Coronavirus Update

Neighborhood temporarily waived prior authorization (PA) requirements for various services throughout the pandemic, however, Neighborhood’s Temporary COVID-19 Prior Authorization Policy was updated October 1, 2021 to reflect the reinstatement of PA requirements for our Medicaid and INTEGRITY lines of business.   For our Commercial lines of business, PA requirements continue to be waived for non-pharmacy primary COVID-19 related diagnostic and treatment services. Pharmacy Authorization processes remain in effect.

Behavioral Health Services

• For all lines of business, we will continue to waive PA requirements for all non-pharmacy primary COVID-19 related diagnostic and treatment services through December 31, 2021 for behavioral health services.

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.

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.
• 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.

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

The Rhode Island Department of Health (RIDOH) has created a dedicated webpage with resources to help healthcare providers with guidance on the COVID-19 vaccine.  Providers can visit this page for more information on how to enroll as a COVID-19 vaccine provider, as well as, how to receive, administer, and recommend COVID-19 vaccines.

All member cost share for behavioral health services are waived under the new expanded telemedicine/telephone-only payment policy.  In office visits are BAU.

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.

Neighborhood has extended the coverage period for the below services and will not require authorization when prescribed by a physician for the listed diagnoses. Please note, this is extended until 12/31/2021 and is the final extension. The coverage will end on 12/31/2021.

If you have any questions, please reach out to Integra at claims@accessintegra.com.

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.

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.

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.

Neighborhood does not require referrals for any service.

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.

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.