This article was revised on April 19, 2021, to update the effective timeline.
Coverage of member cost-share
As previously communicated, Independence is waiving member cost-sharing (i.e., copayment, deductible, and coinsurance) for the following services:
Testing. Independence will waive member cost-sharing for certain COVID-19 diagnostic and antibody tests in accordance with federal guidelines and company medical policy for the duration of the COVID-19 pandemic. For complete details, please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)):
- Inpatient treatment (see table for effective dates).
Independence will waive member cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19, whether for medical or behavioral health.
Independence will waive member cost-sharing for emergency room/department (ED) visits associated with admissions for in-network, inpatient, acute care treatment of COVID-19 whether for medical or behavioral health.*
Medicare Advantage
Inpatient acute care treatment related to a diagnosis of COVID-19 is covered in- or out-of-network with no member cost-sharing.
Independence will waive ED copayments, in- or out-of-network, when a member is admitted to the hospital for a COVID-19 diagnosis.
*Cost-sharing is not waived for outpatient services provided in the ED.
We also communicated that self-funded customers can opt-out of waiving cost-sharing for the treatment of COVID-19; therefore, some Commercial members may still be required to pay their applicable cost-share. For High Deductible Health Plans, in-network cost-sharing waivers detailed above will remain in effect through June 30, 2021.
Claims processing
Processes have been implemented to ensure provider payments are accurate and claims are processed in a timely fashion and in accordance with applicable law and regulatory guidance.
The following chart outlines how claims will be processed for the various services provided to Commercial, Medicare Advantage, Medicare Supplement, and Keystone HMO CHIP members – specifically regarding member cost-sharing:
|
Service |
Effective dates |
Claim process |
|---|
| Testing for COVID-19 | March 6, 2020, through the duration of the public health emergency | Claims with a date of service on or after
March 6, 2020, will process without member cost-share. |
| Inpatient treatment for COVID-19 diagnoses |
Commercial: March 30, 2020, through June 30, 2021
Medicare Advantage, Medicare Supplement, and Keystone CHIP: March 30, 2020, through the end of the public health emergency | Claims with a date of service on or after
March 30, 2020, will process without member cost-share. |
| ED visits associated with admissions for treatment of COVID-19 |
Commercial: March 30, 2020, through June 30, 2021
Medicare Advantage, Medicare Supplement, and Keystone CHIP: March 30, 2020, through the end of the public health emergency | Claims with a date of service on or after
March 30, 2020, will process without member cost-share. |
For information on how we are processing claims for PCP telemedicine services, please read this
article.
Payment adjustments
If cost-sharing was inadvertently applied to the claim and it should have been removed, the claim will be adjusted to pay the provider the correct amount. We ask that providers wait until after the claim has been processed, and adjusted, to bill the member for any applicable cost-share noted on the Provider Explanation of Benefits.
As a result of the processes we have implemented, you will not need to contact the call center or submit a claim investigation via the NaviNet® web portal (NaviNet Open) or PEAR Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal to request an adjustment.
Learn more
Read more about our coverage of services during the COVID-19 public health emergency in our News Articles on our Medical and Claim Payment Policy Portal.
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