December 3, 2020 | By Holly Cassano, CPC, CRC
There are not many positives that are generally born out of a Pandemic, but for the COVID 19 Pandemic, there have been a few and one of them is the creation of the HRSA Uninsured Portal. I call it a provider “Godsend” as it has allowed providers to treat uninsured individuals who reside in the United States, whether full-time or part-time (here on a work visa as well), without having to worry about how their patients will pay for COVID-19 related services.
Unfortunately, I discovered a few months ago, that there are still many practices and providers that are not enrolled in HRSA. I was trying to assist a friend of mine, who is uninsured, obtain a COVID-19 Rapid test and office visit. She had been experiencing several signs and symptoms of the virus, plus she had other comorbidities that put her at a higher risk of contracting it. I started calling around to several primary care and urgent care offices around the area where we both live. To my sheer amazement, there were many practices, that had no idea that the HRSA Portal even existed. I tried to explain it to a few urgent care centers, but they all said she would have to pay upfront, as did the primary care practices I contacted. I then decided that maybe writing about it for NAMAS, might be a good avenue to reach some practices that are still unaware of this valuable resource.
The HRSA Portal (Health Resources and Services Administration), started in March of 2020, after the pandemic was officially declared, but has allowed providers/labs to submit claims for DOS on or after February 4, 2020. HRSA determines eligibility of submitted claims, as well as reimbursement at current Medicare rates. All of which is subject to availability of funds.
HISTORY OF HRSA:
This was born out of a collaborative effort primarily under the FFCRA (Families First Coronavirus Response Act), and the CARES Act (the Coronavirus Aid, Relief, and Economic Security Act), along with HHS (the U.S. Department of Health and Human Services). To date, close to $13 Billion has been paid to over 320,000 enrolled health care providers, in reimbursement for treating the uninsured, during the pandemic (again, ONLY for COVID 19 related services).
UnitedHealth Group is the Administrator for the HRSA Portal and under the direction of HRSA. Non-participating providers will not have to engage in credentialing/contracting with UHC (United Health Care), and therefore adjudication is not subject to UHC Guidelines, it is all under the guidance and terms of HRSA.
HOW TO ENROLL:
A practice/provider must register on the HRSA Portal and provide the following information:
- Validate your TIN
- Add your provider roster
- Register for direct deposit
- Add & attest to your patient roster
- Submit your claims
- Receive your reimbursement
The below links are to guides/videos that will assist you further if necessary:
HRSA PORTAL REGISTRATION: https://www.hrsa.gov/opa/registration/index.html
HRSA USER GUIDE: https://chameleoncloud.io/review/2957-5e98adf692326/prod
Once a TIN is validated and set up with Optum Pay, claims that are deemed eligible for reimbursement are generally paid within about 30 business days. The below links are to guides/videos that will assist you further if necessary:
OPTUM PAY SET UP INSTRUCTIONS GUIDE: https://chameleoncloud.io/review/2957-5e98adf692326/prod
OPTUM PAY SET UP VIDEO: https://coviduninsuredclaim.linkhealth.com/static/ACH%20Enrollment%20Video.mp4
EVERY claim must be electronically submitted utilizing an 837 EDI transaction set. Each claim is submitted outside the HRSA Portal will require the specially created HRSA Program Payer ID 95964, along with the newly created Payer Name: COVID-19 HRSA Uninsured Testing and Treatment Fund.
Once the claims are submitted, either individually or on a roster, a temporary member ID, will be created for each accepted claim. Each time a patient claim is submitted, it will create a new temporary member ID for that patient’s DOS. The below links are to guides/videos that will assist you further if necessary:
Claims submitted on or after February 4, 2020, will be eligible for payment for all COVID-19 testing, testing-related visits, treatment, and vaccination administration fees, for uninsured individuals, that are submitted with a COVID-19 primary diagnosis. Please note that timely filing is the same as Medicare MACs/FI’s, etc., and of course, available funding.
- Specimen collection, diagnostic, and antibody testing
- Testing-related visits to include office, urgent care, emergency room, and telehealth settings
- Treatment including office visit, telehealth, urgent care, emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment
- Administration fees related to FDA-licensed or authorized vaccines
BREAKING THINGS DOWN BY THE CODES:
ALL Claims MUST have a Primary Diagnosis that reflects one of the below COVID-19 diagnosis codes, to be eligible for reimbursement. All claims submitted for testing-related visits rendered in an Office, Urgent Care or Emergency Room or via Telehealth for related services MUST ALSO, include one of the following diagnosis codes: (current list as of November 2021. Some codes may have been deleted/added)
- 818 Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
- 828 Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
- 59 Encounter for screening for other viral diseases (asymptomatic)
- 52 Encounter for screening for COVID-19, asymptomatic
- 822 Contact with and (suspected) exposure to COVID-19
- 16 Personal history of COVID-19
PRIMARY DIAGNOSIS CODE EXCEPTIONS:
- The COVID-19 code may be listed as secondary in the case of pregnancy (O98.5-)
- Any claim that includes one of the following codes is not eligible for reimbursement: 59812, 59820, 76815
- COVID-19 diagnosis code for dates of service or dates of discharge prior to April 1, 2020 (see recent guidance CMS CR 11764 (PDF) for additional information)
- 29 Other coronavirus as the cause of diseases classified elsewhere COVID-19 diagnosis codes
- COVID-19 diagnosis code for dates of service or dates of discharge on or after April 1, 2020: U07.12019-nCoV acute respiratory disease
ANTIBODY TESTED AND RELATED SERVICES:
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: (current list as of November 2021**some codes may have been deleted/added).
- 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])
- 86408 SARS-CoV-2 neutralizing antibody screen
- 86409 SARS-CoV-2 neutralizing antibody titer
All claims submitted for the administration only of an FDA-licensed or authorized vaccine are required to be submitted as a single line item and one of the following codes below must be included to be considered for payment:
- Pfizer: 0001A, 0002A, 0003A, 0004A, (FDA APPROVED) (BOOSTERS APPROVED)
- Moderna: 0011A, 0012A, 0013A, (PENDING FDA APPROVAL) (BOOSTERS APPROVED)
- Janssen: 0031A, (PENDING FDA APPROVAL)
- Only the administration of the vaccine is eligible for reimbursement
- In-home vaccine administration is reimbursable; however, you will need to add a second line item with code M0201.
As with anything payer-related, there are several services that HRSA will not cover/reimburse. They primarily correlate to services that Traditional/Straight Medicare will not cover. Below is a list of NON-COVERED SERVICES:
- Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary
- Outpatient prescription
- All claims submitted must be complete for the DOS
- Corrected claims, voided claims transactions and appeals will not be accepted
- Interim claims will be individually considered for outpatient hospital claims with dos that crossover during a calendar year
- Claims can be submitted individually or on a roster (see below)
- HRSA CSV roster submission form: https://coviduninsuredclaim.linkhealth.com/static/patientrostertemplate.csv
- Provider support line: 866-569-3522 for TTY dial 711(hours of operation are 8 a.m. To 10 p.m. Central time, Monday through Friday)
- Main link to the portal: https://www.hrsa.gov/coviduninsuredclaim
CORRECTED CLAIMS AND APPEALS WILL BE CONSIDERED WHEN A PATIENT’S PRIMARY INSURANCE DENIES, STATING THE PATIENT IS NOT COVERED AND YOU ALREADY SUBMITTED IT TO HRSA AND HRSA DENIED IT FOR ANOTHER PRIMARY INSURANCE.
In conclusion, once you get set up on the portal and go through a few submissions, you will really see the full benefits of this wonderful resource and how it will continue to help your practice’s cash flow and assist the community during this challenging Pandemic that is COVID-19!
Stay safe and remember, We are all in this together!