support Center from 7:30 a.m. to 5:30 p.m., Monday through Friday at 855-923-4633; TTY: 855-627-9604, or by contacting a local certified broker or navigator. Read the full press release.

    Advance Payment Program

    Why is LifeWise doing this?

    We want our community to be healthy. And to be healthy, we need to have a strong provider network. This focus is consistent with the LifeWise emphasis on the role of front-line providers in our healthcare system and supportive of our members’ most common needs throughout the months ahead.


    How much do you expect to advance?

    We’re funding up to $100 million in advance payments for eligible providers in Washington.


    Do providers have to repay this advance?

    Yes. We’ll begin recoupment beginning January 1, 2021 over a 9-month period.


    What if I have questions not answered in the FAQ?

    If you have questions that aren’t answered in the FAQ, you can submit additional questions to us by email.


    What are the eligibility criteria?

    • Be a contracted provider with LifeWise in Washington
    • Be a professional, behavioral health or dental provider
    • For providers that participate in Medicare, they must meet eligibility requirements and participate in the CMS Accelerated and Advance Payments Program during the COVID-19 emergency.
    • For providers that don’t participate in Medicare, they must not be in bankruptcy or have filed a petition for bankruptcy; and not knowingly under an active medical review or an investigation by LifeWise.
    • All eligible providers must have a minimum $1500 as a cash advance
    • Have billed LifeWise for claims between October 1, 2018 and September 30, 2019
    • Have signed an advance payment agreement for the recoupment of the advance payment

    Why are you limiting eligibility?

    We had to make a decision on eligibility that was simple to administer. We realize that does leave a lot of providers out of this process. We decided to limit to this group of providers.


    How do providers apply?

    We want to make this process simple for providers. An application will be available beginning Monday, April 13, at 10:00am on our LifeWise provider website.


    How do providers apply?

    We want to make this process simple for providers. An application will be available beginning Monday, April 13, at 10:00am on our LifeWise provider website.


    How quickly will a provider get their advance?

    We expect payments to begin going out within 20 days of the signed contract being returned. That allows LifeWise to verify eligibility and for the provider to sign an advance payment agreement.


    How much will providers receive?

    Eligible providers could be eligible for a 3-month advance based on an average of historical office visits, behavioral health codes and dental codes incurred between October 1, 2018 and September 30, 2019 and paid through December 31, 2019.


    Can I repay in a lump sum or through an invoice?

    Our repayment options are flexible and will include single lump sum payments, weekly voucher deductions, and invoicing. We won’t have the details on each of these options until later this year, but we can log your preference in our system and let you know the process for repayment based on your choice.


    What’s the advance payment amount based on?

    We’ll be reviewing claims billed between October 1, 2018 and September 30, 2019 and paid by December 31, 2019. Your payment advance will be based your billed charges for fully insured members.


    How will recoupment work?

    LifeWise will begin recoupment January 1, 2021. We’re working through the process for recoupment.


    Do I have to sign a contract for recoupment?

    Yes. LifeWise will require a signed advance payment agreement. If we don’t receive the agreement, the payment will not be sent.


    Are you also stopping the recoupment of overpayments?

    No. Individual member overpayments will not stop.


    COVID-19 and waivers

    Is COVID-19 testing covered?

    For commercial members: We’re waiving in-network copays and deductibles for FDA-authorized COVID-19 testing and treatment. Per new Washington state Office of the Insurance Commissioner (OIC) requirements, we’re also waiving in-network copays and deductibles for other virus/respiratory testing tied to a COVID-19 diagnosis. This applies to both the test and the related provider visit.

    Pre-authorization isn’t required for medically necessary and FDA-authorized COVID-19 testing. If a member requires testing and treatment for COVID-19 and there isn’t an in-network provider within a reasonable distance to perform those services, the claims will be paid as in-network.

    Any additional care related to a COVID-19 diagnosis is covered consistent with the member’s benefits.


    Is treatment covered? Are there any limitations for COVID-19 care?

    LifeWise is waiving member cost shares including copays, deductible, and coinsurance for treatment of COVID-19 or health complications associated with COVID-19, including hospitalizations and medical transportation when needed, FDA-approved medications administered inpatient for both in- and out-of-network providers. This waiver is in effect for dates of service from January 1, 2020 through October 1, 2020.

    This benefit applies to members of insured group, individual, grandfathered, non-grandfathered, and associations. Self-funded group plans have the option to participate. This includes qualified high deductible plan participants.

    This will not apply to Shared Admin, FEP, and Self-funded plans that opt-out. Normal plan benefits apply in this situation for our members. You can check eligibility and benefits on our website.


    Can I offer and bill for drive-through testing? Is that covered?

    Yes. Drive-through testing for COVID-19 is covered and cost shares will be waived as they are for in-clinic testing.


    Are there specific codes I should be using for COVID-19?

    The following summary of coding instruction is provided by the CDC, WHO, and CMS related to the Coronavirus/COVID-19. We urge you to use this COVID-19 coding for patients so cost shares may be waived appropriately.

    There are two new HCPCS codes for lab tests to detect COVID-19: code for U0001 for the Centers for Disease Control (CDC) test panel and code U0002 for other tests.

    The American Medical Association added a new CPT code for reporting the novel coronavirus tests: 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.

    Per the CDC, a new ICD-10 emergency code, U07.1, 2019-nCoV acute respiratory disease, has been established by the WHO for reporting the virus, effective with the next update, October 1, 2020. LifeWise is accepting this code and encourages you to use it.

    To identify patients in the interim who have tested positive for COVID-19, current CDC guidance instructs to code first for the presenting illness followed by B97.29 - Other coronavirus, as the cause of diseases classified elsewhere.

    New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply best coding practices. The scenarios include telehealth services for all patients.

    Examples specifically related to COVID-19 testing include coding for when a patient:

    • Comes to the office for an E/M office visit and is tested for COVID-19
    • Receives a telehealth visit regarding COVID-19
    • Is directed to come to a physician’s office or physician’s group practice site for testing
    • Receives a virtual check-in/online visit regarding COVID-19 (not related to an E/M visit)
    • Is directed to come to a physician's office for testing

    There is also a quick-reference flowchart that outlines Current Procedural Terminology (CPT®) reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources


    Telehealth

    Can I offer telehealth services to my patients?

    Yes. Virtual care is covered under the scope of your current contract with LifeWise, if the care provided is appropriate within the scope of the provider’s licensure. This change applies to LifeWise individual and commercial members. However, some self-funded employer groups do not cover virtual care, so you’ll need to check benefits for your patient before providing care.

    Note: Telehealth services aren’t coded like in-office visits due to different modifiers and Place of Service codes needed to identify a telehealth service. There are additional codes that can be used for online video encounters as well as telephone visits in conjunction with the office visit codes.

    For LifeWise-contracted providers, your current contract covers telehealth services if the care provided is appropriate within the scope of the provider’s licensure. Note: Telehealth services aren’t coded like in-office visits. Refer to your LifeWise contract for allowable information for virtual care codes. For specific coding information for LifeWise patients, see our telehealth payment policy for Washington.

    LifeWise wants to emphasize that this is a temporary relaxation of the rules during this nationwide public health emergency. Correct coding and notification to the patient that the provider is using non-HIPAA compliant communication tools is required.


    Are there specific telehealth codes?

    Yes. Beginning April 7, 2020, LifeWise will be following CMS guidance on telehealth payments during the COVID-19 health crisis. Providers that normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (note GT cannot be used for a Medicare claim). This will allow claims to process at reimbursement consistent with an in-office visit during the public health emergency. This change will be in effect through June 30, 2020, consistent with CMS guidance. We will be reviewing claims back to March 6, 2020, and will remit any additional funds due.

    This guidance is in effect during this public health emergency for fully insured group plans, Individual, and Medicare plans. FEP, Shared Admin, and Self-funded plans that have opted out of this process are excluded from this guidance.

    Refer to your LifeWise contract for allowable information for virtual care codes.

    LifeWise wants to emphasize that this is a temporary relaxation of the rules during this nationwide public health emergency. Correct coding and notification to the patient that the provider is using non-HIPAA compliant communication tools is required.


    What about HIPAA rules?

    Per Health & Human Services and the Office of Civil Rights (OCR), a covered physician or health care provider who wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19. Additionally, the criteria that telehealth may only be used with established patients is being relaxed and new patient encounters can be billed with these codes.


    Are you waiving cost shares for telehealth?

    Yes. Starting March 25, 2020, LifeWise is expanding the telehealth network to address the increased demand related to COVID-19. This expanded coverage is available until June 30, 2020, with the potential to extend the duration based on business and epidemiological considerations.

    Cost shares are waived for telehealth services as follows:

    Telehealth cost shares are waived for all in-network providers. If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through June 30, LifeWise will reimburse when the claim is processed.

    Who is eligible for this in-network expansion?

    This will not apply Shared Admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, Medicare Advantage, and Self-funded plans that opt-out.

    Fully insured plans will be loaded and available on March 25, 2020. Self-funded plans that opt-in will be loaded and available by end of day March 26, 2020.

    This cost share waiver applies to all providers that offer telehealth services through June 30, 2020.

    Can telehealth providers diagnose COVID-19?

    • Telehealth providers can’t diagnose COVID-19 or order any COVID-19 testing. An in-person test is required for COVID-19 diagnosis.
    • Telehealth providers can:
      • Diagnose and treat acute and chronic illnesses that do not include COVID-19 symptoms
      • Fulfill necessary prescriptions or order lab tests at local facilities

    Are there virtual services for patients that are dealing with a mental health issue?

    Yes. LifeWise offers Talkspace for all our members. This is an online, virtual behavioral health provider resource. Many local mental health providers are also offering virtual services. Patients can check with their provider first, or they can go directly to Talkspace.


    Can ABA services be provided virtually?

    Yes, ABA services can be provided virtually for dates of service on or after March 20, 2020. This is temporary and is in effect until government agencies indicate that we no longer need to practice social distancing.

    Claims for services provided virtually must be submitted with appropriate telehealth modifiers using the codes currently on the ABA fee schedule. Reimbursement for virtual care will be at the same amount as if the service were provided in-person. This change applies to our individual and commercial members.


    Can I see new patients using telehealth?

    Providers can care for new patients via a telehealth virtual encounter and bill those services using the appropriate CPT code for the services rendered, in addition to the telehealth modifier and place of service. Virtual care for an established patient should also be billed with an appropriate CPT code, many of which are found in our payment policy. Note that these services must also be billed using the appropriate telehealth modifier and place of service.


    Prior Authorizations

    Is LifeWise extending prior authorization timeframes?

    In order to better serve our members and providers, LifeWise has made some process changes in response to the COVID-19 outbreak. The below list of services and changes will be effective for services requested after February 1, 2020 and will be effective through June 1, 2020:

    • Suspending prior authorization for skilled nursing facilities
    • Processing requests within expedited prior authorization turnaround time defined by WAC as two calendar days for covered services medically necessary for discharge
    • Extending prior authorization duration from 90 to 180 days
    • Contract exclusion and experimental and investigational services are excluded from the above actions

    This change applies to the individual and commercial members of LifeWise.

    Our normal processes still apply for all other services. Continue to use our online prior authorization tool as required and FAX your supporting documents. We’re not currently experiencing any delays in processing, other than requests for additional information. We ask that you wait 5 days before checking online for your authorization.

    This is a temporary measure only effective for services requested after February 1, 2020 through June 1, 2020. We want to ensure our members are receiving the services they need. We’ll continue to evaluate and determine if we need to extend these temporary measures.

    Note: This authorization extension doesn’t apply to Medicare Advantage. We understand this is difficult and we’re working to implement a solution as quickly as possible. We’ll update you as soon as we have new information.

    We’re hopeful this will eliminate the burden on providers to resubmit a PA for elective surgeries that are postponed and to ensure that we’re authorizing necessary services and supplies as quickly as possible. As always, we’re committed to providing you and our members the quality support and services you deserve.


    Are AIM and eviCore adjusting their prior authorization timelines as well?

    Yes, from February 1, 2020 through June 1, 2020:

    • For advanced imaging and sleep studies, AIM has extended the authorization time frame for 6 months from date of approval.
    • For radiation therapy, there is no extension of authorization. AIM’s view is that for these services, timeliness is critical for the patient’s care. They’re always able to extend an authorization if a patient is unable to get into treatment.
    • For services approved through eviCore, prior authorizations have been extended from 90 days to 6 months.

    Pharmacy and Prescriptions

    Are you extending prior authorizations for prescriptions?

    Yes. For drugs with an initial length authorization of 3 months, we’re extending the authorization for 180 days for reviews performed between March 30, 2020 through June 30, 2020. We’ll also pull a list of expiring authorizations; anything that expires in the next 3 months will have the authorization extended for 180 days from March 30, 2020.


    Can patients refill prescriptions early if needed?

    Yes. We’ve adjusted our refill too soon policy for medications. This allows pharmacies to override refill too soon edits during a declared emergency at the pharmacy counter. Members also have access to mail order prescriptions.


    How is LifeWise responding to FDA warnings of potential drug shortages?

    We frequently see drug shortages in the U.S. based on manufacturer issues, raw product issues, etc. We may see new reported shortages based on the COVID-19 impact to Chinese manufacturers.

    LifeWise will respond to these shortages the same way we do today, by ensuring the following:

    • The pharmacy team will check public and industry resources to identify new shortages that may impact our members.
    • We’ll review medical policies to determine if adjustments are needed to ensure access to alternative medications (should we change our preferred drugs or update prior authorization criteria to account for shortages both short and long term).
    • Our review processes already account for drug shortages. If a drug we require as first-line therapy is in short supply, we’ll waive this requirement based on market realities and approve coverage when preferred formulary alternatives are in short supply.

    We’re also reviewing rejected claims to see if members are getting the medications they need. If we see any drug shortages, we’ll seek other options to meet member needs. We’ll continue to monitor the situation with our pharmacy partners, so members won’t run out of needed medications.