Billing

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 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 16, 2020, termination date TBD. Documentation must fully disclose the nature of the services delivered and reason that the service was necessary.

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 https://providers.ccbh.com/uploads/files/Provider-Alerts/20200316-alert4-covid19.pdf

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: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

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: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

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

Providers who are contracted for telepsychiatry should continue to bill using those codes. However, any services that fall outside of the telepsychiatry service should be billed in accordance with contracted codes/modifiers and rates. We ask providers to please indicate place of service ‘02’ in the appropriate place on the claims forms.

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.)

Community Care is currently seeking clarification and will update this page with more information once confirmed.