Skip to Main Content

COVID-19 Updates & Alerts for Providers

Questions and Answers for Health Net of California Network Providers

Due to the rapidly changing environment as a result of COVID-19, the information included in this section is intended to serve as a guide for COVID-19-related information. This information and guidance is in response to the current COVID-19 pandemic and is subject to change, and may be retired at a future date. Unless stated otherwise, special coverage and waivers stated herein expire when the public emergency period ends. This section shall be updated as new information and guidance becomes available; however, providers should continue to refer to the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and the Centers for Medicare & Medicaid Services (CMS) websites for the most up-to-date information.

21-036L


COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19
 

COVID-19 alerts


COVID-19 Vaccine FAQs

What you need to know about the vaccines
 

Vaccine FAQs

Communications & Resources

Stay informed on the latest news and help for you and your patients

Resource FAQs

COVID-19 Trainings & Webinars

Notices about COVID-19-related trainings and webinar sessions

COVID-19 training

COVID-19 General Information

What's covered, how to bill for treatment, telehealth guidance, and more

General FAQs


Historical Information

COVID-19 content that may be retired or no longer relevant to the public health emergency

Retired FAQs

Updated May 4, 2021

The following sections were added and/or updated with additional guidance and information:

COVID-19 General Information

COVID-19 Testing and Screening, Billing and Treatment Information (updated)

Communications & Resources

  • Health Net Communications (updated)
  • DHCS Resources for Providing Care During COVID-19 (updated)

COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19

  Updated 5/5/21

On Friday, April 23, 2021, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) issued a statement that administration of the Johnson & Johnson COVID-19 vaccine can resume after the temporary pause put in place on April 13, 2021.

Health care providers administering the vaccine can use the FDA (PDF) and the California Department of Public Health Johnson & Johnson COVID-19 Vaccine Fact Sheets to help with patient discussions about COVID-19 in general, the Johnson & Johnson vaccine and more.

Visit the CDC for the latest information. The FDA and CDC will continue to monitor the safety of all COVID-19 vaccines.

New safety precautions

As of April 21, 2021, rare adverse events of blood clots with low platelets have been reported in 15 of 3.99 million women (3.8/million) who had received the Johnson & Johnson vaccine. Nearly all reports of this adverse event have been in adult women age 50 or younger. (Refer to CDC's Advisory Committee on Immunization Practices (ACIP) (PDF) dated April 23, 2021, slide 22.)

A review of current data shows that the Johnson & Johnson COVID-19 vaccine's known and potential benefits outweigh its known and potential risks. As a result, the Emergency Use Authorization (EUA) has been changed to caution women under age 50 of the adverse event.

Monitor these symptoms after vaccination

Advise patients who receive the Johnson & Johnson vaccine to monitor for any of these symptoms three weeks after receiving the vaccine, and seek prompt medical attention if experiencing one or more of them:

  • Severe or persistent headache
  • Blurred vision
  • Shortness of breath
  • Chest pain
  • Leg swelling
  • Persistent abdominal pain
  • Easy bruising or tiny blood spots under the skin beyond the injection site

The "Let's Get to ImmUnity" campaign will address questions, concerns with COVID-19 vaccinations specific to the Black and African American communities

The California Department of Public Health (CDPH) is rolling out a tailored outreach for Black and African American communities across the state. This latest element of the "Let's Get to ImmUnity" public education campaign is part of the state's overall Vaccinate ALL 58 effort.

Engaging people where they live to raise awareness about COVID-19 vaccines

In addition to traditional communications, the campaign will meet people where they are via community engagement efforts throughout the state. These efforts will begin in Oakland. The campaign will partner with small businesses and community leaders serving the local Black and African American community. The goal is to increase awareness about the safety and efficacy of the vaccines and mobilize community members to get vaccinated.

Support for equitable vaccine administration across the state

Community engagement efforts will expand to Black and African American communities across the state as the campaign continues and will remain focused on increasing vaccine equity. The "Let's Get to ImmUnity" campaign is placing additional focus on geographic areas in the bottom quarter of the Healthy Places Index (HPI), mirroring the state's announcement last month to increase vaccine supply in these communities. The public education campaign is an important part in the state's five-part plan for equitable vaccine administration.

Stay informed about the latest COVID-19 information from CDPH.

Health Net deploys staffed RVs to select San Bernardino County vaccination sites

Health Net and San Bernardino County are working together to vaccinate thousands more residents over the next two months. Health Net is sending out recreational vehicles (RVs) to select vaccination sites. We are also staffing two county-owned vans that will reach out to residents in remote and hard-to-reach communities across the county.

Patients can sign up at our Vaccination clinic schedule.

These events are not limited to your Health Net patients. Any San Bernardino County resident who is eligible to receive the vaccine based on the California eligibility guidelines can go to our Vaccination clinic schedule and set up an appointment.

In January 2021, the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations (HHS/OIG/OI) issued a health care fraud alert, regarding COVID-19 vaccines. This alert describes how scammers are perpetrating COVID-19-related schemes to beneficiaries, including those enrolled in Medicare. Schemes include telemarketing calls, social media platforms and door-to-door visits. Also, fraudsters are offering COVID-19 tests, HHS grants and prescription cards in exchange for personal details.

Scammers can use personal information collected through these schemes to fraudulently bill federal health care programs and commit medical identity thefts. The services offered are unapproved and illegitimate and may cause harm to the beneficiaries.

Please visit the health care fraud alert for a list of common schemes, and report any suspected COVID-19 health care fraud online or by calling 1-800-HHS-TIPS (800-447-8477).

Los Angeles County is actively providing vaccinations for the following groups:

Appointments must be made in advance through the Los Angeles County Department of Public Health (LAC DPH) website. Also, refer to the LAC DPH website for required documentation for vaccination appointments.

Health care workers must make an appointment in advance through the Vaccination for Healthcare Workers website.

Attention health care providers

LAC DPH is looking for the following licensed clinical professionals to volunteer to help with mass vaccination efforts. Go to Volunteer to Vaccinate for more information or to sign up.

  • Medical Doctor (MD)
  • Doctor of Osteopathy (DO)
  • Physician Assistant (PA)
  • Nurse Practitioner (NP)
  • Registered Nurse (RN)
  • Licensed Vocational Nurse (LVN)
  • Dentist (DDS)
  • Pharmacist (PharmD)

COVID-19 Trainings and Webinars

Notices about COVID-19-related trainings and webinar sessions

All providers and office staff are encouraged to attend an upcoming training to learn more about the COVID-19 vaccine(s), best practices, how to address vaccine hesitancy and more.

Register today!

Register to attend one or more of the trainings below.

Date Time (Pacific time)
March 11, 2021 2:00 p.m. – 3:30 p.m.
March 23, 2021 Noon – 1:30 p.m.
April 14, 2021 2:00 p.m. – 3:30 p.m.
April 27, 2021 Noon – 1:30 p.m.
May 13, 2021 1:00 p.m. – 2:30 p.m.
May 25, 2021 Noon – 1:30 p.m.
June 9, 2021 10:00 a.m. – 11:30 a.m.
June 22, 2021 Noon – 1:30 p.m.
July 16, 2021 10:00 a.m. – 11:30 a.m.
July 30, 2021 11:00 a.m. – 12:30 p.m.

Training topics

  • COVID-19 vaccines
    • Provider selection
    • State and federal programs
    • Approach to mass vaccination
  • Vaccine best practices
    • Administration
    • Documentation
    • Adverse event notification
  • Vaccine hesitancy
    • Communication strategy
    • Key points on communicating about the COVID-19 vaccine
  • Health plan updates
    • HEDIS® medical record collection
    • State minimum performance measures released
    • Supplemental data: Claims and encounters

After the webinar, you will get a copy of the material presented with additional resources.

COVID-19 Vaccine FAQs

What you need to know about the vaccines

Health Net is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a health care 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. For regular and frequent updates on the vaccine information and distribution in California, visit Vaccinate ALL 58.

Important! Enroll to get your California Immunization Information System (IIS) ID

During the Public Health Emergency, COVID-19 vaccines are being provided by state and federal governments at no cost to providers. The California Department of Public Health (CDPH) is overseeing the registration for the COVID-19 vaccination program in California. Enrollment to become a vaccinator is currently limited to providers who are authorized by their local health department (LHD). You may enroll in early 2021 as vaccine supply increases.

Step 1: Get your IIS ID

Enroll in your local registry to receive your Immunization Information System (IIS) ID for enrollment in CalVax. County specific information is below.

Step 2: Enroll in CalVax (now called myCAvax)

CalVax is now myCAvax. Refer to the FAQ document (PDF) on the myCAvax name change for more information. You can now sign into the new website for myCAvax with the same sign-on information you entered for CalVax. Remember to update any bookmarks associated to the former CalVax Provider site.

Make sure you meet all the requirements (PDF) before enrolling. Use the Provider Enrollment Worksheet (PDF) to gather information needed ahead of time to complete enrollment in CalVax.

Refer to the Readiness Checklist: Quick Start Guide (PDF) for additional steps to help providers onboard to the COVID-19 Vaccination Program.

More information on how to prepare for the COVID-19 vaccination can be found in the Health Care Professionals: Preparing for COVID-19 Vaccination from the Centers for Disease Control and Prevention (CDC).

How are the COVID-19 vaccines being prioritized?

Refer to Vaccinate All 58 for the vaccine prioritization process.

Providers have the discretion to vaccinate those who live in high-impact areas (County Healthy Places Index Quartiles 1 and 2), including families. More information is available in Governor Newsom's press release from March 25, 2021 about expanded vaccine eligibility.

NOW VACCINATING

  • Health care workers and long-term care residents.
  • People with a high chance of exposure and those ages 65 and older.
    • Sector populations: food/agriculture, education/childcare, emergency services
  • Individual ages 16 and older at higher risk or with disabilities.
    • Refer to the updated COVID-19 vaccine eligibility guidelines from CDPH for a list of eligible severe health conditions. Individuals with developmental or other significant, high-risk disabilities are also eligible.
    • For Community-Based Adult Services (CBAS) (PDF) – Identify and notify participants ages 18–64 of their vaccine eligibility as of March 15, 2021. You may need to help participants make vaccine appointments and other arrangement to get their vaccines.
    • Patients may self-attest to high-risk health status – To help ensure only eligible patients make appointments, be sure to share accurate eligibility criteria (PDF). At the time of vaccination, you may ask patients to sign a self-attestation that they meet the criteria for high-risk medical conditions or disabilities. Self-attestation would replace requesting documentation of the diagnosis or type of disability to protect patient confidentiality.

STARTS APRIL 1, 2021

  • All individuals ages 50 and older are eligible for the vaccination.

STARTS APRIL 15, 2021

  • All individuals ages 16 and older are eligible for the vaccination.

Minimize disuse of scarce COVID-19 vaccine

After focused and appropriate efforts to reach groups prioritized at the moment, health departments and providers may offer vaccine doses promptly to people in lower priority groups when:

  • Demand subsides in the current groups, or
  • Doses are about to expire according to labeling instructions.

Refer to the CDPH website for updated COVID-19 vaccine eligibility guidelines.

Pediatric distribution

The COVID-19 vaccines are not approved for pediatric use. Studies are in process to review how the vaccines affect children.

The Pfizer/BioNTech COVID-19 vaccine is available to people ages 16 and older, and the Moderna COVID-19 vaccine and Johnson & Johnson/Janssen vaccines are available to people ages 18 and older.

Where can people get information about vaccine availability – My turn?

If you are not providing the COVID-19 vaccine to your patients, refer them to Find out if it's your turn. Appointments to My Turn are added daily, and county participation is expanding across the state. To learn more, refer to the When Can Your Patients Get Their COVID-19 Vaccine? flyers in the Health Net Communications section.

You can also refer patients to their county public health department. A listing of local health departments by county is available through CDPH.

Patients may also call 211 or 311 for information about the COVID-19 vaccines. These are non-emergency numbers that are state- and city-supported and can help direct callers to COVID-19 vaccine services in their area.

Where can I find the latest guidance for the COVID-19 vaccine?

For commercial providers:

For Medi-Cal providers:

For Medicare Advantage providers:

What are the codes to report and bill the COVID-19 vaccine?

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
91303 SARSCOV2 VAC
AD26 .5ML IM
Janssen Janssen COVID-19 Vaccine
0031A ADM SARSCOV2 VAC
AD26 .5ML
Janssen Janssen COVID-19 Vaccine Administration

What are the reporting requirements for the COVID-19 vaccine?

Providers must record details of the vaccination into their system of record within 24 hours, and into the applicable public health system within 72 hours.

How can I help prepare for the COVID-19 vaccine?

  • CMS toolkits – Providers can use this set of toolkits to help prepare to swiftly administer the vaccine once it is available.
  • CMA toolkit - Physician practices can use the California Medical Association toolkit for answers to their frequently asked questions such as vaccine priority, vaccine administrators and addressing patient concerns. The toolkit will be updated often with the latest information.
  • Immunization Action Coalition (IAC) – Provide clinics with resources and tools that cover the different COVID-19 vaccine products available, address vaccine hesitancy, help educate patients on the vaccines, and more.

How will the COVID-19 vaccine be covered for members?

Similar to other preventive immunizations, the COVID-19 vaccines will be offered at no cost to members. In addition:

For commercial members

  • In accordance with state and federal requirements, member liability will be $0 and non-participating provider prior authorization requirements will be waived.
  • Health Net is working to ensure there are no administrative hurdles to our members in accessing and receiving a COVID-19 vaccination. While the national public health emergency (PHE) order is in effect, Health Net will assume payment responsibility for the COVID-19 vaccine's administration fee for all of our commercial group and individual members, including those enrolled with capitated delegated groups. The vaccine itself is available from the federal government free of charge.
  • Applicable claims need to include the AMA issued vaccine administration code for the applicable FDA approved vaccination. You do not need to bill the vaccine code with the vaccine administration code. Reimbursement will follow existing claims submission policies. Providers are expected to bill and accept payment at no greater than the Medicare Allowable rates during the PHE. After expiration of the PHE, existing contract terms, including physician group risk obligations, shall apply.

For Medi-Cal members

For Medicare Advantage members

  • For Calendar Years (CYs) 2020 and 2021, payment for the COVID-19 vaccine and its administration for Medicare Advantage plan members will be made through the original fee-for-service Medicare program. The vaccine itself is available from the federal government free of charge.
  • Health Net will not be able to process these claims.
  • Providers must submit claims for administering the COVID-19 vaccine to their CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.

What resources are available to help with reminders about the second dose of the vaccine, and reporting vaccine side effects?

Providers should refer to the Talking to Your Patients About the COVID-19 Vaccine section for helpful information on how to engage and talk to your patients about the vaccine.

Second-dose vaccine reminders

Providers can offer patients VaxTextSM, a free text messaging service that patients can opt in to receive convenient text message reminders to get their second dose of the COVID-19 vaccine. Vaccine recipients can text ENROLL to 1-833-VaxText (829-8398) to start getting their weekly second dose reminders.

Visit the CDC website for more information.

Reporting vaccine side effects

Patients can report any side effects from the vaccine directly to the Centers for Disease Control & Prevention (CDC) using v-safeSM smartphone-based tool. Patients may be contacted by someone from CDC to check on them and get more information, depending on the answers provided. V-safe will also remind patients to get their second COVID-19 vaccine dose if needed. For more information, visit the CDC website.

As COVID-19 vaccines are approved and distributed, providers will be a key part in its adoption and administration to the American public. Patients look to their health care professionals for medical guidance and assurance, and while much is still unknown, you can start laying the groundwork now for when the vaccines are available. As your partners in health care, we want to share some tips for effectively setting expectations and addressing questions from your patients.

Start COVID-19 vaccine conversations early

Even before you are able to offer COVID-19 vaccinations, consider including the topic in your conversations with patients. This will give you the opportunity to set expectations about vaccine availability, including if/when you might recommend vaccination for them, and learn about any concerns they have.

Engage in effective COVID-19 vaccine conversations

Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

Start with empathy and understanding

  • Acknowledge the disruption COVID-19 has caused in all our lives.
  • Provide an opportunity to recognize common concerns that can be addressed by a vaccine.

Assume patients will want to be vaccinated but may not know when to expect it

  • Consider providing the following general information to patients about the timeline for COVID-19 vaccines:
    • Limited COVID-19 vaccine doses may be available.
    • It is anticipated that vaccine supply will increase substantially throughout 2021.
    • The goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available. However, not everyone will be able to get vaccinated right away.
  • Encourage patients to continue taking steps to protect themselves from COVID-19 and let them know how you plan to share updates about vaccine availability.

Give your strong recommendation

  • Let your patients know if you plan to recommend COVID-19 vaccination for them.
  • Share the importance of COVID-19 vaccines to protect patients' health as well as the health of those around them.
  • Talk about your personal plans to get a COVID-19 vaccine.
  • Reassure your patients that the vaccine is safe.

Listen to and respond to questions

  • If a patient has concerns or questions, this doesn't mean they won't accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
  • Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
  • Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it (see Q&A).

Keep the conversation open

  • After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
  • Encourage patients to take at least one action like:
    • Scheduling another appointment.
    • Reading any additional information you provide them about COVID-19 vaccination.
    • Encourage others to get their COVID-19 vaccine when available.
  • Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.

Resources to help you build vaccines confidence with your patients

View videos developed in collaboration with the CDC, U.S. Department of Health and Human Services (HHS), National Institute of Allergy and Infectious Diseases (NIAID), and top health and medical institutions that cover a range of topics to help physicians and health care providers build vaccine confidence in their patients and address questions about COVID-19 vaccines. Additional video resources are available in the COVID-19 Resource Center.

Access the video series through the California Medical Association (CMA) or directly on YouTube.

Answering patient questions about the vaccine

Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers. Refer members to the COVID-19 Resource Center to view product and audience-specific frequently asked questions about the vaccines and more.

COVID-19 General Information

What's covered, how to bill for treatment, telehealth guidance, and more

Where can I obtain general information and guidance on COVID-19?

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 coronavirus disease 2019 (COVID-19) 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.
  • 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 Centers for Disease Control and Prevention (CDC) 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 CDC and the World Health Organization (WHO) 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 U.S. Food & Drug Administration (FDA).
  6. Visit the California Department of Public Health (CDPH) for information about COVID-19 and the latest guidance from public health officials.

What other information and guidance on COVID-19 is available?

  • All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities may recommend delaying elective inpatient and outpatient surgical and procedural cases. The referring or treating provider must have determined and noted in the relevant record that when considering COVID-19 implications during this public health emergency period, a longer waiting time will not have a detrimental impact on the health of the member.
  • Telehealth services during this emergency period may be used to determine medical necessity for someone to come into the office, emergency room or urgent care center. Refer to Telehealth Guidance and Support for more information.
  • For Commercial and Medi-Cal, where mailing hard-copy notices to members and providers as required by law is delayed due to personnel shortages and/or safety precautions enacted, please contact the member or provider electronically or by telephone. If the provider or PPG, as the case may be, does not have personnel available to mail hard-copy information, it is sufficient to communicate with members and providers electronically and/or by telephone, so long as a log or record of such communications is maintained. (Note: CMS has not yet communicated a similar relaxation of its regulatory requirements for Medicare Advantage.)
  • Health care workers, including those supporting healthcare operations, are considered essential workers and are exempt from the "stay at home," "shelter in place," and "shelter at home" recommendations and orders recently announced.
  • Visit the California Medical Association (CMA) website to view videos from a 12-part webinar series that covers all aspects of implementing telehealth in a medical practice. Topics reviewed include selecting a platform, reimbursement rules and patient interactions, and more.

The Department of Managed Health Care provided notice on January 12, 2021, of an emergency regulation that is being adopted to address the transfer of patients between hospitals due to the surge of COVID-19 hospitalizations in certain regions in California.

The emergency regulation applies to commercial plans only.

The emergency regulation requires health plans and delegated participating physician groups (PPGs) and providers to comply with the following for all patient transfers done pursuant to the State Public Health Officer Order (Order) dated January 15, 2021:

  • Prior authorization or prior notice, or any other requirements that may possibly delay or prevent the transfer of an enrollee will not be imposed.
  • Medically necessary costs associated with the transfer of enrollees must be covered.
  • Receiving facilities must be reimbursed for all medically necessary services provided to the enrollee during the first 72 hours the enrollee is treated at the facility, regardless of whether the facility is in- or out-of-network.

    After the first 72 hours, the receiving facility must continue to be reimbursed if:
    • Within 72 hours of receiving the enrollee, the receiving facility notified the health plan or delegated provider that the facility is treating the enrollee; and
    • The health plan or delegated provider does not disapprove the facility's request to continue providing medically necessary care to the enrollee. If the health plan or delegated provider disapproves the receiving facility’s request to continue providing medically necessary care to the enrollee, the receiving facility will be reimbursed for medically necessary services the receiving facility provides the enrollee up to the time the health plan or delegated provider effectuates the enrollee's transfer or the enrollee is discharged from the receiving facility.
  • Receiving facilities will be reimbursed according to the terms of their contract with the health plan or delegated provider. If the receiving facility is out-of-network, the facility will be reimbursed at the "reasonable and customary" rate as described in California Code of Regulations, title 28, section 1300.71(a)(3)(B).
  • Enrollees transferred to a facility under the Order are liable for no more than the cost-sharing amounts the enrollees would have incurred if they were treated at an in-network facility.

On January 7, 2021, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through April 21, 2021.

With this renewal the various testing, screening, billing, and telehealth coverages that were implemented in response to the COVID-19 Public Health Emergency earlier this year will be extended to Health Net members through late April, until the PHE is either terminated or extended again. This extension does not affect Health Net's additional Medicare coverages that expired on December 31, 2020.

In accordance with this extension, Health Net has updated its information and guidance for COVID-19-related information posted on this page.

Please note, the dates for the COVID-19 Federal Public Health Emergency extension may or may not align with California regulatory requirements or guidance.

Does Health Net allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for covered services.

Commercial and Medi-Cal members - During the course of this declaration of emergency Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

Federally Qualified Health Centers (FQHCs), Regional Health Centers (RHCs), and Indian Health Service (IHS) Clinics - During the course of this declaration of emergency Health Net's Medi-Cal coverage for telehealth services will follow guidelines released by the Department of Health Care Services (DHCS), which includes virtual/telephonic visits consistent with in person visits. Additionally, virtual/telephonic visits provided pursuant to this guidance are eligible for prospective payment system (PPS) rates, or all-inclusive rate (AIR), as applicable, and as communicated by DHCS via email to all Managed Care Plans on April 6, 2020.

Medicare and MMP/Cal MediConnect members - During the course of this declaration of emergency Health Net's coverage for telehealth services will follow guidance released by CMS, which includes telecommunications involving audio and video technology and audio only technology.

Applicable to all lines of business:

  • During the public emergency period, Health Net will reimburse fee-for-service providers the same contracted rate, whether service is provided in person or through telehealth technology.
  • Services that cannot be appropriately delivered remotely are not eligible for telehealth coverage and reimbursement.
  • Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above. Claims processing risk will follow the in-person location place of service where the service would have been delivered in lieu of telehealth.

In addition to telehealth services offered through our network of providers, Health Net has expanded access to telehealth services through third parties. Updated information on those vendor arrangements can be found in the Telehealth Platforms for Providers section or at Health Net Alerts: COVID-19.

What are the guidelines for telehealth services specific to risk adjustment?

For Medicare, providers should follow the guidance in the communication from the Centers for Medicare and Medicaid Services (CMS) dated April 10, 2020, regarding the Applicability of diagnoses from telehealth services for risk adjustment (PDF).

How do I bill for telehealth services during this declaration of emergency period?

For commercial and Medi-Cal

  • Use appropriate American Medical Association (AMA) CPT and HCPCS codes most descriptive for the service delivered
  • For Medi-Cal:
    • Use Place of Service code 02 (Telehealth) – excluding FQHC/RHCs
    • Use appropriate modifiers, when applicable – excluding FQHC/RHCs
      • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
      • Modifier GQ (Asynchronous store and forward telecommunications systems)
  • For Commercial:
    • Use the normal Place of Service code (11, 23, etc.) – excluding FQHC/RHCs
    • Use appropriate modifiers – excluding FQHC/RHCs
      • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
      • Modifier GQ (Asynchronous store and forward telecommunications systems)

The same amount of reimbursement will be provided for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.

Updated Medi-Cal telehealth billing guidance, as well as information regarding FQHC telehealth coverage and billing guidance details, can be found at:

For Medicare and Cal MediConnect

  • Providers should bill and will be reimbursed for Medicare and Cal MediConnect telehealth services as required by CMS
  • Use the normal Place of Service code (11, 23, etc.) with the appropriate telehealth modifiers, as identified by CMS

Updated CMS guidance for telehealth coverage can be found at:

Examples of benefits or services not appropriate for telehealth delivery:

  • Benefits or services that are performed in an operating room or while the patient is under anesthesia
  • Benefits or services that require direct visualization or instrumentation of bodily structures
  • Benefits or services that involve sampling of tissue or insertion/removal of medical device
  • Benefits or services that otherwise require the in-person presence of the patient for any reason

What do I do if my commercial or Medicare telehealth claim did not price at full rate parity for the CPT code?

During the course of this declaration of emergency, commercial and Medicare telehealth claims need to reflect the normal POS (11, 23, etc.) and the applicable telehealth modifier for the claim to price at parity.

Claims for such CPT codes previously billed with POS 02 must be re-billed as corrected claims in order to receive rate parity.

Are there member cost shares for commercial and Medicare network provider telehealth services?

For commercial members, covered telehealth services delivered March 17, 2020 through May 31, 2021 will be offered at zero member cost share. For dates of service on or after June 1, 2021, only COVID-19 screening and testing related telehealth will be offered at zero member cost share in accordance with state and federal requirements. Effective with June 1, 2021 dates of services, all other non-COVID telehealth services will be subject to the cost sharing provisions of a member's benefit plan. Members will continue to retain telehealth benefits included in their Health Net coverage contract or policy, as well as any temporary extended telehealth benefit coverage mandated during the public health emergency period.

This applies to:

  • Telehealth claims paid by Health Net and telehealth services covered and provided by capitated physician groups and IPAs.

For Medicare members, covered telehealth services delivered March 17, 2020 through May 31, 2021 will be offered at zero member cost share. For dates of service on or after June 1, 2021, only COVID-19 screening and testing related telehealth will be offered at zero member cost share in accordance with federal requirements. Effective with June 1, 2021 dates of service, all other non-COVID telehealth services will be subject to the cost sharing provisions of a member's benefit plan. Members will continue to retain telehealth benefits included in their Health Net coverage contract or policy, as well as any temporary extended telehealth benefit coverage mandated during the public health emergency period.

This applies to:

  • All diagnosis codes, not just COVID-19 related diagnosis codes
  • Telehealth claims paid by Health Net and telehealth services covered and provided by capitated physician groups and IPAs.
  • Exceptions:
    • Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Capitated Physician Groups/IPAs:

Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above, including the waiver of member cost share. Eligible waived cost shares, as stated above, for capitated physician groups' or IPAs' paid telehealth services will be reimbursed by the health plan. Details regarding the process for capitated telehealth services to receive reimbursement for waived member cost shares will be released at a later date.

What is Health Net's strategy to support telehealth services for providers and members?

Health Net is committed to supporting your relationship with your patients. We continuously encourage members to first take advantage of the telehealth services provided by their primary care provider before considering Health Net's contracted vendors.

What additional telehealth options are available to my patients?

Health Net offers additional telehealth services to enhance access to care for your patients. These services supplement, but do not replace, the personal care you provide to your patients. Health Net is contracted with Babylon Health (excludes Medicare and Cal MediConnect) and Teladoc® (excludes commercial and Medi-Cal).

Providers can also refer to Telehealth Platforms for Providers for a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

What support will Babylon Health provide to me if my patients use them?

Babylon Health supports the primary care physician (PCP) and their relationship with their patient. Babylon services include:

  • Visit summaries sent to the PCP for close communication and continuity of care.
  • Referring patients back to the assigned PCP for follow up appointments.
  • Prescribing of non-scheduled, non-lifestyle medications.
  • Ordering of and follow up on basic ancillary testing for immediate treatment of the medical condition.
  • Direct communication back to the member's PCP about clinical assessments that include a recommendation for a referral for advanced imaging, such as CT, MRI or referral to a specialist.
    • The PCP, who best knows the member and their clinical needs, then decides whether such referral is required and, if so, directs the patient to the most appropriate resource.
  • Availability of the member's medical records through the Babylon Health app.

What support will Teladoc provide to me if my patients use them?

Teladoc supports the PCP and their relationship with their patient. Teladoc services include:

  • Visit summaries sent to the PCP for close communication and continuity of care, at the member's request.
  • Referring patients back to the assigned PCP for follow-up appointments.
  • Prescribing of non-scheduled, non-lifestyle medications.
  • Availability of the member's medical records through the Teledoc app.

Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Participating Physician Groups (PPGs) delegated by Health Net to authorize services related to COVID-19 screening and testing are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Is Health Net waiving cost-share requirements for screening and testing?

Health Net benefit plans cover screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Exception: Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Waived cost share for capitated physician groups' or IPAs' paid screening/testing services will be reimbursed by the health plan. Details regarding the process for capitated services to receive reimbursement for waived member cost shares will be released at a later date.

Where is COVID-19 testing available?

LabCorp, Quest Diagnostics™ and Bio Reference and several commercial and hospital based laboratories are currently offering testing for COVID-19. Providers are encouraged to visit the following sites for more information on registration and specimen collection requirements:

  • LabCorp – Physicians who send laboratory testing to LabCorp, will require an active account. Please contact LabCorp at 1-800-859-6046 and speak to a customer service representative to set up account.
  • Quest Diagnostics – website or call 1-866-697-8378. Providers can open an account.
  • BioReference – Providers do not need to sign up. Tests can be sent through courier or FedEx depending on area. Providers can open an account or contact BioReference via telephone at 1-833-684-0508 or 1-800-229-5227.
  • Twenty-two public health labs in California are testing samples for COVID-19. Providers can refer members for testing to their county's public health department. Additional information can also be found at the California Department of Public Health.
  • Providers can confirm with Community Hospitals to determine if they are offering testing for COVID-19.

Testing can be ordered only by physicians or other authorized health care providers.

Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

The Lab Patient Service Centers will not be collecting specimens for COVID-19 testing. DO NOT refer patients to Lab Patient Service Centers. Please contact specific labs for instructions for specimen collection and transport, and to obtain specimen collection supplies.

What are the screening and testing guidelines for COVID-19?

Refer to the Centers for Disease Control and Prevention (CDC) for updated guidelines for testing patients suspected of having the COVID-19 infection.

The state of California launched a coronavirus awareness website. This site provides the following testing recommendations (as of September 30, 2020). Providers are encouraged to reference the CDC website for the most current guidance.

What billing codes should be used to bill for COVID-19 testing?

Starting April 1, 2020, fee-for-service providers performing the COVID-19 test can begin billing Health Net for services that are Health Net's responsibility for dates of service February 4, 2020 and after, using the following newly created HCPCS and CPT codes:

Specimen Collection

  • HCPC G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source.
  • HCPC G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.
  • HCPC C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]).
  • CPTs 99000, 99001, or 99211 when billed with a COVID-19 related diagnosis code.

Active Virus Testing

  • HCPC U0001 - For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPC U0002 - For all other commercially available tests: 2019-nCoV Real-Time RT-PCR Diagnostic Panel. (It is not yet clear if the Centers for Medicare & Medicaid Services (CMS) will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.)
  • CPT 87635 – (effective March 13, 2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. The industry standard for reporting of novel coronavirus tests across the nation's health care system.
  • HCPC U0003 - (effective April 14, 2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
  • HCPC U0004 - (effective April 14, 2020): 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
  • CPT 0202U - (effective May 20, 2020): Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 0223U (effective June 25, 2020) Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 87426 (effective June 25, 2020) Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semi-quantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).
  • CPT 0225U (effective September 8, 2020) Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected.
  • CPT 0226U (effective September 8, 2020) Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum.
  • CPT 0240U (effective October 6, 2020) Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 0241U (effective October 6, 2020) Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 87636 (effective October 6, 2020) Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.
  • CPT 87637 (effective October 6, 2020) Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique.
  • CPT 87811 (effective October 6, 2020) Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Effective for dates of service April 10, 2020, and continuing during the course of this declaration of emergency, Health Net benefit plans cover medically necessary FDA approved serologic (antibody) testing ordered by physicians or other authorized health care providers, using AMA approved CPT codes and based on CDC guidance for appropriate use of FDA approved or authorized (Emergency Use Authorization, EUA) antibody tests. Additional clinical guidelines for serologic testing coverage may be communicated at a later date.

Fee-for-service (FFS) providers performing medically necessary FDA approved COVID-19 antibody tests can bill Health Net for services that are Health Net's responsibility for payment, using the following CPT codes:

  • CPT 86318 (Medi-Cal only) Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (eg, reagent strip); (EXISTING PARENT CODE NOT SPECIFIC TO COVID 19).
  • CPT 86328 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), (Coronavirus disease [COVID-19]), (For severe acute respiratory syndrome, coronavirus 2 [SARS-CoV-2] [Coronavirus, disease {COVID-19}] antibody testing using multiple-step method, use 86769).
  • CPT 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using single step method, use 86328).
  • CPT 0224U (effective June 25, 2020) Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed.
  • CPT 86408 (effective August 10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen.
  • CPT 86409 (effective August 10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer.
  • CPT 86413 (effective September 8, 2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.

CDC Antibody Testing Guidance

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.

Health Net will absorb the costs for waived copayments for COVID-19 screening and testing to support our network providers.

In addition to cost-share requirements, authorization requirements will be waived for any claim that is received with these specified codes.

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

For complete and up-to-date diagnosis coding for COVID-19, visit the CDC National Center for Health Statistics website.

The following diagnosis codes can be used to bill for screening and testing services related to COVID-19.

  • Z11.52 (effective January 1, 2021) – Encounter for screening for COVID-19.
  • Z20.822 (effective January 1, 2021) – Contact with and (suspected) exposure to COVID-19.
  • Z20.828 (through December 31, 2020) – Contact with and (suspected) exposure to other viral communicable diseases.
  • Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out.

Is there more information available on COVID-19 billing?

For additional information on coding, refer to the following links from the American Medical Association (AMA):

Where do commercial COVID-19 diagnostic testing claims get billed while the DMHC Emergency Regulations are in effect?

Health Net will comply with the requirements outlined in the DMHC Emergency Regulations, as clarified by subsequent All Plan Letters (APLs) 20-028 and 20-033, which apply to commercial products only for dates of service starting July 17, 2020, until the time the emergency regulations expire, currently slated for May 14, 2021.

During this time period, unless otherwise instructed, separately billable costs for COVID-19 Emergency Regulation defined diagnostic COVID-19 active virus testing and specimen collection services performed outside of an inpatient or emergency room setting should be submitted to Health Net for payment. Health Net systems are configured to process these claims automatically starting with dates of services after October 5th. Health Net will work with capitated commercial groups for eligible testing claims with dates of service July 17th through October 4th in order to either pay the claim to the billing provider or to reimburse the capitated group if payment was already made.

How will COVID-19 diagnostic testing claims that a capitated commercial group already paid for be handled during the Emergency Regulations?

Health Net will work with the capitated group to ensure eligible commercial COVID-19 diagnostic testing claims paid for dates of service July 17th through October 4th do not incur double payment and Health Net will reimburse the groups for such claims that Health Net has not yet paid.

What is the deadline to file claims?

The deadline to file commercial and Medi-Cal claims for dates of service March 5, 2020 through the end of the public emergency period, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines or the timeline in your Health Net Provider Participation Agreement (PPA). This also applies to Medi-Cal late filing penalties.

The deadline to file Medicare claims for dates of service March 5, 2020 through July 25, 2020, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines or the timeline in your Health Net Provider Participation Agreement (PPA).

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is Health Net waiving cost-share requirements for COVID-19 related treatments?

Health Net will waive member cost sharing for COVID-19 related treatments for commercial fully insured members through May 31, 2021. For dates of service or admissions on or after June 1, 2021, the respective treatment cost sharing provisions of a member's benefit plan will apply.

Health Net will waive member cost sharing for COVID-19 related treatments for Medicare members through May 31, 2021. For dates of service or admissions on or after June 1, 2021, the respective treatment cost sharing provisions of a member's benefit plan will apply.

Exceptions:

  • Members in the Blue & Gold benefit plan for the University of California flex funded employer group have not had COVID-19 treatment cost share waived (plan code "FMD" in 2020 and "HFZ" in 2021). Members should contact the employer group plan sponsor with questions related to this plan design matter. Standard cost sharing applies.
  • Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Eligible waived cost shares, as stated above, for capitated physician groups' or IPAs' paid COVID-19 related treatments will be reimbursed by the health plan. Details regarding the process for capitated services to receive reimbursement for waived member cost shares will be released at a later date.

  Updated 5/4/21

Is Health Net waiving prior authorizations for COVID-19 related treatments?

Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available. Effective June 1, 2021, prior authorization requirements for COVID-19 treatment from non-participating providers will resume.

What COVID-19 ICD-10 diagnoses codes are approved for use in treatment?

  • U07.1: 2019-nCoV - Confirmed by lab testing (effective April 1, 2020)
  • M35.81: Multisystem Inflammatory Syndrome (MIS) (effective January 1, 2021)
  • B97.29: Confirmed cases - other coronavirus as the cause of diseases classified elsewhere (prior to April 1, 2020)

  Updated 5/4/21

Does Health Net cover monoclonal antibody infusion treatment for COVID-19?

Through May 31, 2021, COVID-19 monoclonal antibody treatments available under an FDA Emergency Use Authorization (EUA) are covered benefits with no cost share or prior authorization required. Effective with dates of service on or after June 1, 2021, respective treatment cost sharing provisions of a member’s benefit plan will apply and prior authorization requirements for non-participating providers will resume. The medications are available from the federal government at no cost to providers.

The following codes have been published as of November 10, 2020 (Eli Lilly) and November 21, 2020 (Regeneron). However, they are not billable until after the specific treatment received official EUA approval. As of April 16, 2021, the FDA revoked its EUA for Eli Lilly's bamlanivimab when administered alone. Learn more on the FDA's web page.

Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name
Q0239* bamlanivimab-xxxx
(FDA's EUA ended April 16, 2021)
Eli Lilly Injection, bamlanivimab, 700 mg
M0239 bamlanivimab-xxxx infusion
(FDA's EUA ended April 16, 2021)
Eli Lilly Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Q0243* casirivimab and imdevimab Regeneron Injection, casirivimab and imdevimab, 2400 mg
M0243 casirivi and imdevi infusion Regeneron Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring
Q0245* bamlanivimab and etesevimab Eli Lilly Injection, bamlanivimab and etesevimab, 2100 mg
M0245 bamlan and etesev infusion Eli Lilly Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

*medication code not payable

Commercial: The infusion's administration fee is billable to the appropriate payor based on Health Net's existing division of financial responsibility with the capitated physician group/IPA.

Medi-Cal: Per DHCS clarification, the infusion administration is not carved out of the managed Medi-Cal program. The infusion's administration fee is billable to the appropriate payor based on Health Net's existing division of financial responsibility with the capitated physician group/IPA.

Medicare: The infusion's administration fee is billable to CMS directly for both Original Medicare and Medicare Advantage members.

What if my office or facility is impacted by COVID-19?

If your office or facility is impacted by COVID-19 and this affects your ability or capacity to provide services and access to members, please contact your provider network regional representative immediately. If you are affiliated with a participating physician group (PPG) or independent physician association (IPA), please contact your PPG of IPA immediately. Health Net contracted PPGs must notify their Health Net designated network representative of any changes in access to their provider panel.

As a reminder, providers are responsible to provide coverage to their patients, and to communicate this to patients via appropriate signage, messaging, and communications. We encourage the use of telehealth services to promote physical distancing while supporting the needs of your patients, whenever possible. The use of urgent care or emergency room/department services to provide routine coverage for your office is not appropriate, unless the use of emergency room/department services are medically necessary.

If you close your office, or if you switch to only providing virtual appointments, take the following action:

  1. Contact your Health Net provider network regional representative immediately.
  2. Notify your patients who have upcoming appointments about your office changes and provide documentation of how your patients were notified to your Health Net designated network representative.
  3. Inform your patients about available coverage options for your office, including voicemail instructions and/or message for patients, posters and member outreach.

How do Community-Based Adult Services (CBAS) centers continue adult services during the COVID-19 outbreak?

The Department of Health Care Services (DHCS) has released guidance via All Plan Letter (APL) 20-007 that outlines ways CBAS centers may continue to provide services to CBAS participants now remaining at home.

Providers should refer to the Provider Update titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak distributed on April 17, 2020, for additional information.

What steps are certified CBAS providers required to take for approval to participate in CBAS Temporary Alternative Services (TAS)?

The California Department of Aging (CDA) CBAS Branch has issued All Center Letter (ACL) 20-07 that outlines the requirements for CBAS TAS and the steps that certified CBAS providers must take for approval to participate in CBAS TAS.

Providers should refer to the Provider Update titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak:

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented within Health Net's history, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols. As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations. In particular:

  • Health Net's Provider Network Management (PNM) and Provider Relations personnel remain available to providers, with no current impact in their ability to assist with provider issues.
    • However, on-site meetings are being replaced with telephonic and other forms of support.
  • Our key operational units will continue to provide updates to PNM leadership if and when challenges arise.
  • Visit Health Net Alerts: COVID-19 to view regular provider updates.

Communications and Resources

Stay informed on the latest COVID-19 news and help for you and your patients

  • Learn more about resources and educational materials providers and their staffs can use to help their patients feel safe when seeking medical care during the COVID-19 pandemic in provider update, Help Your Patients Feel Safe and Learn How We've Done the Same, distributed on August 27, 2020. Also included is information communicated by Health Net to your Health Net patients, our members, during the crisis.
  • During the COVID-19 state of emergency, the Hospital Notification Unit (HNU) 800 number is temporarily suspended. During this time, contracted hospitals, skilled nursing facilities, long-term care facilities, and long-term acute care hospitals should submit inpatient authorization requests by fax to 1-800-676-7969.

    For additional information, including who to contact for the status of inpatient authorization requests, refer to the provider update, Hospital Notification Unit 800 Number Temporarily Suspended, distributed on October 2, 2020.
  • Give timely flu shots to help keep members healthy! The flu vaccine is critical to keeping the most vulnerable patients from having the flu and COVID-19 at the same time. Encouraging the flu vaccine among members can also help conserve health care system resources during the COVID-19 crisis and reduce the prevalence of illness caused by the flu, thereby reducing outpatient visits or hospital admissions.

    Refer to the provider updates below, distributed on November 16, 2020, for information about flu vaccine coverage, recommendations for giving the vaccine at appointments or referring members to an appropriate resource to access the vaccine, and how to be reimbursed for the vaccine and its administration. Information is also included to inform delegated PPGs of their responsibilities concerning flu vaccine coverage and requirements to ensure members have access to the flu vaccine.
  • When can your patients get their COVID-19 vaccine? California has launched myturn.ca.gov to help residents know when they are eligible to receive the vaccine and how to schedule appointments. Refer to the flyers below, distributed on February 8, 2021, to learn more.
  • Your patients can get a ride to their COVID-19 vaccine. ModivCare offers transportation for members to a health care office or facility, hospital, or pharmacy. Contact information is provided. There is a list of some services associated with transportation that require 24 to 48 hours advance notice. Refer to the flyers below, distributed on March 1, 2021, to learn more.
  • Some drugstores and pharmacies are offering COVID-19 vaccines. Patients can make an appointment directly with the pharmacy online or by phone once they are eligible. Patients are scheduled for their second dose when they get their first dose. Refer to the flyers below, distributed on March 5, 2021, for a list of pharmacies with their website and phone number.
  • COVID-19 information and tools are now in one location. Visit the COVID-19 Resource Center. This is a central hub for all provider and member COVID-19-related questions, answers and resources. Refer to the flyers below, distributed on March 22, to find out more.
  • Dentists are an important part of a patient's overall health care, and that includes talking to patients about recommend vaccines! Dental providers can use the flyer below that Health Net developed in collaboration with the California Dental Association (CDA) to help make it easier to discuss vaccines – especially the COVID-19 vaccines – with patients.
  • Updates to the COVID-19 vaccine eligibility. Learn more information about who can be vaccinated now and in the near future. Refer to the flyers below, distributed on March 30, 2021, to find out more.

  •   Updated 5/4/21

    COVID-19 vaccination outreach was initiated April 6, 2021 to help schedule COVID-19 vaccine appointments, We are contacting patients through text, email, phone and interactive voice response. On April 19, 2021, we partnered with ConsejoSano to send culturally relevant two-way text messaging and outbound phone calls in 27 different languages to high-risk members. The messages are about COVID-19 vaccines and related information as well as how to schedule a vaccine appointment. Refer to the flyers that were distributed April 7, 2021 for more information.

  Updated 5/4/21

Does the Department of Healthcare Services (DHCS) have any resources available for providing care during COVID-19?

Providers are encouraged to reference the following resources distributed by the DHCS to managed care plans (MCPs) to assist with providing care during the COVID-19 crisis:

What resources are available from DHCS to assist with the COVID-19 epidemic's immediate and long-term impacts on the mental health?

Providers can refer to the DHCS notice on suicide and prevention screening and resources (PDF) to assist with providing immediate and long-term care for patients resulting from the COVID-19 crisis.

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Commercial Members:
Providers should refer members on an individual, family or employer plan seeking additional information and guidance on pharmacy and prescriptions to the Health Net member alerts page under the section titled Pharmacy and Prescriptions – Refills and Emergency Supply.

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Health Net encourages participating provider groups (PPGs) to educate contracted providers on disaster-responsive, trauma-informed care. This education or training should include the crucial roles of:

  • Ensuring physical and emotional safety of patients
  • Building trust between providers and patients
  • Recognizing and responding to the signs and symptoms of stress on physical and mental health
  • Promoting patient-centered, evidence-based care
  • Ensuring provider and patient collaboration in treatment planning
  • Sensitivity to the racial, ethnic, cultural, and gender identity of patients
  • Supporting provider resilience

PPGs should ensure their providers and care management teams learn the signs of and assess for stress-related morbidity, and create responsive treatment plans, including supplementing usual care with measures that help regulate the stress response system, such as:

  • Supportive relationships
  • Age-appropriate, healthy nutrition
  • Sufficient, high-quality sleep
  • Mindfulness and meditation
  • Adequate physical activity
  • Mental health care

Additional resources on how to mitigate the stress-related health outcomes anticipated with the COVID-19 emergency can be found at ACEs Aware.

Adverse Childhood Experiences (ACEs) resources and information for Medi-Cal can be found at California Department of Health Care Services | ​​​​​​​​Trauma Screenings and Trauma-Informed Care Provider Trainings.

What additional support does Health Net provide to enhance access to care for my patients?

Health Net offers many solutions to enhance access to care for your patients. These solutions supplement, but do not replace, the personal care you provide to your patients. Examples include:

  • The Nurse Advice Line – Available to members 24 hours a day at 1-800-893-5597 (TTY 711).
  • myStrength (tailored wellness resources to help members with mental health challenges). If a member needs emergent or routine treatment services, call MHN at 1-888-327-0010 or visit myStrength.
  • Health Net Community Connect (Aunt Bertha) – A free online search service, allows members to find free and low cost social services.
  • Heal – On demand doctor house calls is now offering telemedicine visits. Members can schedule care through Heal online or by calling 1-844-644-4325 from 8 a.m. to 8 p.m., 7 days a week.
    • Available for commercial members only

Does Health Net have a list of recommended telehealth platforms for providers?

Health Net has researched a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

Health Net is not affiliated with, and does not endorse, any of the solution platforms represented below. Health Net has reviewed these platforms and summarized their capabilities on behalf of our providers, but we do not have any direct experience with any of these platforms and we cannot guarantee their performance. Your decision to utilize any of these platforms is based on your individual sole discretion as it relates to the needs of your individual practice.

Below is a summary of telehealth platforms you may find helpful in selecting a solution that best meets your practice needs.

Name Description
Amwell Amwell's Private Practice platform is available to California physicians at a discounted rate for the next 12 months. This telehealth solution can be branded for each practice and enables physicians to see their own patients and operate under their own payer contracts. Practice management capabilities include a branded telehealth practice with clinical workflows, online physician enrollment and scheduling appointments with your patients, collecting patient payments at the time of visit, and reporting and visit summaries to assist with clinical documentation.
Doxy.me See your patients from anywhere via a personalized virtual exam room. Click doxy.me/YourDrsName to join them for a video call. You do not need to download software or create an account. Use a browser on a computer or mobile device with a camera and microphone. Practice management capabilities include in-session, live chat-box with current patient and/or next patient(s) in queue, and patient check-in.
VSee Secure, low-bandwidth HD video. Encrypted with military-grade 256-bit AES encryption. VSee Messenger allows providers to securely video chat with patients in their homes. In-session snapshots can be securely sent through individual or group chats. Practice management capabilities include real-time screen share, live annotation, mark-up lab results, CT scans, e-documents, and electronic health record (EHR) integration.
eVisit A user-friendly exam room equips providers with the tools needed to chart, prescribe and take notes. eVisit commits telehealth expertise and technology to fight against COVID-19 with VirtualED™ – a COVID-19-specific workflow that can be implemented quickly at no cost until July 31, 2020. Practice management capabilities include seamless EHR integration, custom patient eligibility and claims solutions. Specializes in increasing provider telehealth footprint to better meet the unique needs of the market. Improves outcomes and revenue with minimal overhead.
Innovaccer COVID-19 management supports automated assessments, remote patient monitoring, education, and treatment. Practice management capabilities include leveraging artificial intelligence to eliminate coding gaps to drive quality performance, a data activation platform that promotes value-based care, and a private virtual examination room with secure audio/visual features to allow for the seamless and effortless rendering of care to patients.
Updox Includes a dedicated virtual exam room to triage COVID-19 patients. No need to download software or create an account. Just use a browser on a computer or mobile device with a camera and microphone. Patients do not need to be pre-registered. Practice management capabilities include document completion, appointment scheduling, and appointment reminders via email and SMS.

Historical Information

COVID-19 content that may be retired or no longer relevant to the public health emergency

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the additional distributions from the Provider Relief Fund to eligible Medicaid and Children's Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens.

For additional information, visit HHS.

Since March, Health Net Medicare Advantage (MA) has waived prior authorizations, co-pays, and other costs related to COVID-19 testing, screening and medically necessary treatment.

We have also waived prescription refill limits and allowed members to refill prescriptions prior to their refill date during this course of declaration of emergency.

As seniors face increased social and economic barriers to care amid this pandemic, we are now offering a number of expanded benefits to help our eligible MA members address issues such as out-of-pocket medical costs, food insecurity, and medication assistance.

Effective July 1, 2020 through December 31, 2020, expanded benefits will include:

  • $0 Member Liability Extension: We are waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states.

Beginning July 1, 2020, providers should waive the member liability for the eligible primary and behavioral health care claims at the point of service, and forego the collection of the member cost share. This is a benefit change for our members and our claims system will be configured to administer these adjusted benefits. We recognize that providers have different reimbursement/accounting arrangements with us, and the costs associated with this benefit change will follow the accounting processes as outlined in the provider’s contract with MA from Health Net. For services rendered to Medicare members with state benefits, providers should continue to collect that member cost share from their State Medicaid Agency as per usual.

What resources are available for providers to request and/or order Personal Protective Equipment (PPE)?

We understand that access to necessary PPE and other important supplies during the COVID-19 crisis has been challenging. If you need access to appropriate PPE and/or other supplies to provide care to your patients, we encourage you to reach out to the following resources for assistance.

Designated Local Public Health Department by County

Resource requests for health care providers and facilities are handled through the designated Public Health Department for your county.

New requests are:

  1. Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
  2. Upon receipt by the RDMHC, the request is then sent to the California Department of Public Health (CDPH) Medical and Health Coordination Center (MHCC) for proper tracking and fulfillment by both the State Operations Center (SOC) and the Emergency Medical Services Agency (EMSA).

Facilities currently facing a shortage of respirators, N95 masks or other supplies, should contact their MHOAC.

Direct Relief®

Direct Relief provides clinics and health care centers throughout the United States and globally with access to no-cost pharmaceuticals, medical supplies and other resources to care for the world's most vulnerable people.

Learn more about Direct Relief and how to become a network partner.

Western Drug Medical Supply

Western Drug Medical Supply is a leading provider of home medical equipment and supplies in Southern California. They have a large volume of masks procured and have volunteered to donate to providers located in Southern California who need them. Providers should reach out to Western Drug directly or at 1-800-891-3661.

Last Updated: 05/05/2021