We have received several questions and concerns about the novel Coronavirus (respiratory illness), called COVID-19. We are gathering resources to keep you informed, as well as help you understand what we’re doing to ensure that services will continue to be provided to EOCCO members and their families if the outbreak were to worsen.
New billing procedures
Oregon health Authority (OHA) has approved the following HCPCS codes that can be used for COVID-19 testing and treatment:
When billing for these services, please ensure that the appropriate modifiers and condition code are used:
- Modifier CR - for all professional claims
- Condition code DR - for all institutional claims
We are making every effort to ensure that our members have access to the procedures that have been delayed due to COVID-19.
Existing prior authorizations - EOCCO will allow a 6-month extension on all existing prior authorization upon provider request.
New prior authorizations - During the COVID-19 pandemic, EOCCO will automatically extend prior authorizations for 6 months from the receive/ fax date.
Updated Telehealth guidelines
Updated telemedicine and telehealth guidance is now available.
We have made updates to our telehealth/telemedicine guidelines. Notable changes include the ability to bill E & M codes for telephonic visits as well as additional behavioral health codes. For more information, access the full guidelines
Mail order pharmacy option for EOCCO members
Postal Prescription Services (PPS) Mail Order pharmacy is in-network for EOCCO and can fill and ship medications to EOCCO members. Members can typically obtain a 30-day supply of medications at a time. PPS has access to all retail medications.
In the current environment, members are allowed a one-time refill-too- soon override to obtain an additional 30-day supply of medications. To obtain an override, either the member or the pharmacy must contact EOCCO Pharmacy Customer Service and make the request. The override will allow for a maximum 60-day supply. Medication override does not apply to controlled substances.
To find out more about mail order pharmacy, visit https://www.ppsrx.com or call EOCCO Pharmacy Customer Service at 1-888-474-8539. Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m. PST TTY users, please call 711
Specialty medications can be shipped to a member’s home through Ardon Health, our specialty pharmacy services. Specialty medications are limited to a 30-day supply, but the one-time point of service refill too soon override can be utilized.
To find out more about specialty medications, contact Ardon Health at 1-855-425-4085 Hours: Monday through Friday, 8:00 a.m.to 7:00 p.m. PST Saturday hours: 8:00 a.m. to 12:00 p.m. PST TTY users, please call 711
Changes to covered pharmacy benefitsIn response to the COVID-19 outbreak, EOCCO is currently allowing a one-time operational “refill too soon” override up to the benefit maximum which is no more than 30 days.
Updated telemedicine and telehealth guidance is now available
As of March 13, 2020, the Oregon Healthy Authority has updated the prioritized list for telemedicine and telehealth to allow members and providers more flexibility around accessing services in response to the COVID-19 outbreak. The intent is to reduce barriers to care and ensure alternatives to on-site clinic visits in order to reduce the spread of the virus.
Telemedicine guidelines are available.
What we’re doing now
- We’ve added a news article with Coronavirus updates and guidance to our website, accessible from both the members and providers homepage.
- We plan to maintain an expanded team of customer service representatives to manage the potential increase of calls due to Coronavirus.
- In response to the potential shutdown of office locations or call centers, we are developing a plan to avoid disruption of service, which includes preparing our customer service representatives and claims staff to work from home.
What we’re communicating to our members
It is recommended that members who are feeling sick with mild symptoms and do not need medical care should stay home while they recover. If planning to visit a doctor, we have advised members to call the clinic before visiting so plans can be made to prevent exposing others to the illness.
What you can expect
We’re continuing to work with Oregon Health Authority (OHA) on a more comprehensive response plan as it relates to EOCCO member benefits and will communicate new details as they become available.
In the meantime, to stay up to date on COVID-19, we recommend visiting the OHA website or the Centers for Disease Control (CDC) website for more information.