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COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured
> FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration
FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration
Catalog of Federal Domestic Assistance number (CFDA): 93.461
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General Questions
What is the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program?
How much money is available in the fund?
Who is administering the program?
Is the COVID-19 Uninsured Program considered to be a health plan and therefore subject to Health Insurance Portability and Accountability Act (HIPAA) requirements?
Eligibility Questions
When a provider administers an FDA-authorized or licensed COVID-19 vaccine to an individual who may have foreign health care coverage or may be uninsured, is that vaccine administration eligible for reimbursement in the Uninsured Program?
Who is eligible for funding?
Can health care providers submit claims for unaccompanied children, including both children who enter the country without their parent or legal guardian and children who for other reasons have been separated from their parent or legal guardian?
Who is considered to be an "uninsured individual" for purposes of providers requesting reimbursement for testing, treatment, or vaccine administration?
Can health care providers submit claims for uninsured individuals who are undocumented?
How does the HRSA COVID-19 Uninsured Program process claims for Medicaid enrollees who have limited Medicaid benefits (e.g., those enrolled in Medicaid for family planning benefits)?
Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible?
What is the difference between the funds available to reimburse providers for COVID-19 testing, treatment, and vaccine administration services furnished to uninsured individuals through the Health Resources and Services Administration (HRSA) and the funds available through the Families First Coronavirus Response Act (FFCRA) to provide Medicaid coverage of COVID-19 testing services for uninsured individuals?
Which type of health care providers are eligible for reimbursement under this program? Are non-profits or Federally Qualified Health Centers (FQHCs) eligible?
Do Health Center Program requirements restrict or limit health centers in submitting claims for reimbursement to the HRSA COVID-19 Uninsured Program?
If a hospital charity program covered all of the cost of an uninsured individual’s treatment for COVID-19, can a health care provider submit a claim for reimbursement?
The Ryan White HIV/AIDS Program is a payer of last resort, would these program funds be considered a payer before this fund?
Are Indian Health Service (IHS), Tribal and Urban Indian Program (I/T/Us) beneficiaries considered "uninsured individuals" for purposes of the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program?
Who is ineligible for payment from the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program?
How does the HRSA COVID-19 Uninsured Program differ from the HRSA COVID-19 Coverage Assistance Fund?
What if a provider submitted a claim to the HRSA COVID-19 Uninsured Program and the patient is actually underinsured?
What services are eligible for reimbursement?
Why is claim reimbursement eligibility for diagnostic testing services performed by independent labs different than claim reimbursement eligibility for such services performed by hospitals (including hospital labs) or physicians?
Can health care providers submit a claim for testing furnished to an uninsured individual that is performed by a laboratory with which it has a client bill arrangement?
What services are ineligible for reimbursement?
Are claims subject to timely filing limits?
Are diagnostic testing and testing-related visits eligible for reimbursement if the result of the COVID-19 test is negative?
If a provider tests for COVID-19 as part of pre-operative or other medical treatment unrelated to COVID-19, is the test eligible for reimbursement?
If a patient is admitted to the hospital and a COVID-19 test is performed, the results of which are negative, is the test or any part of the inpatient claim eligible for reimbursement?
If a patient presents to the emergency department with cough and fever and then tested negative for COVID-19, would the test and the emergency room visit be eligible for reimbursement?
Can funds be used for remote screening activities even if they do not administer an actual test?
If a patient is being treated for cancer and also tests positive for COVID-19, is the cancer treatment eligible for reimbursement?
The Terms and Conditions for the Uninsured Treatment pool of funding indicate that providers can request claims for reimbursement for care or treatment related to positive diagnoses of COVID-19. To qualify as a positive diagnosis of COVID-19, does the primary diagnosis on a claim for treatment need to be B97.29 or U07.1?
If a patient is treated for sepsis and also tests positive for COVID-19, is the sepsis treatment eligible for reimbursement?
Prior to the April 1, 2020, effective date for U07.1 COVID-19 diagnosis, the program guidelines indicate that treatment would be eligible for reimbursement if B97.29 is the primary diagnosis. Can B97.29 be used for a primary diagnosis?
Are ambulance providers and other emergency medical service providers eligible for reimbursement for treatment services? Will claims for presumptive diagnoses be eligible for reimbursement under this program?
May a provider of the COVID-19 vaccine charge cost sharing for a vaccine or its administration to an enrollee in Marketplace coverage in months 2 or 3 of the grace period applicable for enrollees receiving advance payments of the premium tax credit (APTC)?
Could a provider submit for reimbursement from the Health Resources and Services Administration (HRSA) COVID-19 Claims Reimbursement to Health Care Providers and Facilities for COVID-19 Testing, Treatment, and Vaccine Administration for the Uninsured Program (referred to as the HRSA COVID-19 Uninsured Program) claims for cost-sharing for testing, treatment, or COVID-19 vaccine administration fees furnished for enrollees in Marketplace coverage in months 2 and 3 of the grace period applicable for enrollees receiving advance payments of the premium tax credit?
Payment Questions
Will the HRSA COVID-19 Uninsured Program provide claims reimbursement for monoclonal antibody therapy?
Beginning January 1, 2021, what is the HRSA COVID-19 Uninsured Program reimbursement rate for high-throughput COVID-19 polymerase chain reaction (PCR) testing claims with HCPCS codes U0003 and U0004?
How do eligible providers receive funding?
What is the timeline for requesting and receiving reimbursement?
How do eligible providers submit claims?
What type of unique identifiable identification information is required when submitting patient information?
If a temporary member ID is valid for 120 days, can providers still submit a claim after the 120-day period is over?
Can providers submit a paper reimbursement request and/or request reimbursement via check?
Do providers have to pay back the funding they received?
How are the reimbursement rates determined?
Given the Uninsured program is paid generally at Medicare rates, does reimbursement include the 20% add-on to the Medicare diagnosis related group (DRG) payment for COVID-19 treatment?
If a provider already received payment from an uninsured individual, are they required to reimburse that individual after receiving payment from the program?
When I submit a claim as part of the HRSA COVID-19 Uninsured Program, will I receive an 835 file through my clearinghouse to help me review the amount paid on each submitted claim? If not, where should I go to receive the associated claims payment information?
When I tried to enter my TIN in the program portal, I received a message that said the TIN already has a program administrator, and the person listed no longer works at my organization. How do I change the TIN administrator?
How do providers return/refund any overpayments they received?
Compliance Questions
How should providers account for these funds for purposes of cost reports and similar reports?
Pharmacy Questions
What types of claims does the Uninsured Program (UIP) accept? Are National Council for Prescription Drug Programs (NCPDP) claims accepted?
What is a clearinghouse?
To participate in the Uninsured Program (UIP), are all steps completed in the program portal?
Do all tabs need to be completed on the provider roster?
Is Optum Pay™ the same as OptumRx®?
Are pharmacies/pharmacists that administer COVID-19 tests or vaccines eligible providers for reimbursement under the program?
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