Your State Level Resources: Third-Party Payer Updates
M
uch like CMS did, many payers made changes as a result of and during the COVID-19 public health emergency (PHE). There was not a mandate requiring them to make any specific changes, so not every payer made changes. Many payers did, however, but they didn’t all make the same changes, nor did they make the changes effective at the exact same time. Keeping up with and tracking those changes may seem like a daunting task—but it is certainly a critical one. Some of the most common changes we saw made by third-party payers fell into one of the following categories: 1. Prior authorization requirements
normal” in terms of these policies. It is imperative that you stay in touch with these changes and watch for notices from the payers that you work with. VGM has also created a tool that houses links to hundreds of payers. Right now, the links contained within the tool outline the changes that have been made by these various payers. Once they start returning to their standard policies, coverage criteria, etc., they will likely house information regarding that return on some of these same webpages. A link to VGM’s resource tool for third-party payer changes can be found at www.vgm.com/coronavirus under the heading of “Health Plan Policy Changes.” Checklist for Third Party Payer Changes
2. Signature requirements (proof of delivery)
Third Party Payer Changes Tracking
3. Face-to-face requirements 4. Allowing telehealth for certain services or to meet certain requirements
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Identify all payers to which my company submits claims
5. Allowing different levels of clinicians to write orders
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Identify what COVID-19 related changes the payer has made
6. Covering equipment under different circumstances than was previously allowed
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Determined whether changes are temporary or permanent
7. Reimbursement changes (especially for those payers that follow the Medicare fee schedule)
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For temporary changes, identify a start and end date for the policy changes
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Identify what the payer is responsible for to ensure proper claims processing and payment
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Identify what my company is responsible for doing to ensure proper claims processing and payment
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Each payer could in fact decide on their own when to go “back to normal.”
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Regardless of the type of change, and whether the policy was slightly relaxed/modified or waived entirely, the vast majority of these changes are temporary and will only last through the end of the PHE. Each payer could in fact decide on their own when to go “back to
COVID-19: VGM’s Next Steps Guide
Your State Level Resources: Third-Party Payer Updates | 19
