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20-313 State of Emergency: Coronavirus (Known as COVID-19) in the State of California

Date: 03/17/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Here’s what you need to know about COVID-19

The Department of Health Care Services (DHCS) memorandum dated March 16, 2020, is under review. We will communicate out additional information as needed.

On March 4, 2020, Governor Gavin Newsom declared a state of emergency in the state of California due to the spread of COVID-19. On Sunday, March 15, 2020, the Governor’s office provided additional guidance through an executive order. Health Net* is providing assistance to members in all counties affected by COVID-19.

Health Net COVID-19 alerts page and public health guidance

To obtain the latest updates and guidance on assisting patients and when to take action, visit provider.healthnet.com where you will see a link to Health Net Alerts: COVID-19 in the yellow bar.

You can also visit the websites below for more information about COVID-19 and the latest guidance from public health officials:

Is your office impacted?

If your office or facility is impacted by COVID-19 and this affects your ability to provide services and access to CalViva Health members, please contact your provider network regional representative immediately. If you are affiliated with a participating physician group (PPG), please contact your PPG immediately.

Waiver of screening and testing cost-sharing amounts

For all members, Health Net is waiving all associated member cost-share amounts for medically necessary COVID-19 screening and testing, and doctor office, urgent care and outpatient hospital (including emergency departments) visits.

Where can members go for COVID-19 testing?

Providers can refer members to their county’s public health department at www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx. Additionally we are aware that Quest Diagnostics and Laboratory Corporation of America started offering COVID-19 tests earlier this week. We expect expansion of such testing capabilities to continue to evolve.

Prior authorization and precertification

To ensure members receive the care they need as quickly as possible, On behalf of CalViva Health, Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Delegated PPGs

PPGs delegated by Health Net to authorize services related to COVID-19 screening and testing are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Filing claims

The deadline to file claims for providers impacted by COVID-19 will be extended to three months beyond standard filing timelines or the timeline in your Provider Participation Agreement (PPA) when Health Net is paying claims on behalf of CalViva Health. Providers may contact the Provider Services Center at 1-888-893-1569 for additional guidance on claims extension time frames.

Balance billing

As a reminder, balance billing is strictly prohibited by state and federal law and Health Net’s PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Prescription information

Providers should inform their patients that to obtain an emergency supply of prescription medication, affected CalViva Health members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected CalViva Health members can contact the CalViva Health Medi-Cal Member Services Department at 1-888-893-1569 for questions or assistance.

Coping assistance

CalViva Health members impacted by COVID-19 may contact CalViva Health, for referrals to behavioral health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the state of emergency and its immediate aftermath, affected CalViva Health members may contact the CalViva Health Medi-Cal Member Services Department at 1-888-893-1569.

Telehealth service options

Telehealth service options are under review. Additional information will be distributed at a later time.

Additional information

Depending on how COVID-19 progresses, additional changes to policies may be made to ensure members have access to necessary health care services. Please refer to provider.healthnet.com where you will see a link to Health Net’s COVID-19 in the yellow bar for regular updates.

If you have questions regarding the information contained in this update, contact CalViva Health at 1-888-893-1569.



Last Updated: 04/01/2020