COVID-19 Coronavirus Provider FAQ

Can I temporarily consolidate my practice?

Please email networkoperations@independenthealth.com for requests for any type of temporary practice consolidation or changes.

Is there an impact to my contract if I temporarily close my office?

Please email the Credentialing Department at credentialing@independenthealth.com to discuss options.

Will Independent Health remain open for business and continue to process claims during this crisis?

Yes, Independent Health continues to be fully operational.

Are pre-authorizations going to be lifted, COVID-19 related or otherwise?

This depends on the service. Information on authorization waivers will be posted in the provider portal soon. Please return regularly to his page for ongoing updates.

Will Independent Health extend the timely filing requirements?

No, not at this time. Independent Health will comply with all published regulatory guidance as it is released.

How do I recognize a self-funded member if they are carved out of Independent Health's (guidance)?

Self-funded members are identified on the member ID card. The back of the ID card for these members will indicate "administered by Nova" near the top.

If you have questions regarding self-funded members, please contact Self-Funded Services directly using the phone number also on the back of the ID card.

Will Independent Health allow Telehealth services?

Yes, in response to the COVID-19 crisis, Independent Health will issue a temporary expansion of covered telehealth services.

The Centers for Disease Control and Prevention (CDC) and New York State are encouraging health care providers to use telehealth and telemedicine services in order to alleviate the need for office visits when appropriate, and to minimize patient-to-patient exposure of illness.

How long will Independent Health allow for telephone services to be performed?

We will reassess the need to continue or discontinue the coverage after a period of 30 days and will communicate accordingly.

Are telehealth services allowed for all lines of business, including Self-Funded?

Please refer to this Coverage Grid.

Can I perform services using the telephone?

Please refer to this Coverage Grid.

Can telemedicine be done via Skype/Facetime?

Yes, as appropriate. Please refer to this Coverage Grid.

Can clinical staff perform telephone visits (i.e., nurses)?

There are specific instructions in this Coverage Grid for RN “only” services.

Can specialists bill for telehealth services?

Yes.

Does the notice from Independent Health to PCP practices requesting them to bill telephone visits also apply to the Independent Advanced Nurse Practitioners?

Yes.

Can patients be at home for telehealth visits?

Yes.

Can new patient visits be performed via Telemedicine (audio/visual via Medent) or just established visits?

Yes, as appropriate. Please refer to this Coverage Grid.

What is the Member Liability for telehealth services?

Please refer to this Coverage Grid.

What is the guidance for new patient visits?

Due to Centers for Disease Control and Prevention, New York State and Erie County Departments of Health recommendations, Independent Health is encouraging telehealth/telemedicine when appropriate and will cover any in-network telehealth/telemedicine services, whether or not COVID-19 related.

Please view the Coverage Grid for information on new patient visits.

Please return to our provider portal regularly for ongoing updates based on information shared by regulatory and public health agencies as well as Independent Health policy, reimbursement and other changes.

Will neuro psych testing be covered under the Telehealth policy?

Yes, as appropriate. Please refer to this Coverage Grid.

Will Independent Health pay for all telehealth visits or just COVID-19 screening visits?

Telehealth visits will be reimbursed for all patient visits in addition to those related to COVID-19.

Please refer to this Coverage Grid.

Since this public health situation caused the need to keep people out of the office, should we now have a higher reimbursement for telemedicine than office visits?

Independent Health has increased reimbursement for telehealth-specific service codes. Please refer to the Telehealth Fee Schedule.

Should I count the time for a telehealth visit if it includes the nursing staff?

No, only the physician or Advanced Practice Practitioner should record time-based codes based on the amount of medical discussion time.

What modifier should be used for telephone visits?

A modifier is not required. Please refer to this Coverage Grid.

What POS should be used when telephone visits are being conducted from the office to the patient’s home?

POS 02

What are the document requirements for billing telemedicine services?

The same documentation requirements apply when services are rendered via telemedicine as they are for in-person visits, including:

  • Method of Communication
  • Start and end times (for time-based codes)
  • Patient consent (verbal or electronic), if required
  • Completed SOAP notes must be included in the documentation.
What is the Independent Health allowed reimbursement for the telehealth codes for physicians and mid-level practitioners?

Please refer to the Telehealth Fee Schedule. The same percentage applies to Advanced Practice Practitioners as any other service.

Reimbursement for Primary Value providers is included in the global payment for the applicable lines of business.

Is Independent Health going to reimburse for the E/M Telehealth codes G0425-G0427 and what would the reimbursement be?

Yes, as appropriate. Please refer to the Telehealth Fee Schedule.

What codes are billable for two-way audio-visual telemedicine services?

Any code can be billed which best describes the service rendered via telemedicine. Please refer to the Telehealth Policy for further information.

What is the difference between virtual check-ins and phone visit codes?

Telephone services are provided only via telephone. Virtual check-ins can be performed via telephone or other telecommunication means (e.g., audio, secure text, use of patient portal). Virtual service is a “store and forward” remote evaluation where the patient submits a recorded video and/or images and the provider evaluates, interprets and provides follow-up with the patient within 24 hours.

Are codes 98966-98968 (telephone assessment from a non-physician) covered?

Please refer to this Coverage Grid.

Why are codes 98966-98969 included in the Primary Value codes set but are not included in the COVID telehealth option grid?

Please refer to the Telehealth Fee Schedule.

Can I bill codes 99211-99215 with a POS 02? How is this different than 99442 (phone) or 99422 (on-line)?

Please refer to this Coverage Grid.

What are the codes for telephone, virtual check-ins and virtual service visits?
  • Telephone services codes = 99441-99443
  • Virtual check-in code = G2012
  • Virtual service code = G2010
What are the differences between codes G2012 and 99441-99443?

With the expansions of the benefit due to the regulations, some of these services may seem duplicative. Providers should select the code that best describes the service performed where the member has coverage.

Please refer to this Coverage Grid.

For nursing home visits that are seen via telemedicine, should providers bill the applicable nursing home codes or bill the regular E/M codes under POS 02?

Telemedicine via synchronous, two-way, audio-visual technology would be billed using the nursing home codes with POS 02. If only the telephone is used, the providers should bill the telephone E/M code for the appropriate length of time.

Please refer to this Coverage Grid.

For telephone services, do providers bill the behavioral health (for our social workers) and medical nutrition codes (for our diabetic educators), or should they be using the regular E/M codes, or telephone codes?

Please refer to this Coverage Grid.

For telehealth phone calls, if the patients calls in and they are triaged, does it count if the doctor calls them back?

Yes, the billing is based on the cumulative number of minutes performed for that date of service.

Will Independent Health waive the requirement for a face-to-face visit in order for a member to receive replacement DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) equipment and will a telehealth visit with the ordering provider suffice?

Yes, a telehealth visit for this purpose is now acceptable.

Can lactation counseling be delivered via telehealth?

Yes. Please refer to the posted Coverage Grid.

Will Independent Health waive sleep study requirements for CPAP supplies (e.g., when a member needs an updated sleep study and order from the physician to obtain a new mask for existing equipment)?

Yes.

Will Independent Health relax authorization requirements for DME providers?

There are no changes in authorization requirements for DME at this time.

Will Independent Health cover respiratory services for acute treatment of COVID-19?

Yes.

Will Independent Health suspend the need to have a signed patient attestation and delivery record for a DME item at this time?

Independent Health is waiving signature and proof of delivery requirements for Durable Medical Equipment when a signature cannot be obtained due to COVID-19.

Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

Will the requirements on delivery receipts be exempt from future post payment review?

No, not at this time.

Will Independent Health allow early or excess supply refills?

Obtaining early refills is acceptable, but please do not obtain supplies in excess.

Can Independent Health allow an extension of the expiration date of written orders for an additional nine months from the date orders currently expire for recurring medical supply orders and on-going DME rental claims (oxygen), specifically CPAP supplies?

No, the expiration date is still required. This requirement would be revisited if regulation or requirement changes occur.

Has Independent Health considered waiving all place of service edits that would normally result in a claim denial for Infusion, Respiratory Therapy and DME while a patient is placed in an in-patient facility related to COVID-19?

Independent Health is not making this change at this time.

Will Independent Health extend the timely filing requirements?

Independent Health will continue to follow regulatory requirements. At this time, there are no federal or state changes issued to the timing of this requirement.

Will Independent Health suspend all audits for at least 6 months to allow us to focus more effectively on emergency activities?

Audit activities are currently being reviewed, but changes have not been communicated at that time.

Will Independent Health extend the appeal deadlines beyond current requirements?

Independent Health will continue to follow regulatory requirements. At this time, there are no federal or state changes issued to the timing of this requirement.