Last update: May 13, 2021, 10:31 a.m. CT
The Coronavirus Aid, Relief and Economic Security (CARES) Act is designed to provide relief to individuals and businesses impacted by COVID-19. Here is key information that applies to health care professionals and to claim payments.
As part of the CARES Act, the U.S. Department of Health and Human Services (HHS) is contracting with UnitedHealth Group to facilitate the delivery of HHS’ initial $30 billion distribution to providers as quickly as possible in support of the national response to COVID-19. For information, visit hhs.gov/providerrelief. For questions regarding the distribution of funds, please call the toll-free CARES Provider Relief line at 866-569-3522.
On March 27, 2020, President Donald Trump signed into law a $2 trillion bipartisan package called the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act is designed to inject stimulus into the economy and provide relief to individuals and businesses impacted by COVID-19.
Here’s how UnitedHealthcare will apply the CARES Act increase in the DRG weighting factor to care provider payments.
For dates of service from Jan. 27, 2020 through the end of the national public health emergency period, Section 3710 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act increases the weighting factor applicable to the diagnosis-related group (DRG) by 20 percent under the Centers for Medicare & Medicaid Services (CMS) inpatient prospective payment system (IPPS) in the case of a discharge of an individual diagnosed with COVID-19. Due to a delay in CMS releasing necessary information related to the increase in this weighting factor, and to accelerate payment to care providers, UnitedHealthcare will process inpatient claims according to currently available information. Once CMS officially releases the updated weighting factor information, UnitedHealthcare will automatically reprocess the impacted claims. No action is required by care providers to initiate the reprocessing.
Medicaid and Individual and Group Market (Commercial) Health Plans
UnitedHealthcare pays contracted facilities according to the terms of their participation agreement. Facilities in our Medicaid and Individual and Group Market Health Plan (commercial) networks may be contracted based on several payment methodologies, including the MS-DRG payment method. As applied to providers in the Medicaid and Individual and Group Market Health Plan (commercial) networks, this payment method does not follow the CMS IPPS payment method. The payment appendices do not include add-on payments in the calculation of the contract rate. Providers in our Medicaid and Individual and Group Market Health Plan (commercial) networks are not entitled to the CARES Act 20% add-on payment under the terms of their participation agreement.
As previously noted, Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act creates a temporary waiver of the Medicare Sequester. Upon expiration of the waiver, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver for contracted care providers, out-of-network care providers and capitated groups.
Contracted Care Providers
We intend to implement the waiver according to the terms of care provider participation agreements. Upon expiration of the waiver, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver.
Out-of-Network Care Providers
For out-of-network providers who treat UnitedHealthcare Medicare Advantage members, we intend to implement the waiver for physician, facility, ancillary provider and other health care professional payments for claims with dates of service or dates of discharge from May 1, 2020 through the end of the waiver period. Once the waiver period ends, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver.
Capitated groups who are delegated for claims payment should review their direct contracts with downstream care providers to determine how their payment methodologies and rates relate to Medicare methodology and rates, and to determine whether to implement the waiver. If you have questions, please contact your network representative.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.