COVID-19 Information for Care Providers
In this time of unprecedented crisis in our nation and world, HealthLink is committed to providing support related to the COVID-19 emergency. We will be providing frequent updates on topics related to COVID-19 coverage. Rest assured that the team at HealthLink is staying abreast of all current information, and will adjust policies to support you and your patients as needed.
HealthLink is closely monitoring COVID-19 developments and what it means for our members and our healthcare provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.
To help address care providers' questions, HealthLink has developed the following frequently asked questions.
COVID-19 testing, treatment, and vaccines
HealthLink provides access to a network of doctors, hospitals and other healthcare facilities as part of a members' health plan. We do not make benefit and coverage decisions for the plan. We recommend that all clients follow federal mandates, as well as any state mandates that apply. The federal CARES Act requires most health plans to cover the COVID-19 vaccine and its administration at $0 member cost share during the national public health emergency. Members should contact their employer or benefit administrator to confirm the $0 cost share for vaccination; and to confirm coverage for COVID-19 testing and treatment.
HealthLink State of Illinois health plan members: COVID-19 diagnostic test and exam: Covered at 100%; no member cost share. This benefit is effective through July 20, 2021. COVID-19 treatment: if you are diagnosed with COVID-19, your treatment will be covered at 100%, with no member cost share. This benefit is effective through July 20, 2021. COVID-19 Vaccine: Covered at 100%; no member cost share. This benefit is effective through July 20, 2021. Telemedicine Program from HealthLink: Covered at 100%; no member cost share. Members can call 855-717-6800, visit HealthLink.careclix.com or download the HealthLink Telemedicine app to start a telephone or video visit with a board-certified doctor, psychiatrist or psychologist. This benefit is effective through July 20, 2021. Telehealth services: This benefit is effective through June 30, 2021. Telehealth services through electronic or telephonic method include medical consults, psychiatry, mental health treatment, substance use disorder treatment and related services.
- In-network providers - Covered at 100%, no member cost share.
- Out-of-network providers - subject to the same plan benefits as if they were rendered in an office setting; members will be responsible for any out-of-pocket expenses.
HealthLink State of Illinois health plan members: Based on the State of Illinois Executive Order 2020-09, issued March 19, 2020: Section 1. "Telehealth Services" shall be defined to include the provision of health care, psychiatry, mental health treatment, substance use disorder treatment, and related services to a patient, regardless of their location, through electronic or telephonic methods, such as telephone (landline or cellular), video technology commonly available on smart phones and other devices such as FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, and videoconferencing, as well as any method within the meaning of "telehealth services" under Section 356z.22 of the Illinois Insurance Code, 215 ILCS 5. "Health insurance coverage" and "health insurance issuer" shall have the meanings given in Section 5 of the Illinois Health Insurance Portability and Accountability Act, 215 ILCS 97. Section 5. Telehealth Services subject to this Executive Order's coverage requirements may be provided by any in-network physicians, physician assistants, optometrists, advanced practice registered nurses, clinical psychologists, prescribing psychologists, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, other mental health providers, and other substance use disorder treatment providers, as long as they are licensed, registered, certified, or authorized to practice in the State of Illinois, regardless of whether or not the in-network provider was originally established prior to the COVID-19 pandemic in any designated telehealth network for the policy, contract, or certificate of health insurance coverage. Existing insurance law requirements regarding coverage of treatments based on licensure apply, such as the coverage requirements for treatment of autism spectrum disorders contained in Section 356z.14 of the Illinois Insurance Code, 215 ILCS 5.
HealthLink will continue to process provider credentialing within the standard timeframe even if we are unable to verify provider application data due to disruptions to licensing boards and other agencies. We will verify this information when available.
If HealthLink finds that a practitioner fails to meet our minimum criteria because of sanctions, disciplinary action etc., we will follow the normal process of sending these applications to committee review, which will add to the expected average timeline. We are monitoring and will comply with state and federal directives regarding provider credentialing.
Frequently Asked Questions
What is HealthLink doing in response to COVID-19?
HealthLink is committed to help provide increased access to care and help alleviate the added stress on individuals, families and the nation's healthcare system. Our actions should reduce barriers to seeing a doctor, getting tested and receiving treatment.
While we have moved our associates to work at home status, we are still fully operational and can address any of your questions or concerns through our usual communication channels.
How is HealthLink monitoring COVID-19?
HealthLink is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders. HealthLink has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics is deploying the plan as necessary.
HealthLink's continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and HealthLink's Virtual Command Center for Emergency Management command, control and communication.
In addition, HealthLink has established a team of experts to monitor, assess and help facilitate timely mitigation and response where it has influence as appropriate for the evolving novel coronavirus threat.
How can you ensure that your contracted providers can still provide services?
HealthLink is committed to working with and supporting its contracted providers. If a member does not have appropriate access to network doctors we will authorize coverage for out-of-network doctors as medically necessary.
How is HealthLink reimbursing participating hospitals that perform COVID-19 diagnostic testing in an emergency room or inpatient setting?
Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of member cost share amounts waived by the employer.
How is HealthLink reimbursing participating hospitals which are performing COVID-19 diagnostic testing in a drive thru testing setting?
Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, HealthLink will recognize the codes 87635 and U0002, and will allow drive thru COVID-19 tests according to the lab fee schedule. Participating hospitals without lab fee schedules will follow the same lab testing as defined in their facility agreement with HealthLink.
How is HealthLink reimbursing providers for FDA-Approved COVID-19 Vaccines?
The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. HealthLink will price the administration of COVID-19 FDA approved vaccines in accordance with Federal and State mandates.
Does HealthLink require a prior authorization on the focused test used to diagnose COVID-19?
No, prior authorization is not required for diagnostic services related to COVID-19 testing.
Does HealthLink require use of a contracted provider for the COVID-19 lab test in order for waiver of the member's cost share to apply?
The State of Illinois will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers for the members enrolled in their health plan.
You or your patient can contact the benefit administrator listed on the member ID card with questions regarding coverage for all other members.
Virtual, telehealth and telephonic care
Will HealthLink cover telephone- only services in addition to telehealth via video + audio?
While HealthLink does not make benefit and coverage decisions for members, we recommend that our clients consider waiving member cost share for telephone-only services to reflect the concerns we have heard from providers about the need to support continuity of care for members during extended periods of social distancing. Self-insured plan sponsors may opt out of waiving these costs.
What codes would be appropriate to consider for a telehealth visit with a patient who wants to receive health guidance related to COVID-19?
Submit Telehealth with the CPT code for the service rendered, Place of Service Code (POS) "02", and append either modifier "95" or "GT".
View the CDC's official Coding and Reporting Guidelines for the latest directives.
Where can HealthLink members go for more information?
HealthLink.com and HealthLink's member facing blog (https://www.healthlink.com/coronavirus) are great resources for members with questions and are being updated regularly.
Coding, billing and claims
Does HealthLink have recommendations for reporting, testing and specimen collection?
The CDC updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information from the CDC: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.
What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19?
View the CDC's official Coding and Reporting Guidelines for the latest directives.
Does HealthLink expect any slowdown with claim adjudication because of COVID-19?
We are not seeing any impacts to claims payment processing at this time.