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Provider Notifications

WELLCARE BY ALLWELL NOTIFICATIONS

Medicare Billing Updates

 

THE CENTERS FOR MEDICARE AND MEDICAID (CMS) RELEASE BILLING GUIDELINES FOR COVID-19 Vaccine

SilverSummit Healthplan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance (PDF) for Medicaid and Children’s Health Insurance Program (CHIP) providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

·   SilverSummit Healthplan will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Nevada’s coverage determinations for Medicaid beneficiaries

  • Member liability will be $0
  • Non-participating provider pre-auth requirements will be waived
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

CODE

CPT SHORT DESCRIPTOR

LABELER NAME

VACCINE/PROCEDURE NAME

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

Administration – First Dose

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

Administration – Second Dose

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine

Administration – First Dose

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine

Administration – Second Dose

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services SilverSummit Healthplan covers, please contact Provider Services at 1-844-366-2880.

2020

NOVEMBER    

Virtual Annual Medicaid Provider Workshop Flyer 11.20.20 (PDF)

JULY             

Deadline for Provider Relief Fund 7.27.20

Frontline healthcare providers are eligible to apply for payments from the U.S. Department of Health and Human Services' Provider Relief Fund. Providers have until August 3, 2020, to apply for funding through the Enhanced Provider Relief Fund Payment Portal.

JUNE           

CC.PP.053 - Leveling of Emergency Room Services

Thank you for your continued partnership with SilverSummit Healthplan. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of enforcement of the claims reimbursement edits within our claims adjudication system for the policy described below. SilverSummit Healthplan will be implementing these edits effective 07/17/2020. For questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at the numbers below:  For questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at the numbers below:  *Medicaid Provider Services: 1-844-366-2880 *Ambetter Provider Services: 1-866-263-8134  *Allwell Provider Services: 1-833-854-4766               

SilverSummit Healthplan Cardiology Update 6.3.20 (PDF)

SilverSummit Healthplan (SSHP) is pleased to announce we are partnering with Nevada Heart  Center and Heart Center of Nevada as our preferred cardiology provider groups effective May 15, 2020.  Please refer all members who need cardiology services to either of these groups. SSHP members who are being seen by another cardiologist group will be able to remain with their current cardiologist through November 2020.  SSHP will assist in the transition process of any members after this date.  We remain committed to providing the resources you need, while you continue to provide quality of care to the members. If you have any questions, please contact Provider Services at 1-844-366-2880.  *Nevada Heart&Vascular Center*  (702) 240-6482 or (702) CARDIAC  Scheduling Fax (702) 240-3428   *Heart Center of Nevada* 

VerifyHCP (Lexis Nexis) 6.3.20

We are proud to introduce We are proud to introduce our contracted clinicians to VerifyHCP®, a quick and easy clinician directory verification portal developed by LexisNexis® Risk Solutions. To make attestation more efficient for you and your staff, VerifyHCP enables practices to validate or update pre-populated directory information in one place across all participating health plans.  

Updated practice information allows us to provide patients with current directory information so they can select in-network providers, choose health plans, and ultimately access care. Our goal is to make this process as easy as possible for clinicians and their practices and to receive 100% response to outreach requests. Clinicians who do not respond to verification requests may face delayed claim reimbursements and removal from directories.  

Clinician and practice outreach:  Outreach to confirm and update directory information will begin 06/15/2020. Several outreach methods will be used including email, fax, and phone, with email being the primary method. Clinicians and practices will be directed to register and log in to the Verify Health Care Portal to confirm their directory information on file is accurate. The Portal is a secure, free website for clinicians and their staff to use to confirm directory information, as required by CMS and various state laws.  

Contact LexisNexis Risk Solutions Tech Support with questions about the portal.  Thank you again for our on-going partnership. 

Warmline 6.1.20

Warmline launched to support Nevada's health care workers.

Please see the release from the Department of Health and Human Services for more information.

MAY

Telehealth for your Patients 5.26.20

Thank you for your continued partnership with Silversummit Healthplan.  We know many of you recently started utilizing TeleHealth services to care for your patients. TeleHealth services offer patients an alternative method for care and are an excellent option for communicating with their healthcare provider during this time and throughout the year.  

Below, please refer to the list of qualifying HEDIS measures with CPT/HCPCS Code that can be completed by way of Telehealth.   

For questions about this or any other questions, please don’t hesitate to reach out to our Provider Services team at 1-844-366-2880.  

Medicaid Provider Services: 1-844-366-2880 

Ambetter Provider Services: 1-866-263-8134 

Allwell Provider Services: 1-833-854-4766 

 

 PRIMARY GAP CLOSURE VIA TELEHEALTH 

 CODING & BILLING:  CPT/HCPCS 

AAP

Adults Access to Preventive/Ambulatory Health Services 

18–39 Years Old: 99385, 99395

40–64 Years Old: 99386, 99396

65+ Years: 99387, 99397

AMB

Ambulatory Care 

98970-98972, 99421-99423, 98966-98968, 99441-99443, 72020, 72052, 72100, 72110, 72114, 72120, 72131-72133, 72141, 72142, 72146-72149, 72156, 72158, 72200, 72202, 72220  

ADD

Follow-Up Care for Children Prescribed ADHD Meds 

Initiation Phase 

90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853, 90875, 90876

Continuation and Management Phase 

99221-99223, 99231-99233, 99238, 99239, 99251-99255, 99291  

FUH

Follow-Up after Hospitalization for Mental Illness 

98960-98962, 99078, 99201-99205, 99211-99215,  99217-99220, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397,  99401-99404, 99411, 99412, 99510, G0155, G0176, G0177, G0409, G0463, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010-H2020, M0064, T1015, 90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853,  90870, 90875, 90876, 99221-99223, 99231-99233, 99238, 99239, 99251-99255  

FUA

Follow-Up after ED visit for Alcohol/Drug Abuse or Dependence 

98960-98962, 99078, 99201-99205, 99211-99215,  99217-99220, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397,  99401-99404, 99411, 99412, 99510, 98970-98972, 99421-99423, 98966-98968, 99441-99443,G0155, G0176, G0177, G0396, G0397, G0409-G0411, G0443, G0463, H0001, H0002, H0004, H0005, H0007, H0015, H0016, H0022, H0031, H0034-H0037, H0039, H0040, H0047, H2000, H2001, H2010-H2020, H2035, H2036, M0064, S0201, S9480, S9484, S9485, T1006, T1012, T1015, 90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853,  90870, 90875, 90876, 99221-99223,  99231-99233, 99238, 99239, 99251-99255    

FUM

Follow-Up after ED visit for Mental Illness 

98960-98962, 99078, 99201-99205, 99211-99215,  99217-99220, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397,  99401-99404, 99411, 99412, 99510, G0155, G0176, G0177, G0409, G0463, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010-H2020, M0064, T1015, 90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853,  90870, 90875, 90876, 99221-99223,  99231-99233, 99238, 99239, 99251-99255   

IET

Initiation and Engagement of Alcohol/Drug Abuse or Dependence Treatment 

98962, 99078, 99201-99205, 99211-99215, 99217-99220, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99408, 99409, 99411, 99412, 99510, 98966-98968, 99441-99443, 98970-98972, 99421-99423,H0033, J0570-J0575, J2315, S0109, Q9991, Q9992, G0155, G0176, G0177, G0396, G0397, G0409-G0411, G0443, G0463, H0001, H0002, H0004, H0005, H0007, H0015, H0016, H0022, H0031, H0034-H0037, H0039, H0040, H0047, H2000, H2001, H2010-H2020, H2035, H2036, M0064, S0201, S9480, S9484, S9485, T1006, T1012, T1015, 90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221-99223,  99231-99233, 99238, 99239, 99251-99255  

TRC

Transitions of Care (4 components- MRP one of them) 

CPT/HCPCS: 99483, 99495, 99496 

CPTII: 1111F 

Telephone Visits: 98966-98968, 99441-99443   

Resources 

Centers for Medicare & Medicaid Services: Medicare Telemedicine Health Care Provider Fact Sheet

SilverSummit Healthplan has been working in close partnership with the state, local and federal authorities to serve and protect patients during these challenging times.   

We remain committed to providing the resources you need, while you continue to provide quality of care to the members.  If you have any questions regarding Telehealth, please contact Provider Services at 1-844-366-2880. 

COVID-19 Billing Guide for the Providers 5.18.20

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).  

COVID-19 Provider Guidance 5.18.20

Coronavirus disease 2019 (COVID-19) is an emerging illness.  Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.  New information, obtained daily, will further inform the risk assessment, treatment options and next steps.  We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance:

  • Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches.  Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.  
  • However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
  • Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
  • Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
  • Monitor and manage ill and exposed healthcare personnel.
  • Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

Take Action:

1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.

2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.

3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.

4. Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

5. Be familiar with the intended scope of available testing and recommendations from the FDA.    

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

New Telehealth Policies Expand Coverage for Healthcare Services 5.18.20

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.  These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through July 25, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services. 

Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state. For further billing and coding guidance for telehealth services, we recommend following what is being published by:

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

APRIL

Web Portal Enhancement 4.23.20

The Online Tools You Need Just Got Even Better!

We’ve improved our secure provider portal to make doing business with us easier. New visual trackers and other enhancements will
allow you to be more efficient, saving you time and hassle.

Manage claims more efficiently with easier online claims and tracking.

• Visually track your claims. See which have been approved or denied with the new color-coded tracker.

• Easily view Denial Codes. Denial Code descriptions are now on the Claims Details page—you no longer need to open each claim line.

The reconsideration process is now all online for ease of use:

• Make your case. Submit reconsideration comments using expanded text fields.

• Add context. Easily attach documentation when you file a reconsideration.

• Stay current. Opt in/out for reconsideration status change emails.

Quickly check member eligibility online with the new overview page.

• Now you can see all important member data on one page.

Prior Authorization pop-up window makes the process more efficient.

• This helpful reminder prompts you to attach supporting documents to avoid delays.

Log in today to see the difference!

In addition to these new features, your portal is the place to:

  • Confirm member benefits
  • Review payment status
  • Check cost shares
  • Request prior authorization

For more information or training, please contact your Provider Representative. They will be happy to help.

Payment Policy Notification 4.20.20

Thank you for your continued partnership with Silversummit Healthplan. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new policies Silversummit Healthplan will be implementing effective 6/1/2020.

For more detailed information about these policies, please refer to our website at https://www.silversummithealthplan.com/providers/resources/COPY_clinical-payment-policies.html. For questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 1 -844-366-2880.

Number

Policy Name

Policy Description

Line of Business (LOB)

CC.PP.066

Leveling of Care: Evaluation and Management Overcoding

The purpose of this policy is to ensure that the level of E&M service reported by the provider reflects the services performed. When a provider submits an E&M service that exceeds the maximum level of E&M service based on the diagnosis and other claim documentation elements, the E&M code is reduced to reflect the maximum level of E&M service

Medicaid, Marketplace, Medicare

COVID-19 Screening and Treatment Guidance 4.7.20

Thank you for your ongoing partnership with SilverSummit Healthplan during this time of great need. As we continue to learn more about the novel coronavirus and its resulting illness COVID-19, we want to update you on the latest information related to delivering high quality healthcare to our members.

We are working to quickly address and support screening, testing and treatment for COVID-19, and are closely following guidance from the Centers for Medicare and Medicaid Services (CMS). As of April 1, 2020, the following guidance can be used to bill for services related to the screening and treatment of COVID-19.

COVID-19 Screening Services:

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.
  • If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:
    • Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
    • Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation
  • This applies to services that occurred as of February 4, 2020.
  • Providers billing with these codes will not be limited by provider type.

COVID-19 Treatment Services:

· Ambetter for SilverSummit Healthplan will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.

· For dates of service from February 4, 2020 through March 31, 2020 providers should use the ICD-10 diagnosis code:

    o B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere

· For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:

    o U07.1 - 2019-nCov Confirmed by Lab Testing

As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers. For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply.

Again, we thank you for your unwavering commitment to the care and well-being of our members, as well as to the communities we share. Please don’t hesitate to reach out to Provider Services at 1-866-263-8134 with any questions you may have.

COVID-19 Extended Coverage 4.1.20

As we continue to learn more and address the novel coronavirus and its resulting illness COVID-19, we want to update you on important coverage information around its testing, treatment and care. 

SilverSummit Healthplan has been working in close partnership with state, local and federal authorities to serve and protect patients during the COVID-19 outbreak, including ensuring that its members and providers have the most up-to-date information to protect themselves and their families from the virus. We remain committed to protecting our communities during the outbreak. 

To ensure you are keeping your environment safe from the coronavirus, please refer to the CDC guidelines here. 

MARCH

SSHP Network COVID-19 Normal Operations 3.27.20

As you are now aware, Gov. Steve Sisolak has mandated a shutdown of non-essential businesses throughout the state of Nevada due to the COVID-19 situation. 

During this time SilverSummit, Ambetter, and Allwell business practices will continue with no interruption to the members or providers. Our Member and Provider Services teams will remain staffed and maintain their normal business hours and can be reached as follows: 

Medicaid: 1-844-366-2880 

Medicaid Provider Services: 8:00 – 5:00, Monday-Friday 

Ambetter: 1-866-263-8134 

Ambetter Provider Services: 8:00 – 5:00, Monday-Friday 

Ambetter Member Services: 8:00 – 8:00, Monday-Friday 

Allwell: 1-833-854-4766 

Allwell Provider Services: 8:00 – 5:00, Monday-Friday 

Allwell Member Services: From October 1 – March 31, 7 days a week from 8 a.m. to 8 p.m. From April 1 – September 30, Monday – Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays.

Although field visits have been suspended, your Provider Relations Specialists continue to be available via telephone and email to perform virtual visits, provide orientations and training, and assist with any complex claims issues you may have. The Provider Relations team can also be reached through the general email inbox at NVSS_ProviderRelations@SilverSummitHealthPlan.com.  

SilverSummit Healthplan will continue working in close partnership with state, local and federal authorities to serve and protect patients during the COVID-19 outbreak, including ensuring that its members and providers have the most up-to-date information to protect themselves and their families from the virus. We remain committed to protecting our communities during the outbreak. 

To ensure you are keeping your environment safe from the coronavirus, please refer to the CDC guidelines here

High Risk Pregnancy Referral Form 3.27.20

SilverSummit Healthplan Medicaid Members who are identified as High Risk must be referred to High Risk Pregnancy for an evaluation and ultrasound. Additionally, all high level ultrasounds which includes any ultrasound other than for primary or initial diagnosis of growth, fluid or fetal presentation should be referred to High Risk Pregnancy Center.  High Risk Pregnancy Center has 3 locations in Clark County and one location in Washoe County.  Members may outreach directly to High Risk Pregnancy for an appointment.  No referral is required. 

High Risk Pregnancy Center: https://hrpregnancy.com/ 

To schedule an appointment, call High Risk Pregnancy at 877-272-4617 

  • 2011 Pinto Lane Suite 200, Las Vegas, NV 89106 (Off Charleston & I-15) Fax: (702) 382-3575
  • 9090 W. Post Road Suite 100, Las Vegas, NV 89148 (Near the campus of Southern Hills Hospital) Fax: (702) 946-5411 
  • 2845 Siena Heights Drive Suite 350, Henderson, NV 89052 (Near the campus of St. Rose Siena Hospital) Fax: (702) 932-2299 
  • 9780 S. McCarran Blvd Suite 1, Reno, NV 89523 Call: 877.272.4617 Fax: (775) 404-0000 

As a reminder, please ensure all SSHP Members complete the Notification of Pregnancy.  Members can receive rewards through My Health Pays Rewards program. 

Notification of Pregnancy Rewards Program 

  • $50 for Notification of Pregnancy (1 per pregnancy) if completed within the first trimester
  • $25 for Notification of Pregnancy (1 per pregnancy) if completed within the second trimester
  • $20 First prenatal visit (1 per pregnancy)
  • $20 Post-Partum doctor visit (must be completed 4-6 weeks after delivery)
  • $10 For 6 infant well care visits up to 15 months old. (These visits are recommended at 3-5 days old, before 30 days old, and at 2, 4, 6, 9, 12 and 15 months old)

Smart Start for Your Baby Rewards Program (to be eligible for this reward, you must notify us if you are pregnant, or prior to having your baby by calling us or submitting a complete Notification of Pregnancy form. 

  • $20 – Start Smart For Your Baby program enrollment (1 per pregnancy)
  • $10 – Start Smart For Your Baby program Prenatal (3 claims per reward – max 3 rewards per pregnancy - Max $30

Telehealth Billing Guidelines 3.26.20

Please review the Telehealth Billing Instructions for information on how to bill the originating site and/or distant site when billing for telehealth services. The instructions are located on the Providers Billing Information webpage at https://www.medicaid.nv.gov.  

  • The originating site is where the recipient is receiving services. If the originating site is enrolled as a Nevada Medicaid provider, they may bill HCPCS code Q3014. If the telecommunication system used is a recipient's smart phone or home computer, the facility fee may not be billed.
  • The distant site, where the provider is delivering services, will use the appropriate Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with Place of Service code 02.
  • The GT modifier is not required as long as the place of service is correct, unless you are billing as a Critical Access Hospital (PT 75).

Please review Telehealth policy for information on covered and non-covered services in Medicaid Services Manual (MSM) Chapter 3400 Telehealth Services on the http://dhcfp.nv.gov/ website.  

During the Novel Coronavirus (COVID-19) crisis, the Centers for Medicare & Medicaid Services (CMS) has authorized the use of non-HIPAA-compliant (Health Insurance Portability and Accountability Act) tele-communications systems, such as Skype, FaceTime and audio only telephone communications. Providers are encouraged to continue to use HIPAA-compliant platforms whenever possible.  There is no difference in the billing guidelines for these communications systems.  

Providers are encouraged to monitor the Division of Health Care Financing and Policy’s COVID-19 webpage (http://dhcfp.nv.gov/covid19/) for additional resources and information regarding telehealth coverage during this crisis.  For additional questions, please send an email to dhcfp@dhcfp.nv.gov.  

COVID-19 Update for Providers  3.26.20

As we continue to learn more and address the novel coronavirus and its resulting illness COVID-19, we want to update you on important coverage information around its testing, treatment and care.

Silver Summit Health Plan will be extending coverage for COVID-19. This important step is being taken in partnership with other major insurers and with the support of the White House Coronavirus Task Force.

We intend to cover COVID-19 testing and screening services for Silver Summit Medicaid, Allwell Medicare and Ambetter Marketplace members and are waiving all associated member cost share amounts for COVID-19 testing and screening. To ensure that our members receive the care they need as quickly as possible, Silver Summit Health Plan will not require prior authorization, prior certification, prior notification or step therapy protocols for these services.

This coverage extension follows the Centers for Medicare & Medicaid Services’ (CMS) guidance that coronavirus tests will be fully covered without cost-sharing for Medicare and Medicaid plans, a decision that Silver Summit Health Plan fully supports for our members covered under these programs. We also support the administration’s guidance to provide more flexibility to Medicare Advantage and Part D plans. The specific guidance includes:

· Waiving cost-sharing for COVID-19 tests regardless of the test result
· Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
· Removing prior authorizations requirements for COVID 19 prevention, screening and treatment
· Waiving prescription refill limits
· Relaxing restrictions on home or mail delivery of prescription drugs
· Expanding access to certain telehealth services

Silver Summit Health Plan has been working in close partnership with state, local and federal authorities to serve and protect patients during the COVID-19 outbreak, including ensuring that its members and providers have the most up-to-date information to protect themselves and their families from the virus. We remain committed to protecting our communities during the outbreak.
To ensure you are keeping your environment safe from the coronavirus, please refer to the CDC guidelines here.

If you have any questions regarding this matter, please contact Provider Services at 1-844-366-2880.

COVID-19 HIE Press Release 3.18.20

The HIE released the following press release. To access the HID please visit their website to create an account and receive training.
https://healthienevada.org/covid-19-access-to-medical-records/

Press Release from HIE:

To save lives and reduce the spread of COVID-19, HealtHIE Nevada is offering free access to our HealtHIE Chart provider portal which contains comprehensive medical records on nearly every Nevadan. The HIE collects medical records from acute care hospitals, emergency departments, urgent care sites, skilled nursing facilities, doctor offices, laboratories, imaging centers, and other healthcare organizations across the state. HealtHIE Nevada’s connections to the State Public Health Lab, Southern Nevada Health District, Washoe County Health District, private labs, and the majority of diagnostic services provides COVID-19 and other test results.

In the case of COVID-19, the number of seriously ill patients the healthcare system can handle at the same time is determined by the efficiency of the healthcare system. Healthcare providers need rapid, reliable access to patient information. Failure to quickly find relevant patient information can lead to dangerous delays, costly rework, errors, and wasteful inefficiencies that a COVID-19 stressed healthcare system can ill afford. 

Universal Health Systems In-Network Announcement 3.18.20

SilverSummit Healthplan is pleased to announce the Universal Health Systems will be a participating provider for SilverSummit Medicaid members effective 4/1/2020.   

The following facilities are now in-network for all members in our Ambetter, Allwell and SilverSummit Healthplan Medicaid products:

· Centennial Hills Hospital Medical Center
· Desert Springs Hospital Medical Center
· Henderson Hospital
· Spring Valley Hospital Medical Center
· Summerlin Hospital Medical Center
· Valley Hospital Medical Center
· Desert View Hospital
· Northern Nevada Medical Center (Ambetter and Medicaid only)

COVID-19 Healthcare Provider FAQ 3.12.20

Disease Background

What is currently known about the coronavirus disease (COVID-19)?

  • Coronavirus disease 2019 is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.
  • At this time, the immediate health risk from COVID-19 is considered low for the general American public who are unlikely to be exposed.
  • New information, obtained daily, will further inform the risk assessment, treatment options and next steps.

Is the coronavirus (COVID-19) a risk in the United States?

  • This is a developing story. According the CDC, the new coronavirus will likely start to spread in the United States over the next few months. It is a not a question of whether it will happen, but when it will happen and how many people will be infected and have a severe illness.
  • The goal of the public health community is to slow the spread of the virus so communities have time to prepare and limit the number of infections.
  • According to the CDC, the risk of infection in the US in currently very low for the general American public who are unlikely to be exposed.

Why are people so worried about coronavirus?

  • This is a new virus, and it is creating great concern in the community.
  • There is not a vaccine yet for this novel virus, and we do not have a specific medicine to treat it. An effective vaccine could be months or even years away- most likely 12-18 months.
  • This coronavirus is contagious – similar to the flu. Most people who become infected with the coronavirus have a mild illness or may not even have any symptoms.

How did the outbreak begin?

  • In December 2019, there was a cluster of cases of pneumonia and respiratory diseases, first identified in the Wuhan City, Hubei Province, China.
  • Early on, many of the patients in the outbreak in Wuhan, China had some link to a large seafood and live animal market.

What is causing the outbreak?

  • A previously unknown virus is responsible for the infections. The virus was originally named the “2019- novel coronavirus”. The virus was later renamed “SARS-CoV-2”, and the related disease is now called “coronavirus disease 2019” (or “COVID-19”).

What is a coronavirus?

  • Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Other examples of coronaviruses include SARS-CoV and MERS- CoV.
    • SARS-CoV causes severe acute respiratory syndrome that had a global outbreak in 2003.
    • MERS-CoV is causes Middle East Respiratory Syndrome, a respiratory illness that had global impact in 2012.

Is SARS-CoV-2 the same virus that causes the common cold?

  • There are other species of coronaviruses that commonly infect humans can cause mild illness, like the common cold. These are different from SARS-CoV-2 and its related disease, coronavirus disease 2019 (COVID-19).

How does SARS-CoV-2 spread to humans?

  • The virus is thought to spread mainly from person-to-person. Examples of person to person transmission include:
    • Between people who are in close contact with one another (within about 6 feet)
    • Via respiratory droplets produced when an infected person coughs or sneezes
    • Droplets landing in the mouths or noses of people who are nearby or possibly that could be inhaled into the lungs
  • In addition, other destinations have seemingly community spread because some people have been infected who are not sure how or where they became infected.
  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Symptoms & Diagnosis

How do I know if this is the flu or coronavirus?

  • Both are respiratory illnesses. Fever, cough, shortness of breath can be seen with both illnesses, and both can start very quickly with lots of aches and fatigue. People who become ill with coronavirus will develop severe respiratory symptoms.
  • There are lab tests to confirm the diagnosis of flu and coronavirus, but the tests are not available in every state yet.
  • Healthcare providers should be sure to ask patients whether or not they have traveled to an infected area as this information can help differentiate coronavirus from flu.

What are the symptoms of COVID-19?

  • Patients with COVID-19 have reported mild to severe respiratory symptoms.
  • Symptoms include fever, cough, and shortness of breath.

When do symptoms of COVID-19 occur?

  • Symptoms may appear 2-14 days after exposure.

Is there a test to diagnose COVID-19?

  • Yes. The CDC has developed a new laboratory test to evaluate patient samples for the presence of SARS-CoV-2. The CDC performs initial and confirmatory testing, as well as laboratories the CDC has designated as qualified, including U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories. The test will not be available in U.S. hospitals or other primary care settings, at this time.

Is there a specific treatment available for COVID-19?

  • There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat patients with 2019-nCoV infection, nor a vaccine to prevent onset of COVID-19. Many companies are working with the CDC to develop treatments at this time.
  • Vaccine development is not a quick process, but many are working with CDC and their federal officials to support vaccine development as fast as possible.

What should healthcare providers do for a suspected COVID-19 case?

  • Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.
  • Instruct symptomatic patients with travel history to China or other infected areas to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients with travel history to China or other infected areas should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
  • Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
  • Monitor and manage ill and exposed healthcare personnel.
  • Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

What determines risk for COVID-19?

  • Individual risk depends on exposure to the SARS-CoV-2.
  • At this time, the immediate health risk from COVID-19 is considered low for the general American public, who are unlikely to be exposed to this virus.
  • Specific individuals will have an increased risk of infection, such as healthcare workers caring for patients with COVID-19 and other close contacts of persons with COVID-19.
  • Assessment of this risk could change as in time if the spread of the virus increases.

How dangerous is coronavirus compared to other outbreaks?

  • Seasonal flu has about a ~0.1% mortality. This means that one person dies for every 1,000 infected. The coronavirus has a ~2% morality or 2 people die for every 100 infected. In contrast, the SARS (severe acute respiratory syndrome) outbreak in 2003 had a 10% mortality rate, meaning 1 in 10 people died.

If a patient is otherwise healthy and gets coronavirus, should they worry?

  • If a patient is low risk (healthy, not elderly or with chronic diseases), most likely the illness will run the course similar to a mild case of the flu. Treatment recommendations for the fever, dry cough and fatigue should be hydration and rest. Studies have shown that the infection tends to be less severe in children.
  • Some people develop a more severe case with shortness of breath and even respiratory failure. Those people need immediate medical attention.
  • Healthcare providers should notify any necessary local and/or state health departments in the event of a person under investigation for COVID-19.

What other communicable diseases could causes similar symptoms and how can they be treated?

  • Influenza, a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States at this time. Young children, older adults, pregnant women, and those with certain health conditions, such as asthma, diabetes, cancer, or HIV/AIDS, are at higher risk for influenza.
  • Everyone 6 months and older should receive an influenza vaccine.
  • Treatment for influenza includes:
    • Antiviral drugs can treat flu illness
    • Antiviral drugs are different from antibiotics. Flu antivirals are prescription medicines (pills, liquid, intravenous solution, or an inhaled powder) and are not available over-the-counter
    • Antiviral drugs can make illness milder and shorten the time you are sick. They also can prevent serious flu complications, like pneumonia

Coverage

Will this be covered by SILVERSUMMIT HEALTHPLAN?

SilverSummit Healthplan intends to cover COVID-19 testing and screening services for SilverSummit, Alwell, and Ambetter members and is waiving all associated member cost share amounts for COVID-19 testing and screening. To ensure that our members receive the care they need as quickly as possible, SilverSummit Healthplan will not require prior authorization, prior certification, prior notification or step therapy protocols for these services.

The specific guidance includes:

  • Waiving cost-sharing for COVID-19 tests
  • Waiving cost-sharing for COVID-19 treatments in doctor's offices or emergency rooms and services delivered via telehealth
  • Removing prior authorizations requirements
  • Waiving prescription refill limits
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Expanding access to certain telehealth services

SilverSummit Healthplan has been working in close partnership with authorities to serve and protect patients during the COVID-19 outbreak, including ensuring that our members and providers have the most up-to-date information to protect themselves and their families from the virus. We remain committed to protecting our communities during the outbreak.

Prevention Actions

As a healthcare provider, what actions should I take concerning COVID-19?

  • Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  • Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
  • Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local or state health department healthcare providers to notify local or state health department in the event of a person under investigation for COVID-19.
  • Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

What general recommendations have been made regarding coronavirus?

  • Decrease exposure to other sick individuals.
  • Use hand hygiene and other steps to decrease the spread of any communicable illnesses.
    • If you are running a fever, you should not be in close contact with other people.
    • Cover your nose and mouth with a tissue when you cough or sneeze.
    • Wash your hands often with soap and water or products with 60% alcohol.
  • Refer to the Centers for Disease Control and Prevention (CDC)’s website for up to date guidance.

What recommendations can be given to those concerned about exposure?

  • According to the CDC, the best way to prevent illness is to avoid being exposed to this virus. Stay home except to get medical care, and separate yourself from other people and animals in your home.
  • According to the CDC, if you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from China or other infected areas, you should call ahead to a healthcare professional and mention your recent travel or close contact.
  • According to the CDC, if you have had close contact with someone showing these symptoms who has recently traveled from infected areas, you should call ahead to a healthcare professional and mention your close contact and their recent travel. Your healthcare professional will work with your state’s public health department and the CDC to determine if you need to be tested for COVID-19.
  • People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.
  • Healthcare providers should follow appropriate testing protocols and notify any necessary local and/or state health department authorities if case is of suspected diagnosis.

What actions can help decrease the spread of a virus?

  • Common sense measures are essential to controlling the spread of the disease. These steps are helpful to reduce the spread of any communicable virus, such as:
    • Try to avoid close contact with sick people.
    • While sick, limit contact with others as much as possible to keep from infecting them.
    • If you are running a fever you should not be in close contact with other people.
    • Cover your nose and mouth with a tissue when you cough or sneeze. After using a tissue, throw it in the trash and wash your hands.
    • Wash your hands often with soap and water. This simple measure is the most effective method to control the spread of many viral illnesses. If soap and water are not available, use an alcohol- based hand rub.
    • Avoid touching your eyes, nose and mouth.
    • Clean and disinfect surfaces and objects that may be contaminated with germs thoroughly and often.

References

  • Centers for Disease Control and Prevention
  • European Centre for Disease Prevention and Control
  • World Health Organization

SilverSummit Healthplan Taking Additional Steps to Protect Members' Health Amid COVID-19 Outbreak 3.12.20

As we continue to learn more and address the novel coronavirus and its resulting illness COVID-19, we want to update you on important coverage information around its testing, treatment and care.

SilverSummit Healthplan will be extending coverage for COVID-19. This important step is being taken in partnership with other major insurers and with the support of the White House Coronavirus Task Force.

We intend to cover COVID-19 testing and screening services for SilververSummit, Allwell and Ambetter members and are waiving all associated member cost share amounts for COVID-19 testing and screening. To ensure that our members receive the care they need as quickly as possible, SilverSummit Healthplan will not require prior authorization, prior certification, prior notification or step therapy protocols for these services.

This coverage extension follows the Centers for Medicare & Medicaid Services’ (CMS) guidance that coronavirus tests will be fully covered without cost-sharing for Medicare and Medicaid plans, a decision that SilverSummit Healthplan fully supports for our members covered under these programs. We also support the administration’s guidance to provide more flexibility to Medicare Advantage and Part D plans. The specific guidance includes:

  • Waiving cost-sharing for COVID-19 tests
  • Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
  • Removing prior authorizations requirements
  • Waiving prescription refill limits
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Expanding access to certain telehealth services

SilverSummit Healthplan has been working in close partnership with state, local and federal authorities to serve and protect patients during the COVID-19 outbreak, including ensuring that its members and providers have the most up-to-date information to protect themselves and their families from the virus. We remain committed to protecting our communities during the outbreak.

To ensure you are keeping your environment safe from the coronavirus, please refer to the CDC guidelines here (PDF).

COVID-19 is an Emerging Illness 3.3.20

Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.  At this time, most people in the United States will have little immediate risk of exposure to this virus.  New information, obtained daily, will further inform the risk assessment, treatment options and next steps.  We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance:

  • Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.
  • Instruct symptomatic patients with travel history to China or other infected areas to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients with travel history to China or other infected areas should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
  • Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
  • Monitor and manage ill and exposed healthcare personnel.
  • Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

Take Action:

  1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.
  3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
  4. Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

FEBRUARY

On Demand: Patient Diabetes Management Program 2.10.20

On.DemandTM puts essential tools at your patients’ fingertips to empower them to manage their diabetes and improve their overall health. Using cellular technology, real-time glucose readings, and automatic supply refills, the program facilitates timely intervention while reducing waste and removing barriers to participation.

Your Role as a Provider:

On.Demand is a partnership between you, your patient and SilverSummit Healthplan. While providing patients with education and support, the program also provides you with early, actionable information for managing the care of your most at-risk patients.

First, you’ll receive a request to send a new prescription for an On.Demand cellular-enabled glucometer when a patient is identified and enrolled.

As standard practice, once testing begins we will regularly notify you by fax if a patient has atypical results or is symptomatic, and provide you with his or her health data. We also encourage patients to contact you directly. 

You may call at any time to request a list of your patients’ blood sugar readings for a defined period to help you evaluate the efficacy of a current treatment plan or the result of any recent changes. 

How the Program Works:

In addition to providing patients with education and support when needed,

  • Patients receive an On.Demand supply kit with a glucometer, test strips and instructions. As test strips are used and recorded, additional ones are automatically sent out.
  • Blood glucose readings are transmitted to a secure  website and monitored by our health coaches, certified  diabetes educators. 
  • Through clinical triage, patients registering high or low readings are identified to receive outreach support calls.
  • Patients with a pattern of high or low blood sugar, poor testing compliance, or a pattern of poor blood glucose control receive educational outreach calls. 
  • Patients who do not test for five days receive a customer service call to discuss barriers to testing.

Contact SilverSummit Healthplan On.Demand program at 1-888-982-7618.

The On.Demand DiabetesTM program is built on a comprehensive set of protocols based on standard and evidence-based guidelines from the American Diabetes Association, the American Heart Association, the National Institutes of Health, and others. Our clinical guidelines and standards of care are available on request.

JANUARY

Revalidation Reminder 1.1.20

This is a friendly reminder to ensure you are enrolled with Nevada Medicaid FFS. Nevada Medicaid requires all providers to revalidate at least every 5 years, with the exception of Durable Medical Equipment (DMEPOS) suppliers which must revalidate every 3 years. Providers are encouraged to revalidate online by logging into the Nevada Medicaid FFS Provider Web Portal.  

Your organization is receiving this letter because we have been notified by the state that the organization or a practitioner within the organization need to revalidate with FFS within the next 60 days (November and December). Please keep your tracking number provided to you by the state for revalidation, as a representative from SilverSummit Healthplan may reach out to confirm. Providing this tracking number will avoid any potential break in network status with SilverSummit.  

Should you have any questions regarding your revalidation period, please contact: NevadaProviderTraining@dxc.com  

Allwell P3 Notification 1.1.20

SilverSummit Healthplan, in coordination with P3 Health Partners, would like to take the opportunity to welcome you to the Allwell Medicare Advantage provider network effective 1/1/2020.

The SilverSummit Healthplan has reached an agreement with P3 Health Partners which allows all P3 providers to participate in the Allwell Medicare Advantage network beginning in 2020. 

In preparation for this, SilverSummit will be reaching out to your office to facilitate the collection of documents necessary to properly configure your contract and credential your practitioners.   

If you have any questions or concerns – SilverSummit is here for you!