This page is intended to be a resource for our provider network to find answers to critical questions during the COVID-19 crisis. As we receive more information, Community Care will be updating the site, so check back frequently for the most up-to-date information.  As new questions are added, they will appear at the top of the list.

We were told that the option of telehealth only applies to dual-eligible members. Is this correct?

No, Telehealth can be used for any HealthChoices eligible recipient.

Targeted Case Management - clients will need food, medications, and basic human needs, which are not billable. Are these services billable during this pandemic?

Community Care approves limited activities provided by targeted case management such as obtaining medications, food, or other life essentials that a member is unable to access independently, effective March 6, 2020 through the end of the emergency declaration period. Documentation must fully disclose the nature of the services delivered and reason that the service was necessary and could be accommodated by no other means.

Can we bill Community Care as primary if we are unsure if the primary will pay for telehealth or if they do not allow reimbursement for telehealth?

The Third-Party Liability (TPL) rules still apply. Providers may submit a claim to Community Care as primary only if the primary payer issues an appropriate denial.

How do we bill for Telehealth?

Please refer to Provider Alert #4

Providers are to bill the codes/modifiers on their current fee schedule at the current rates. Claims should be populated with a place of service ‘02’ to reflect that the service was provided via Telehealth.

If Medicare won't cover a service via Telehealth, will Community Care?

CMS has expanded its allowance of Telehealth during this crisis:

Does the client need to have Telehealth/virtual care benefit as part of their insurance plan?

CMS has expanded its allowance of Telehealth during this crisis:

Should we be using our telepsych codes or our regular behavioral health codes?

Providers who are specifically contracted for telepsychiatry should continue to bill using those codes. Providers who are not contracted for telepsychiatry should use the existing codes on their fee schedule and bill in accordance with these contracted codes/modifiers and rates. For these claims, providers must also indicate The Place of Service ‘02’ is required to be indicated in the appropriate place on the claim for every service delivered via telehealth.

Do we need to obtain authorizations specific to Telehealth, or use the same authorizations we have been using?

The current authorizations for face-to-face services will cover all services delivered via Telehealth.

Are there limitations to Telehealth? (i.e., licensing restrictions, delivering multiple smaller units of time that are individually less than a billable unit but delivered within one day totaling billable amounts, etc.)

Please review the Provider Alert section of our website for detailed information regarding the delivery of services via telehealth. Provider Alerts: HealthChoices Providers - Community Care ( Provider Alerts specific to telehealth include PA04 (2020), PA07 (2020), and PA26 (2020).