Providers for Florida Healthy Kids

Important information for CCP’s Participating PCP Providers about COVID-19

 

Now that COVID-19 has reached South Florida and a State of Emergency has been imposed, Community Care Plan (CCP) would like to take this opportunity to update our participating providers regarding several interim operational procedures effective immediately for CCPs Florida Healthy Kids (FHK) lines of business. These steps will be effective immediately through April 30, 2020. CCP will notify you if this date changes.

Prior Authorization Requirements

In an effort to reduce the administrative burden on participating providers of CCP, CCP is waiving prior authorization for medically necessary physician & hospital services, advanced practice registered nursing services, physician assistant services, telehealth, home health services, and durable medical equipment and supplies. This will allow providers to redeploy resources used to complete these functions, as needed.

In addition to the services listed above, CCP is waiving prior authorization requirements for all services (except pharmacy services) necessary to appropriately evaluate and treat CCP FHK enrollees diagnosed with COVID-19.

Limits on Services

  • CCP is lifting all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. This will assist CCP enrollees who may need to be self-quarantined for a period of time.
  • CCP will reimburse for a 90-day supply of maintenance prescriptions when available at the pharmacy. CCP enrollees must request that the pharmacy dispense a 90-day supply. In addition, CCP is waiving any limits on mail order delivery of maintenance prescriptions.

Co-payments

CCP is waiving co-payment requirements for Emergency Room Visits, Inpatient Care, Urgent Care Centers, physician & hospital services, advanced practice registered nursing services, physician assistant services, telehealth, home health services, and durable medical equipment and supplies for the FHK line of business.

In-person Provider Site Visits

In order to reduce community-spread of the virus, CCP will be postponing in-person provider-site visit requirements (e.g., enrollment, credentialing, etc.) until further notice. Your assigned Provider Operations Representative will be contacting you in the not too distant future to schedule a Site-Visit via WebEx or telephonically at a mutually convenient time.

Reimbursement of Telemedicine/Telehealth services?

CCP’s Florida Healthy Kids lines of business reimburses for telemedicine/telehealth services that use interactive telecommunication equipment such as, at a minimum, audio and video equipment that permit two-way, real time, interactive communication between the patient and practitioner.

PCPs must include modifier GT on the CMS-1500 claim form.

Example: 99213 GT

Telemedicine/telehealth services must also be documented appropriately in the member’s medical record. Medical records for services provided via telemedicine/telehealth will be reviewed against the telemedicine/telehealth claims to ensure that the services rendered are documented to: