Guidance for the COVID-19 Public Health Emergency
Following CMS guidance, we’re waiving all member copays for COVID-19 testing. We are also waiving prior authorization (PA) requirements for testing.
How to order testing
For patients who meet current guidance for evaluation of COVID-19, order the test from 1 of our laboratory partners in your state:
- Florida, Ohio, and Texas
Do not send patients directly to our laboratory partners locations. Instead, collect the appropriate specimen at the healthcare facility where the patient was seen and the test was ordered. Appropriate specimens include:
- Nasopharyngeal (NP) or oropharyngeal (OP) swab in viral transport medium
- NP or OP washes/aspirates in sterile cups
- Bronchial washings or bronchoalveolar lavage (BAL) specimens in sterile cups
With the exception of monoclonal antibody infusion therapy, coverage of COVID-19 treatment will follow our regular health plan policy. We'll cover primary care provider (PCP) visits and hospital stays as normal.
If you vaccinate or administer monoclonal antibody treatment to Devoted Health members on or after January 1, 2022, submit claims directly to Devoted Health. Original Medicare will no longer pay these claims. For additional information, please review the CMS guidelines:
Referrals and Prior Authorizations
Providers are required to submit referral requests before our members can see most types of specialists. To review which specialists require referrals, visit our Provider page and select your state.
Services, procedures, and items that normally require authorization will still need an authorization.
For emergency inpatient admissions related to the treatment of COVID-19, we require only notification. CT scans of the chest do not require a prior authorization per existing policies.
As our knowledge of COVID-19 evolves and treatment patterns become more clear, we will continue to monitor our prior authorization list to ensure timely access to care for members.
In response to COVID-19, CMS expanded the range of reimbursable telehealth services. They’re also waiving potential HIPAA violations for providers who use everyday technologies, like FaceTime or Skype, to treat patients for COVID-19 and other medical concerns. These changes aim to limit community spread of the virus by encouraging people to stay home when they need routine care or have only mild symptoms.
How to get started
If your provider office has limited telehealth capabilities or wants to expand them, check out our Telehealth Quick Reference Guide (QRG). We continually update this guide to let you know the services you can use and the latest guidance from CMS.
Covered telehealth services
In 2021, we covered telehealth visits at $0 copay. Starting in 2022, the following telehealth services will continue to be covered when serviced by a provider, but copays may apply.
- Primary care visits
- Physician specialist visits
- Mental health visits (individual and group)
- Podiatry visits
- Psychiatric visits (individual and group)
- Physical therapy, occupational therapy, and speech language pathology services
- Substance use sessions (individual and group)
- Kidney disease education
- Diabetes self-management training
Providers and members can check their Evidence of Coverage for specific copays.
For more details on covered services, see:
- Devoted Health telehealth billing requirements
- Full list of telehealth services paid for by Medicare
Our Messaging to Members
To keep our members safe, we’re asking them to practice social distancing and to stay home.
We tell our members to call their PCPs right away if they have a cough, fever, or shortness of breath and think they may have COVID-19. We emphasize that they should call before going in for an appointment.
We’ve also developed a COVID monitoring program for members who have been exposed to COVID, are exhibiting symptoms, or have been diagnosed with COVID. Our nurse clinical guides call members on a regular cadence to check on their symptoms and help them connect with care if needed. As part of the program, we also send pulse oximeters to members with confirmed cases of COVID.
We've lifted early refill restrictions so members can get an early refill for up to a 100-day supply of their medication. And we’re encouraging members to take advantage of CVS free delivery and mail order.
We’re encouraging all members without contraindications to get the vaccine. We’re also keeping members informed with vaccine Q&A, resources, and more.
How You Can Help
To encourage our members to stay home, we’re asking our partners, hospitals, and providers to consider adopting the following practices:
- Have a phone process in place so those with COVID-19 symptoms can avoid office visits or urgent care (when possible and clinically safe)
- Use telehealth visits when possible (see the latest CMS guidance)
- Ask members to sign up for mail-order (it's safer, cheaper, and better for adherence) and send up to 100-day scripts with 3 refills to the mail-order pharmacy
- Have nonessential personnel work from home
Who’s at Risk
Check the latest CDC guidance on the clinical and epidemiological criteria for COVID-19 infection risk.
We’ll continue to keep a close eye on what’s happening with the virus. If you have any questions, call our Provider Services team at 1-877-762-3515.