​​​COVID-19 (Coronavirus): Member cost-share claims processing for testing and treatment

February 10, 2021

This article was revised on February 10, 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:

​​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.

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-19March 6, 2020, through the duration of the public health emergencyClaims 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 March 31, 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
COVID-19

Commercial: March 30, 2020, through March 31, 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 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) to request an adjustment.

Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COV​ID-19​ webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

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.

​NaviNet® is a registered trademark of NantHealth, an independent company.​