COVID-19 Payment Increase for Medallion 4 Providers of Certain Evaluation and Management Codes
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The purpose of this memo is to inform you that the Department of Medical Assistance Services (DMAS) has directed all Medallion 4.0 Managed Care Organizations (MCOs) to provide MCO contracted physicians and non-physician professional providers who provided Evaluation and Management (E&M) services between March 1, 2020 and June 30, 2020 a temporary uniform payment increase of 29% for these services. The directed payment is a temporary relief payment for Medallion 4.0 in-network physicians and participating non-physician professional providers who provided E&M services within the CPT procedure code range of 99200 through 99499 to Medicaid Medallion 4.0 members during the COVID-19 pandemic. No additional funding will be provided by DMAS to the MCOs for this temporary increase.
DMAS is currently working with the Medallion 4.0 MCOs to develop a plan to adjust the impacted claims and pay providers by October 31, 2020. Providers should not resubmit claims to the MCO. Network providers should direct questions about MCO directed payments to their contracted MCOs. MCO operational processes for these changes may vary from MCO to MCO.
The CMS guidance document providing authority for this temporary adjustment can be found at https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/cib051420.pdf.
This directive does not apply to CCC Plus claims incurred during this period. Certain CCC Plus providers previously received a directed payment as a result of the COVID-19 pandemic.
DMAS will issue additional information regarding the implementation of this policy as it is developed.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
1-800-884-9730 or 1-800-772-9996 |
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KEPRO Service authorization information for fee-for-service members.
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), |