Important Information About COVID-19
Prestige Health Choice has been closely monitoring the Centers for Disease Control and Prevention (CDC) for the latest information about COVID-19, and has been engaged in making the necessary plans based on guidance from the CDC. Prestige Health Choice recommends that providers follow CDC, Centers for Medicare and Medicaid Services (CMS), and state-specific guidance with regard to COVID-19 evaluation, testing, diagnosis, treatment, and reporting.
Prestige Health Choice will cover all medically necessary services required to facilitate testing and treatment of COVID-19 for its eligible members, in accordance with federal and state guidance. No prior authorization is required for COVID-19 testing. Coronavirus testing codes follow:
|Test Category||Detection Methos||Procedure Code||Coverage Date|
|CDC Testing||Real-Time RTPCR diagnostic panel||U0001||On or after 2/4/20|
|Non-CDC Testing||Any technique||U0002||On or after 2/4/20|
|Non-CDC Testing||Infectious agent detection by nucleic acid (DNA or RNA)||87635||On or after 3/13/20|
|Rapid testing using high throughput technologies, as described by CMS||Infectious agent detection by nucleic acid (DNA or RNA)||U0003||On or after 4/14/20|
|Rapid testing using high throughput technologies, as described by CMS||Any technique||U0004||On or after 4/14/20|
|Other rapid testing||Antibody testing||86328||On or after 4/10/20|
|Other rapid testing||Antibody testing||86769||On or after 4/10/20|
*Providers cannot use U0001-U0004 or 87635 for antibody testing.
Practitioner Laboratory Coverage for practitioner laboratories that are CLIA certified, may perform the COVID-19 laboratory tests as described within the April 27, 2020 AHCA Provider Alert, are as follows:
CDC links for more information:
If you suspect you or a patient has COVID-19
The CDC instructs providers to consult with local or state health departments to determine whether patients meet criteria for Persons under Investigation (PUI). Providers should immediately notify infection control personnel at their facility if they suspect COVID-19 in a patient. Please notify your state or local health department if a patient is classified as a PUI for COVID-19.
Providers should report recognized exposures, regularly monitor themselves for fever and symptoms of respiratory infection, and not report to work when ill. Providers in low-, medium-, or high-risk exposure categories who develop signs or symptoms compatible with COVID-19 are strongly encouraged to contact their established point of contact (public health authorities or their facility’s occupational health program) for medical evaluation prior to returning to work.
The CDC has also introduced an interactive “self-checker” on its website. The self-checker tool isn’t intended to replace a medical diagnosis or treatment. Rather, it was developed to help individuals decide when to treat their symptoms safely at home and when to seek medical care. For more information please visit the CDC’s dedicated testing site.
CDC links for more information:
- CDC: Healthcare Professionals: Frequently Asked Questions and Answers
- Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)
For more resources and guidance, please access the CDC COVID-19 homepage.
Access and availability to care
Office closures and use of telehealth during the COVID-19 response period
Prestige Health Choice continues to monitor the latest information regarding COVID-19, and wants to help ensure that our members have access to care for their health care needs. To help accomplish that, we ask that any participating provider who will be closing their office for an extended period of time notify Prestige Health Choice at 1-800-617-5727 and their patients/members, and indicate whether virtual visits, telephonic consultation, and/or secure web-portal consultation will be available during this period.
Prestige Health Choice covers telehealth visits for our members in accordance with state and federal policy. Similar to Medicare, many states are adopting expanded or interim policies related to the originating site, payment for telephonic visits, and expanded licensure.
If your office plans to close or limit on-site visits, and provide virtual, telephonic, or web-based support, please see updated guidance provided by the state at https://ahca.myflorida.com/Medicaid/alerts_90-day.shtml. You can access recent telehealth guidance from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) here: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. Prestige Health Choice will provide updates as we receive them.
If your office is closing for an extended period of time and not offering virtual, telephonic, or web-based visits, please direct your patients who are our members to contact Prestige Health Choice Member Services at 1-855-355-9800 (TTY 1-855-358-5856). We have tools in place to connect members to alternate providers who can support their continued care. Members can also receive support by calling our 24/7 Nurse Call Line at 1-855-398-5615.
During the current State of Emergency, please visit the AHCA website for the most current updates on how telemedicine services may be provided to Florida Medicaid enrollees, including Prestige Health Choice members. General information can be found at: https://ahca.myflorida.com/covid-19_alerts.shtml.
The AHCA FAQs are updated frequently and can be found at: https://ahca.myflorida.com/docs/COVID-19_Medicaid_FAQs_3-22-2020.pdf.
Prestige Health Choice is processing claims in accordance with the AHCA policy transmittal guidelines:
- Medical and behavioral health providers: https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Medicaid_Telemedicine_Guidance_20200318.pdf
- Therapy service and Early Intervention Services: https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Telemedicine_Guidance_Therapy_Services-EIS_20200320.pdf. Please remember that therapy authorization requirements still apply.
Claims Payment Exception process
In accordance with Florida Medicaid Health Alert dated March 16, 2020 (https://ahca.myflorida.com/covid-19_alerts.shtml) related to the 2019 novel coronavirus (COVID-19), Prestige Health Choice has implemented the following exceptions to our normal claims processing guidelines:
- Prior authorization requirements have been lifted for all members for services rendered by the following provider types and/or services effective March 16, 2020, and until further notice:
- Skilled nursing facilities
- Long-term acute care hospitals
- Hospital services
- Physician services
- Advanced practice registered nursing services
- Physician assistant services
- Home health services
- Durable medical equipment and supplies
- Prior authorization requirements have been lifted for all services (except pharmacy services) rendered to members diagnosed with COVID-19 for all provider types effective March 16, 2020, and until further notice.
- Prestige Health Choice will waive benefit limits on medically necessary services (specifically related to frequency, duration, and scope) to maintain the health safety of members diagnosed with COVID-19 or when necessary to maintain a member safely in his or her home.
- Non-participating providers meeting the above criteria will not be required to obtain authorization for medically necessary services.
- Note: Non-participating providers must have a valid Florida Medicaid ID. Providers that need to obtain a provisional (temporary) Medicaid ID should refer to the Provisional Provider Enrollment section below.
- Completion of Preadmission Screening and Resident Review (PASRR) requirements will be waived effective March 16, 2020, and until further notice.
Claims meeting the above criteria can be submitted electronically (using payer ID 77003), or via paper to the following address:
Prestige Health Choice
Attn: Claims Department
P.O. Box 7367
London, KY 40742
If you have a claim that does not meet any of the above criteria, but you believe should be considered as an exception to normal claims processing requirements as a result of Statewide Medicaid Managed Care (SMMC) Policy Transmittal: 2020-15, please complete the COVID-19 Claims Payment Exception Form (PDF). These claims will require additional consideration and should be mailed to:
Prestige Health Choice
Exception Claims Processing
11631 Kew Gardens Avenue, Suite 200
Palm Beach Gardens, FL 33410
For general claims submission guidelines: http://www.prestigehealthchoice.com/provider/claims-and-billing/index.aspx.
If you have any questions related to the Claims Payment Exception process, please call 1-800-617-5727 or email us at PrestigeClaimExceptions@prestigehealthchoice.com.
Provisional provider enrollment
Providers must have a valid Florida Medicaid ID. Providers that need to obtain a provisional (temporary) Medicaid ID should follow the steps below:
- Open the Provisional Provider Enrollment Form (PDF).
- Email the completed form to PNM_Inquiries@prestigehealthchoice.com and enter Prestige Provisional Enrollment Request in the subject line.
For more information regarding Provisional Enrollment, please access the AHCA Provisional Enrollment page located at: http://portal.flmmis.com/flpublic/Provider_ProviderServices/Provider_Enrollment/Provider_Enrollment_NewMedicaidProviders/tabid/158/desktopdefault/+/Default.aspx
In accordance with Executive Order 20-72, prohibiting hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices from providing non-essential elective medical procedures during the State of Emergency. As a result, procedures that may have already been prior approved by the managed care plan must be postponed. In order to reduce the administrative burden for providers that already obtained approval for procedures postponed as a result of this executive order, the managed care plan must extend the approval period for affected authorizations for at least six months.
- Florida Medicaid lifted all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. The edits prohibiting early prescription refills will remain lifted until further notice by AHCA. This will assist recipients who may need to be self-quarantined for a period of time.
- Florida Medicaid will reimburse for a 90-day supply of maintenance prescriptions when available at the pharmacy. The recipient must request that the pharmacy dispense a 90-day supply.
- Recipients may also ask about the availability of no cost prescription delivery as many retail pharmacies have added this option due to COVID-19 concerns.
- Prestige Members may also use Walgreens Pharmacy mail order service. Members can call Walgreens Mail Order at 1-800-345-1985 to have their prescriptions delivered direct to their home. Providers may also call Walgreens Pharmacy mail order service on behalf of a Prestige member.
- Pharmacy authorization requirements apply. For additional assistance, please contact Prestige Health Choice Provider Services at 1-800-617-5727.