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.
EOCCO covers antibody testing. To ensure clinically appropriate use of antibody/serology testing, Oregon Health Authority (OHA) has released a memo stating that Oregon Health Plan will only cover COVID-19 antibody testing (serology testing) to diagnose COVID-19 when:
- Administered tests have FDA Emergency Use Authorization (EUA) or FDA approval
- The purpose of testing is to evaluate a hospitalized person under age 21 for possible multisystem inflammatory syndrome in children (MIS-C)
The following codes must be used for billing antibody tests that meet the above criteria set by OHA:
- 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus dieses [COVID-19])
For more information, please contact EOCCO Customer Service at 888-788-9821.
Updated telehealth and telemedicine guidance available
We have made updates to our telehealth/telemedicine guidelines. Notable changes include telehealth parity, patient to clinician services criteria and clarification regarding crossover claims and modifier 95. For more information, access the full guidelines.
Important reminder about Personal Protective Equipment (PPE)
Oregon Health Authority and Eastern Oregon Coordinated Care Organization would like to remind providers that it is prohibited to bill EOCCO members for the use of PPE. Members may not be billed for any PPE provided to them during their visit or PPE used by any provider or clinic staff during an appointment or visit.
To request PPE, please contact your local county health department.
Important billing instructions
As directed by the Oregon Health Authority (OHA), all Oregon Health Plan (Medicaid) providers who submit professional (CMS-1500 or 837P) or institutional (UB-04 or 837I) claims must add the following modifier/code for each service related to COVID-19 prevention, identification, diagnosis or treatment:
- Enter modifier CR (Catastrophe/Disaster) for professional claims
- Enter condition code DR (Disaster-Related) for institutional claims
If you have previously billed COVID-19-related services on or after February 1, 2020 without using the appropriate modifier/code outlined above, please resubmit claims using the appropriate modifier/code for qualified services (prevention, identification, diagnosis or treatment).
To better serve your needs during these uncertain times, we want to hear from you. You should have received an email from us with a link to our COVID-19 Provider Survey. The purpose of this survey is to help us better understand what you are going through during the COVID-19 crisis. Please complete the survey by Tuesday, April 21.
If you did not receive the survey email, you can access it here.
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.