COVID-19 Reimbursement for Uninsured Patients

Community Health Centers (CHC) are eligible for reimbursement for the testing and treatment of COVID-19 patients who are uninsured. The Families First Coronavirus Response Act (FFCRA) Relief Fund appropriated $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured; and the Provider Relief Fund appropriated additional funds to reimburse providers for treating uninsured individuals with a COVID-19 diagnosis. The Health Resources & Services Administration (HRSA) has contracted with the UnitedHealth Group to pay for these services generally at Medicare rates for eligible services rendered on or after February 4, 2020.
 

Which Providers are Eligible?

Federally Qualified Health Centers, Rural Health Centers, Hospitals, Physicians, DME Companies, Laboratories, and Urgent Care Centers are eligible to enroll through the UnitedHealth Group’s Optum portal. CHC’s are required to use a unique identifier that enables entry into the HRSA COVID-19 Uninsured Program Portal. Or, if a CHC already has an Optum ID, it can be used to register through the portal. If the facility does not have an Optum ID, visit the program portal registration page.
 

How to Enroll

Step 1: Provider Enrollment

Each CHC will need to enroll as a provider participant using the Optum portal and accept the following terms.

  • Agree to program terms and conditions.
  • Accept defined program reimbursement as payment in full.
  • Agree not to balance bill the patient.
  • Agree to a post-reimbursement audit review.

Through the Optum portal, the CHC will validate the Taxpayer Identification Number (TIN) which can take 1-2 business days to process. Then, the CHC will add the provider roster for verification which can take 5-7 business days.

Step 2: Attestation

Provider must attest to the following for each patient that they have checked for health care coverage eligibility and confirmed that the patient is uninsured; verified that the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage; and no other payer will reimburse them for COVID-19 testing and/or care for that patient.

Step 3: Checking Patient Eligibility

CHC will check patient eligibility individually or through a batch format (Link to CSV file). Within 24 hours, facility will receive a temporary member ID for each individual after submitting patient information. The temporary member ID will be valid for 30 days from date of service, and eligible claims can be submitted using the temporary member ID with date of service within the validity period.

Step 4: Submit Claims Electronically

Eligible Claims with the appropriate diagnosis and procedure codes can then be submitted through the Optum portal. Reimbursement will be received periodically via direct deposit. All claims submitted must be complete and final, and no interim bills or corrected claims will be accepted. The Medicare timely filing requirements will apply to these claims, and there will be no adjustments to payment once claim reimbursements are made.
 

Additional Requirements

For COVID-19 Testing, CHC may submit specimen collection, diagnostic, and antibody testing as well as testing-related visits in the office or telehealth setting. Treatment in the office or telehealth setting is covered in this program as well as FDA approved drugs and vaccines as they become available for COVID-19 treatment. Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:

The HRSA COVID-19 Uninsured Program does not provide coding guidance to providers. Rather, the program provides billing guidance to allow providers to identify and submit only claims eligible for reimbursement under this program, which is exclusively for reimbursing providers for COVID-19 testing of uninsured individuals and treatment for uninsured individuals when COVID-19 is the primary reason for treatment. HRSA has developed the following guidance for claims reimbursement submission:

For dates of service or discharges on or after April 1, 2020, providers will use primary diagnosis U07.1 to indicate COVID-19 is the primary reason for treatment except for pregnancy for which providers will use O98.5 as primary diagnosis and U07.1 as the secondary diagnosis.

For dates of services or discharges prior to April 1, 2020, there is no equivalent diagnosis to indicate COVID-19 is the primary reason for treatment. To address this issue, HRSA has established separate guidance for this program to use B97.29 as the primary diagnosis when COVID-19 is the primary reason for treatment except for pregnancy for which providers would use O98.5 as the primary diagnosis and B97.29 as the secondary diagnosis (similar to how U07.1 is used).

For diagnostic testing and testing-related services to be eligible for reimbursement, claims submitted for testing-related visits rendered in an office or via telehealth setting must include one of the following diagnosis codes:

  • Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
  • Z20.828: Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
  • Z11.59: Encounter for screening for other viral diseases (asymptomatic)

For antibody testing and testing-related services to be eligible for reimbursement, claims submitted for testing-related visits rendered in an office, urgent care or emergency room or via telehealth setting must include one of the following procedure codes:

  • 86318: Immunoassay for infectious agent antibody, qualitative or semi-quantitative, single step method (e.g., reagent strip)
  • 86328: Immunoassay for infectious agent antibody(ies), qualitative or semi-quantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
  • 86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])

To access the Optum Portal for enrollment please visit: https://healthid.optum.com/tb/app/

For more information related to COVID-19 Claims Reimbursement please visit: https://coviduninsuredclaim.linkhealth.com/