Oct. 16, 2020
Fellow physicians and healthcare professionals:
The last several months have been unlike any other in our lifetime as we are navigating this pandemic together. However, I believe we will emerge on the other side in a stronger, better state. As we continue along this new normal together, I want to share two updates with you regarding reactivating standard authorization processes and new programs for your Humana patients to support the care they receive from you.
Reinstating Authorizations for COVID-19 Diagnoses
Humana is reinstating authorization requirements for COVID-19 related diagnoses for Medicare Advantage and commercial plans. Medicaid and commercial plans will continue to follow state regulations and existing state executive orders as applicable.
We are providing advanced notice so you can prepare for this change. Availity and telephonic authorization tools will continue to provide an approval upon submission of a COVID-19 related authorization request or notification through Oct. 23, 2020, and no process changes are required through that date. We will reinstate authorization requirements on COVID-19 diagnoses for Medicare Advantage and commercial plans for authorizations requested on or after Oct. 24, 2020.
This return to our standard authorization policy applies to participating/in-network and non-participating/out-of network providers. As we resume regular authorization processes, we will continue to monitor local situations and adjust policy accordingly. This includes continuing to suspend authorizations wherever a state executive order to do so exists.
Please note: Humana continues to waive out-of-pocket costs related to COVID-19 testing. Additionally, Humana will waive out-of-pocket costs related to treatment for confirmed cases of COVID-19. These cost share waivers apply to all of our Medicare Advantage, Medicaid and fully-insured commercial members. Finally, there are no prior authorization requirements related to COVID-19 testing.
In order to ensure your COVID-19 related claims are processed appropriately, please follow the CDC guidance on diagnosis coding. Please make every effort to document diagnosis information accurately to ensure that the correct member cost share waiver(s) are applied.
New Programs to Support Your Care Through the Pandemic
We continue to take actions to help support your treatment plans and to protect, inform and care for your Humana patients – especially to support them with access to care for managing their health.
- Access to at-home and drive-thru COVID-19 testing. Humana has collaborated with LabCorp® to offer at-home COVID-19 test kits and Quest Diagnostics for drive-thru COVID-19 testing at hundreds of Walmart Neighborhood Market pharmacies throughout the country. Physicians also have the ability to electronically order the Walmart drive-thru testing option for their patients through Quest Diagnostics. For more information about the Humana COVID-19 Testing Program and how to place a lab order, please visit our provider COVID-19 website at https://www.humana.com/provider/coronavirus.
- At-home preventive screening kits. We mailed nearly 1 million preventive care screening test kits to in-need Medicare Advantage and Medicaid members. These kits provide Humana members with a convenient way to complete a screening for colorectal cancer, HbA1c and kidney checks from the comfort and safety of home. You will be notified of the results for your patients who complete the screening, so you can prioritize follow-up with patients whose results are out of range. Members received the kits at no cost, nor will costs for test completions be included in claims for risk-based providers.
- Proactive care outreach to support members’ social needs. Since March, we have proactively outreached to every member in our medical plans to identify and address social needs, and we are continuing our outreach today. Our telephonic, email and text outreach has identified key gaps in medication availability, transportation to care and access to food. To support our Medicare Advantage members, we have arranged for delivery of more than a million meals. As of Sept. 1, we also expanded our Healthy Foods Card program to more than 90% of our Medicare Advantage dual special needs plan (DSNP) members under flexibility granted by CMS. For resources to share with patients, visit Humana’s provider COVID-19 “Patient Resources” webpage at https://www.humana.com/provider/coronavirus/patient-resources.
- Supporting access to care for flu shots. As you encourage patients to get their flu shots early this year, we are assisting your efforts to get patients vaccinated for the flu this season by scheduling vaccine appointments and arranging transportation per the member’s plan benefits. If you are not providing the flu shot in your clinics or have limited access to flu vaccines, you can refer patients to the Humana Pharmacy Finder at , opens new window, which will assist them with local resources.
We will continue to monitor the progression of COVID-19, and update you about resources and benefits that affect your patients and policies and processes that affect your organizations as this public health crisis evolves.
From all of us at Humana, we extend a heartfelt thank you for everything you do for our members and for the country as we confront this crisis and emerge on the other side, stronger.
If you have questions about the above procedures and actions, please refer to our provider COVID website at provider COVID-19 website or call provider relations at 1-866-427-7478.
William Shrank, M.D., MSHS
Chief Medical and Corporate Affairs Officer