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July 19, 2021 at 5:00 PM CT

COVID-19 national public health emergency extension

The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency by another 90 days. It was scheduled to end July 19, 2021 and now is scheduled through Oct. 17, 2021. The Summary of COVID-19 Temporary Program ProvisionsCOVID-19 Billing Guide and UHCprovider.com/COVID19 web pages have been updated to reflect this extension.

COVID-19 Information for Empire Plan Network Providers

Last update: May 13, 2021, 10:01 a.m. CT

The Empire Plan is a self-funded, non-ERISA health insurance option available to those eligible to participate in the New York State Health Insurance Program (NYSHIP) - primarily New York State government employees, retirees, and their dependents. Nationwide, the plan covers over one million members. 

The top priority of UnitedHealthcare and The Empire Plan is the health and well-being of the people we serve. A team of experts is working quickly to make sure our members and their care providers have what they need to respond to the COVID-19 public health emergency. We understand the urgency and sensitivity during this time and want to do everything we can to support your needs. 

The information provided on this page is intended to supplement the general COVID-19 information provided at UHCprovider.com/covid19 and offer Empire Plan-specific guidance when needed. Be sure to check back here and at UHCprovider.com often for updates.

As with any public health emergency, UnitedHealthcare and The Empire Plan will work with and follow all COVID-19 guidance and protocols issued by the U.S. Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and state and local public health departments. For the latest news and guidance on the virus, please visit cdc.gov/coronavirus/2019-ncov.

In accordance with current regulations, UnitedHealthcare will waive Empire Plan member copays, coinsurance and deductibles for:

  • COVID-19 testing performed at approved locations and following Centers for Disease Control and Prevention (CDC) guidelines.
  • Visits in conjunction with the above COVID-19 testing to diagnose the novel coronavirus (COVID-19) at the following locations, including through telehealth:
    • An in-network provider’s office
    • An in-network urgent care center
    • An emergency department of a hospital
    • Any other in-network outpatient provider setting able to diagnose the novel coronavirus (COVID-19)

Members should not be billed copayments or have any cost sharing for the above services.

To help ensure proper claim payment, please follow the coding/billing guidance below.

Service
Code(s) to bill
Additional information

Testing-related services, including visits

Appropriate service code, including Evaluation and Management (E&M) codes

Place of service:

(23) Emergency room

(20) Urgent care

(11) Office visits/telehealth

(02) Telehealth, as of Jan. 1, 2021

Cost share will be waived when billed with appropriate ICD-10 diagnosis code Z03.818, Z11.52, Z11.59, Z20.822 or Z20.828.

Specimen collection

HCPCS codes: G2023 and G2024

Cost share will be waived for these COVID-19-specific specimen collection codes.

CPT® code: 99001

Cost share will be waived for specimen collection when billed with appropriate ICD-10 diagnosis code Z03.818, Z11.52, Z11.59, Z20.822, or Z20.828.

C9803

Outpatient hospital facility only. Submit to The Empire Plan Hospital Program (BlueCross).

 

If you have previously submitted claims where you believe UnitedHealthcare incorrectly applied a copayment, submit a corrected claim or contact customer care at 877-7-NYSHIP (877-769-7447). If you have any questions, contact your Empire Plan network representative.

Update Regarding Empire Plan Timely Filing

As noted in the February 2021 issue of The Empire Plan Network News, UnitedHealthcare is following the IRS/DOL regulation related to the National Emergency declared by the president. This regulation pauses the time clock for claim submission during the national emergency period that began on March 1, 2020. 

We previously indicated that this pause extends through the end date of the National Emergency period plus an additional 60 days. However, a recent clarification indicates that the timeframe may be extended 60 days after the president declares an end to the National Emergency period, up to a maximum of one year after the normal deadline. Based on this, the filing deadlines are as follows:

  • 2019 Empire Plan Claims – Timely filing deadline is April 29, 2021.
  • 2020 Empire Plan Claims – To expedite reimbursement, we encourage you to submit by April 30, 2021 (the normal deadline of 120 days after the end of the calendar year). However, based on the IRS/DOL regulation, claims may currently be submitted through Sept. 17, 2021, given the national public health emergency period is currently scheduled to end on July 19, 2021. This submission date is subject to change if the national public health emergency period is extended.

We apologize for any confusion caused by our prior communication.

Disclaimer:

The Empire’s policyholder is the State of New York, and each aspect of the plan (hospital, prescription drugs, medical, behavioral health) is awarded separately via a Request for Proposal process, meaning multiple carriers are involved in plan administration. The UnitedHealthcare portion of the plan includes a non-hospital based PPO component for in-network benefits. In addition to use of UnitedHealthcare’s nationally contracted providers nationwide, UnitedHealthcare’s Options PPO network providers serve as the participating providers for the in-network component in:  Arizona, Connecticut, Florida, Illinois (Chicago and surrounding counties), Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, Washington D.C. and West Virginia. UnitedHealthcare’s Empire Plan Network Management based in Kingston, NY, manages a standalone Empire Plan Network for all other states, with the primary population of those providers located in New York.