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MississippiCAN/CHIP

MississippiCAN and CHIP COVID-19 Prior Authorizations 04/27/2020

Marketplace

Prior Authorizations Molina will extend authorizations for all elective surgeries, procedures, physical therapy, speech therapy, DME and occupational therapy that are scheduled to expire prior to Sept. 1st to be honored up to September 1, 2020. This does not include extending or adding services not included in the primary request. Authorization for new procedures not previously approved and new therapy requests must go through the normal approval process but should not expire before May 31, 2020 or after the usual 90- day approval whichever is longer. .

MississippiCAN/CHIP

MississippiCAN and CHIP Telehealth 03/16/2020

Marketplace

Effective immediately, Molina Healthcare of Mississippi is expanding telehealth services for Molina members to better protect you and our members from exposure to the COVID-19 virus.
All providers with the ability to connect with patients through video or audio care are encouraged to do so.
Molina Healthcare will waive any site restrictions for members so that providers are able to bill for telehealth services performed while the patient is in the comfort of their home.

 

Marketplace COVID-19 Teleheatlh Billing

 

At Molina Healthcare, we recognize the stress that COVID-19 has put on you and your practice. To help you focus on your work, we’ve made some adjustments to simplify billing and payments for you and our members.

When billing for telehealth for all lines of business for Molina Healthcare:

• -As you provide telehealth services to your patients who are our members, please bill as you normally would but use POS 02. The claims will process for payment at the same rate as regular, in-person visits. Cost share will apply if applicable.
• -This guidance applies to Physicians, Physician Assistants, Nurse Practitioners, Psychologists, Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Board Certified Behavioral Analysts (BCBA), and Board-Certified Behavioral Analysts-Doctoral (BCBA-D) only.
• -This also applies to Rural Health Clinics, Federally Qualified Health Centers, Indian Health Service Clinics, and Community Mental Health/Private Mental Health facilities
• -The provider types listed above should bill with the E&M Code that represents the level of work most appropriate as if the patient was seen face to face. RHCs, FQHCs, IHSCs, and Community/Private Mental Health Clinics should follow their normal billing process but simply adjust the POS to 02.
• -Documentation should follow normal guidelines established and described in the CPT-Manual.

 

Cost Share Waiver (Copays)

The Centers for Medicare and Medicaid Services approved SPA 20-0011 on June 30, 2020. SPA 20-0011 waives cost sharing for all beneficiaries, regardless of the ultimate diagnosis, for testing services and treatments for COVID-19, including vaccines, specialized equipment, and therapies effective March 1, 2020.

https://medicaid.ms.gov/cost-sharing-waived-for-covid-19-related-services/.

MississippiCAN, CHIP, and Marketplace

Molina will relax refill timing on all prescriptions until September 1, 2020. (If the outbreak continues please monitor our provider notifications for potential extension of this policy). Refill timing will be relaxed to allow refills up to 7 days early.

Molina will allow 90-day prescription volumes on medications.

COVID-19 Billing

COVID-19 Vaccine Administration Claims Submission Information

RHCs and FQHCs are approved as temporary distant site providers and will be reimbursed their PPS rate for services which meet the definition of an encounter rendered via Telehealth with both a video and audio component. Services rendered via Telehealth with only an audio component will receive the fee-for-service payment listed in DOM’s Emergency Telehealth policy.

To view the Mississippi Division of Medicaid Emergency Telehealth Policy and additional information on Medicaid policies, coding, and reimbursement related to the COVID-19 outbreak, visit the agency’s resource page at https://medicaid.ms.gov/corona-virus-updates/

FAQ

What billing codes are related to COVID-19?
Billing and Testing Guidance for Providers
What is Molina doing to help its members?
What is Molina doing to help its providers?

Helpful Links

State of Mississippi COVID19 Resource Center
Mississippi State Department of Health (MSDH) Guidance
Centers for Disease Control and Prevention Website
Mississippi Division of Medicaid COVID-19 Updates & Information