Provider Notice Issued 12/08/2020

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Date:   December 8, 2020

To:       All Medical Assistance Program Providers

Re:      HFS Procedure for Rate Determination and Claim Processing as New COVID-19 Testing Codes are Released

This notice informs providers of the HFS procedures for rate determination and claims processing of new COVID-19 laboratory test codes. This information is applicable for the Department’s fee-for-service population. The Department’s Managed Care Organizations (MCOs) will follow the same lab test code coverage and rate policies; however, the MCOs will not put them in place until guidance is received from the Centers for Medicare and Medicaid Services.   

COVID-19 laboratory testing codes will be added to the HFS database as they are released by the Centers for Medicare and Medicaid Services (CMS). However, until a Medicare or National Government Services (NGS) rate is assigned to a code, any claim billed fee-for-service containing that code will suspend. Once a national or regional rate is assigned, the HFS system will be updated with a rate and any suspended claims will be released into processing. This is not the case for the Department’s MCOs. The MCOs will not be able to process claims for payment until their systems have been updated with a rate.

The COVID-19 fee schedule, available on the COVID-19 Updates webpage, will be updated as codes and rates are updated. 

Questions regarding the information provided above may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or to the applicable MCO.

Kelly Cunningham

Interim Medicaid Administrator