Frequently Asked Questions for Providers

Provider Eligibility and Qualifications

Question: I am a provider that was provisionally credentialed for the COVID-19 event. Do I still need to enroll through DXC?

Answer: If provisionally credentialed with an MCO, you will still need to complete a temporary emergency enrollment application with DXC to be paid for testing and testing related services to the uninsured. The application is available online, here.

 

Question: I am an out-of-state provider for Louisiana Medicaid services. Do I need to enroll as a provider for special COVID-19 coverage through DXC?

Answer: If you are an out-of-state provider currently enrolled with DXC, then you do not need to re-enroll for COVID-19.  However, if you are not enrolled with DXC as a Medicaid provider, you will need to complete a temporary emergency enrollment application with DXC to be paid for testing and testing related services to the uninsured. The application is available online, here.

 

Question: Can I provide COVID-19 testing services if I am in the process of enrolling?

Answer: You must be an enrolled provider prior to supplying Medicaid reimbursable services. You can call DXC Provider Enrollment to confirm status of your provider application. That number is (225) 216-6370.

 

Question: Can my provider enrollment be retroactive?

Answer: Retroactive provider enrollment is possible back to March 1, 2020, but there are exceptions. Not all provider types are eligible for retro enrollment. For example, physicians and physician groups are eligible but FQHCs and RHCs are not. Additionally, the provider must meet all eligibility requirements on the active date of enrollment.

 

Question: Is this different from the testing coverage that is provided by the U.S. Department of Health and Human Services (HHS)? How can a provider bill HHS?

Answer: Yes. A portion of the federal funding dedicated to COVID-19 relief will be used to reimburse COVID-19 testing and treatment for the uninsured per the CARES Act. Providers must submit claims to HHS for reimbursement. Additional information and a portal for submitting reimbursement claims are available at https://www.hhs.gov/provider-relief/index.html.

 

Question: A patient has presented in my office for testing that states they are already covered or have already applied for coverage through the Medicaid COVID-19 Uninsured Eligibility group. As such, they do not need to fill out an application. If there is no application completed in my office, how do I provide Medicaid my attestation that I will not bill HHS and Medicaid for the same coverage?  

Answer: If the provider does not need to submit an application on behalf of the patient, the provider can complete a portion of the application and submit to Medicaid to provide the attestation. The provider can do this by completing the following parts of the application:

  • Section 2 – Applicant Information. Fill in, at a minimum, the patient name, social security number and date of birth.
  • Section 4 – Health Insurance.
  • For provider use only (page 3). Include your signature, date signed, your name and email address.

If the provider does not have proof that the patient has coverage, they can have the patient complete the application in their office. It will not impact coverage if Medicaid receives multiple applications.

 

Question: If Medicaid discovers there is third party coverage available after the provider submits the claim, will the provider be notified and given policy information to bill the correct provider?

Answer: Yes, the provider will receive the denial and the remittance advice (RA) will explain the third party coverage. It will not report the patient’s specific policy information.

 

Patient Eligibility and Qualifications

Question: If a patient has applied for full Medicaid, but has not yet received approval, should they apply for the COVID-19 coverage? What happens if they apply for both and get approved for full coverage?

Answer: If a patient has applied for full Medicaid, the provider should check MEVS to determine if the individual has been approved for coverage. If there is no coverage in MEVS, the patient should apply for the COVID-19 coverage. When considering eligibility for the full Medicaid application, Medicaid does not consider COVID-19 coverage. The only way to be considered for that temporary coverage is to apply using the simplified application. If the patient is approved for COVID-19 coverage and subsequently approved for full Medicaid coverage, they will be moved to full Medicaid.

 

Question: Why should a provider check MEVS if the member is uninsured since they would not be in the Medicaid system?

Answer: The provider should always check MEVS for coverage to confirm that the patient’s information is accurate. It is possible that the patient is not aware of existing or expired coverage with Medicaid. 

 

Question: What does “satisfactory immigration status” mean?

Answer:  Someone that is in the United States legally would be considered to have satisfactory immigration status. This would include a U.S. Citizen or a qualified alien or someone not subject to the five-year bar. It is the responsibility of the patient to provide immigration information and attest to the accuracy of that information on the application. 

 

Services Covered

Question: Are “rule out” tests covered? Examples would include flu or strep. 

Answer: No. The benefit only covers testing for COVID-19. Patients with suspected COVID-19 (e.g., due to symptoms or an exposure) should be tested for COVID-19. The decision to test for COVID-19 should not be based on the results of any other test.

 

Question: Will after hour visits (99051) be reimbursed?

Answer: Yes. In addition to the appropriate evaluation and management code, providers may bill for after-hours services when provided Monday through Friday between 5 p.m. and 8 a.m. (when outside of regular office hours), weekends (12 a.m. Saturday through midnight on Sunday), or state/governor proclaimed legal holidays (12 a.m. through midnight). See the Medicaid Professional Services provider manual for billing details.

 

Question: If a patient tests negative for COVID-19, how is the provider to bill regarding order of diagnoses?  

Answer: Providers should follow diagnosis coding guidelines produced by the Centers for Disease Control and Prevention.

 

Patient Application Process

Question: Is there a way to apply online?

Answer: No. There is only a paper application. However, individuals can call 1-888-544-7996 to apply by phone.

 

Question: Should the provider keep a copy of the Provider Checklist in the patient’s record? If the patient provides false information to receive services, could this be used as supporting documentation in a recoupment?  

Answer: Maintaining a copy of the Provider Checklist is at the discretion of the provider. Medicaid will not seek recoupment from the patient unless they are convicted of benefits fraud. In such cases, Medicaid does not recover from the provider either. If the patient has other coverage, it is possible that Medicaid will seek recoupment from the provider.

 

Question: Does Medicaid have to approve/process the application before services can be provided?

Answer: No. If the patient is ultimately determined ineligible for the Medicaid COVID-19 Uninsured Eligibility group, the provider should bill HHS.

 

Question: The application process allows the provider to provide their details on the form so they will get a copy of the eligibility decision letter from Medicaid. If the patient has already submitted an application prior to seeing the provider, how will the provider find out about the decision.  

Answer: The provider can check MEVS for coverage. The eligibility group will show up as “COVID-19 Uninsured Eligibility Group”. 

 

Question: How long will it take from submission of an application to decision?   

Answer: Medicaid anticipates turnaround time for approval will be between 3-5 business days.