COVID-19 Provider Guidance
Neighborhood is grateful to our network providers for the care and response provided to our members during the COVID-19 pandemic. In an effort to assist you in working with Neighborhood during this evolving situation, we have compiled a list of frequently asked questions and answers regarding COVID-19.
Below is a list of frequently used payment policies during the COVID-19 pandemic. Click here to view all current Neighborhood billing guidelines and payment polices. Former versions of the temporary COVID-19 payment polices are listed in the “Archives.”
- COVID-19 Vaccine Payment Policy – Updated June 15, 2021
- Temporary COVID-19 Prior Authorization Policy – Updated June 10, 2021
- Temporary COVID-19 Telemedicine/Telephone-only
- Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits
- Temporary COVID-19 Testing and Treatment Services Policy
- Telemedicine Payment Policy
Throughout this challenging time, Neighborhood has worked closely with the Rhode Island Department of Health, the Rhode Island Office of the Health Insurance Commissioner (OHIC), the Executive Office of Health & Human Services, and other health experts to understand the impact to our members, providers, as well as, our own business. This page will be updated as more information becomes available.
Wellness Summit: Addressing Physician Burnout during the COVID Pandemic | Click here to watch the June 15, 2021 event. Presented in partnership with Providence Business News, this was the first summit of a two-part wellness series supporting health care professionals. The second summit is scheduled for September 9, 2021. To receive an invitation to this event and sign up for email communication from Neighborhood, click here.
What is Neighborhood’s temporary COVID-19 prior authorization policy?
Neighborhood temporarily waived prior authorization (PA) requirements for various services throughout the pandemic. Based on OHIC bulletin 2021-03, Neighborhood’s Temporary COVID-19 Prior Authorization Policy was updated June 10, 2021 to include the following:
- While no longer required by OHIC, Neighborhood will continue to waive PA requirements for all non-pharmacy COVID-19 related medical and behavioral health diagnostic and treatment services through August 31, 2021 for all lines of business (LOB). Neighborhood will continue to support our hospital systems to ensure any barriers are addressed as vaccine efforts continue and vaccination rates increase.
- Reinstatement of “pre-pandemic” PA procedures for all other services, including all inpatient medical admissions and all behavioral health services for all LOB, including:
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- Inpatient Acute Care level of care determinations
- Skilled Nursing Facilities
- Inpatient Rehabilitation
- Long Term Care Facilities
- In-patient COVID-19 related treatment in out-of-network facilities
Neighborhood will require notification for admissions and transfers with a primary COVID-19 diagnosis to track and serve members admitted to inpatient facilities, as that is the current process. Notification of admission or transfer can be faxed directly to Neighborhood’s Utilization Management (UM) department. The UM fax number is 1-401-459-6023.
Neighborhood’s behavioral health vendor requires notification for all admissions and transfers. Neighborhood reserves the right to perform retrospective reviews and concurrent reviews. For the most current behavioral health information, providers should contact OPTUM Provider Express.
Neighborhood reserves the right to perform retrospective reviews and concurrent reviews. Pharmacy Authorization processes remain in effect.
Who should be tested for COVID-19?
The Rhode Island Department of Health (RIDOH) recommends COVID-19 testing for:
- People with symptoms of COVID-19
- People who may have been exposed to someone with COVID-19
- Certain asymptomatic populations.
Test Ordering Options
Outpatient healthcare providers can order COVID-19 tests for patients in the following ways:
- Use the online ordering system at ri.gov to order a test for a patient who has symptoms or may have been exposed to someone with COVID-19. The ordering clinician may choose from a list of State-run testing sites located throughout Rhode Island. VIEW STEPS
- Refer patients to a local respiratory clinic for COVID-19 testing.
- Primary care providers and respiratory clinics performing in-office specimen collection and sending tests to a lab for processing should order tests according to the office’s or lab’s protocol.
- Additional testing options for pediatric patients are noted below.
RIDOH encourages facilities that have the capacity to conduct point-of-care testing to contact test kit manufacturers directly to place an order. RIDOH has a limited supply of BinaxNOW rapid antigen test kits that are available to some clinics. To see if your facility qualifies to receive some of these tests, email ridoh.providerquestions@health.ri.gov.
Health care workers who are not able to get tested through their employers can use the testing options above.
Connecticut and Massachusetts healthcare providers caring for Rhode Island residents can gain access to Rhode Island’s online ordering portal by emailing ridoh.providerquestions@health.ri.gov. Rhode Island providers seeing Massachusetts patients can refer those patients to testing through a Respiratory Clinic or in their home state as needed.
All Rhode Islanders can also self-schedule a COVID-19 test on portal.ri.gov, regardless of whether they have symptoms or if they have been identified as a close contact of someone with COVID-19.
For more information about COVID-19 testing in Rhode Island, including an up-to-date list of testing sites and guidance about testing for different populations, visit health.ri.gov/covid/testing.
Pediatric Patient Testing
Providers may use the online ordering system at schedulecovidtest.ri.gov to schedule a COVID-19 test for a pediatric patient. The parent or caregiver may be asked to swab children younger than age 12 with coaching from the staff at the testing site.
This page has information about clinics that offer COVID-19 testing for children. Note that some locations have restrictions on the age groups that can be tested.
Parents can also schedule a COVID-19 test for a child enrolled in a K-12 public or private school by calling the K-12 test scheduling service at 844-857-1814. This program is reserved for K-12 students and staff members who are symptomatic or have been identified as a close contact of a positive case. Pre K students and staff must be part of a Pre K program that is associated with an elementary school to be eligible for this testing program. MORE INFORMATION
What ICD-10 code should I use to diagnosis COVID-19?
Effective January 1, 2021, ICD-10 diagnosis code Z20.822 is replacing previously used code Z20.828 in the following instances:
Claims for exposure to someone with a confirmed case of COVID-19 should be billed with the following ICD-10-CM code:
- Dates of service April 1, 2020 to December 31, 2020:
Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases)
- Dates of service January 1, 2021 and after:
Z20.822 (Contact with and (suspected) exposure to COVID-19
Claims for members presenting with symptoms of and being screened for COVID-19 and the test results are either unknown or negative should be billed with the following ICD-10-CM codes as applicable:
- R05 (Cough)
- 02 (Shortness of breath)
- 9 (Fever, unspecified)
- 818 (Encounter for observation for suspected exposure to other biological agents ruled out)
- 828 (Contact with and (suspected) exposure to other viral communicable diseases) –Effective April 1, 2020 to December 31, 2020
- 822 (Contact with and (suspected) exposure to COVID-19)- Replaces Z20.828 Effective January 1, 2021
- Effective 1/1 CPT Code U0005 is a covered PCR and Antigen Testing code
For more information, go to: https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-19-508.pdf
How can providers help with vaccine outreach?
The Rhode Island Department of Health (RIDOH) has created community partner activation briefs, which offer ways that healthcare providers and organizations can get involved in sharing the RIDOH message related to the COVID-19 vaccine.
In addition, the Ad Council and the COVID Collaborative have released a new resource designed to address healthcare professionals’ questions about COVID-19 vaccination. Organized in the form of a toolkit, the resource includes videos (featuring Dr. Anthony Fauci and other leading healthcare and medical experts), a press release, FAQ’s, talking points, social media posts and many customizable materials. Topics addressed include safety, availability, cost, side effects, vaccine administration, answering patients’ questions and more. Find the toolkit on the National Public Health Information Coalition (NPHIC) website: https://www.nphic.org/cvirus-adcouncil-toolkit
Is Neighborhood’s temporary telemedicine payment policy for telephone only?
Neighborhood expanded its existing payment policy for telemedicine services temporarily during the COVID-19 pandemic. The payment policy is not limited to telephone only. Neighborhood encourages all providers to use HIPAA-compliant technology when available, but recognizes in some cases this may ne be possible. If using alternative options, Neighborhood requests that providers implement reasonable HIPAA safeguards. For more information, please visit: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf
Will Neighborhood and Optum waive co-pays for behavioral health care services?
All member cost share for behavioral health services are waived under the new expanded telemedicine/telephone-only payment policy. In office visits are BAU.
Has Neighborhood waived the PCP assignment/requirement for members during COVID-19?
Yes, Neighborhood has temporarily waived the PCP assignment/requirement, beginning April 1, 2020. This means a Neighborhood member can see any primary care provider they can access during the COVID-19 pandemic for their healthcare, regardless of the PCP name assigned on the member’s Neighborhood ID card.
As a reminder, Neighborhood does not require referrals for any service.
Is Neighborhood offering a benefit exception for any durable medical equipment (DME)?
Effective April 1, 2020 Neighborhood and our DME partner DMEnsion/Integra are temporarily allowing 90-day benefit exceptions, in select cases, for Automatic Blood Pressure Monitors and Electronic Scales, ensuring the most at-risk members are able to receive services they need to remain comfortable in their homes.
Effective 4/1/2020 through 9/30/2021, the following services will not require authorization when prescribed by a physician for the listed diagnoses. Please note a prescription is still required.
If you have any questions, please email dmensionprovider-relations@dmension.net.
| HCPCS | Description | Diagnoses | Quantity Limit | Allowable |
| A4670 | Automatic Blood Pressure Monitor | All | 1 unit | $85 |
| E1639 | Scale | – End Stage Renal Disease (ESRD) – Chronic Heart Failure (CHF) – Chronic Kidney Failure |
1 unit | $75 |
On behalf of Neighborhood and DMEnsion/Integra, we are grateful for our DMEPOS providers on the front lines. We acknowledge that the COVID-19 pandemic is having an impact on the health of family members, friends, the businesses on which we rely, and the global economy. Our thoughts are with those affected in this unprecedented time. Please contact the DMEnsion Benefit Management Customer Service team, servicing Neighborhood providers at 866-205-2122 with any questions.
Will Neighborhood “emergency credential” providers during the State of Emergency?
Neighborhood is grateful for healthcare professionals who were willing to obtain an emergency medical license in Rhode Island to help during the COVID-19 crisis. Effective June 11, 2021, Neighborhood will no longer “emergency credential” providers. Neighborhood will resume all normal credentialing and re-credentialing processes effective June 11, 2021.
Are there updates to pharmacy coding to allow for early refills or extended day supplies?
Yes, dispensing pharmacists will be able to enter overrides at the pharmacy at point of sale. The guidelines below have been put in place to allow for medication access, but to also prevent situations like stockpiling. Pharmacies should call their help desk if they experience any issues processing prescriptions.
- The coding will enable dispensing pharmacists to enter a submission clarification code (SCC13) at the pharmacy to bypass the refill-too-soon (RTS) rejections.
- Medicaid and Exchange plans that have a maximum day supply (DS) of 30 at retail will be able to obtain up to three, 30 days supply early fills.
- Members will have a maximum of 3 fills within a 90-day window. Members can request all 3 fills at once, but they would have to wait another 90 days to obtain the SSC13 RTS benefit again. Please note that consecutive filling is at the discretion of the dispensing pharmacist. For example, if there is limited inventory of medications at that pharmacy, the pharmacist may not be able to dispense all 3 fills at once.
- **Controlled substances and Specialty medications are excluded**
- Exchange plans that have a maximum day supply of 90 at retail will be able to obtain a 1-time 90 DS early refill.
- **Controlled substances and Specialty medications are excluded**
- MMP plans have early refill benefits, but no restriction on number of fills at this time.
Will Neighborhood waive deductible and/or cost-sharing requirements for Commercial members with costs related to COVID-19 testing?
Neighborhood will waive the cost of the diagnostic testing and treatment for COVID-19. Neighborhood has developed a Temporary COVID-19 Testing Services payment policy for billing diagnostic testing services and treatment related to COVID-19.
Will Neighborhood waive referral requirements for members seeking testing or treatment for COVID-19?
Neighborhood does not require referrals for any service.
What else is Neighborhood doing to address COVID-19?
Neighborhood is actively engaged with the Rhode Island Department of Health (RIDOH) and other regulatory agencies. In addition, Neighborhood is:
- Educating members on steps they can take to prepare and stay healthy.
- Directing members to CALL their provider if they exhibit symptoms.
- Creating a web page, offering information from the Centers for Disease Control and Prevention (CDC) and RIDOH, including the local COVID-19 Info Line 401-222-8022 (available Monday through Friday, 8:30 a.m. to 4:30 p.m.) and email: RIDOH.COVID19Questions@health.ri.gov
- Continuously monitoring COVID-19 developments and assessing whether emergency preparedness plans and modifications to plan practices need to be implemented.
When will the Neighborhood building in Smithfield re-open?
For the safety of Neighborhood staff, our members, and our community, Neighborhood closed its office to visitors, effective March 23, 2020. As a company, Neighborhood has engaged our emergency response team to activate protocols that aim to minimize disruption to daily business operations that impact members and providers. We are beginning to re-open to some employees in summer 2021 and have plans to be fully open to all staff and visitors very soon. Neighborhood members and providers can still reach us during normal business hours.
Additional Resources
- Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (From CMS on January 7, 2021)
- COVID-19 Long-Term Care Facility Guidance (From CMS on April 2, 2020)
- Telehealth Toolkits for General Practitioners and ESRD Providers (From CMS on March 20, 2020)
- General Provider Telehealth and Telemedicine Tool Kit (From CMS on March 17, 2020)
Last updated: Jul 28, 2021 @ 11:43 am
Previous Updates: Mar 10, 2020 @ 4:46 pm; Mar 6, 2020 @ 5:08 pm