Insurance Carriers are Required to reimburse providers for telehealth services during the COVID-19 Emergency

What you need to know about DOI Emergency Regulation 20-E-05

When is this regulation effective?

April 3, 2020 until the end of the emergency.

Which plans does this apply to?

The regulation applies to all carriers offering individual, small group, large group plans, managed care plans, and student health insurance coverage that are CO-DOI regulated and subject to the ACA.

Which communication platforms are covered?

All audio visual and telephone communications systems, including audio only telephone calls and non-public facing live video technologies. Carriers cannot deny payment for the use of remote communications technologies that do not fully comply with HIPAA requirements during the COVID-19 emergency and they cannot impose specific requirements or limitations on the platforms used to deliver services.

Public-facing live video communications are not HIPAA compliant and should be avoided. (Examples: Facebook Live, Instagram Live, TikTok, and Twitch)

How will providers be reimbursed for telehealth services?

At the same rates as those same services delivered in-person.

Can I see new patients?

Yes. Carriers cannot require a covered person to have an existing patient/provider relationship for that person to receive medically necessary services via telehealth from that provider.

How do I bill telehealth services?

Carriers are required to notify providers of any specific instructions necessary to bill telehealth as well as display these instructions prominently on their website. For claims processing, a carrier cannot require documentation of a service provided via telehealth beyond what is required of the same service provided in-person.

Division of Insurance: FAQ

Categories: Resources, COVID