FrontPath PPO Claims Processing & Coverage
As you may be aware, many FrontPath in-network primary care and specialty physician office-based practices are transitioning to using “virtual” or telemedicine visits for the delivery of care to most patients in their practice during this COVID-19 situation. These telemedicine visits with FrontPath providers include visits via secure video conference and/or telephone conference for the provider’s existing patients. This includes some mental health providers. This approach is a safeguard for both patients and providers.
These telemedicine visits provided by FrontPath in-network providers are different from a telemedicine program managed by a vendor because they are visits with a provider from whom the enrollee already seeks care.
FrontPath strongly recommends that FrontPath member groups check with your third party administrator (TPA) to ensure that the TPA's claims system is set up to treat these telemedicine visits with FrontPath in-network providers as covered services in at least the same way that an “on-site” office visit would be covered for your enrollees. It is anticipated that this may be needed through 12/31/2020.
These telemedicine visit claims will be repriced by FrontPath’s claims repricing agent according to the provider’s contract using the CMS methodology for telemedicine visits, and transmitted to the TPA in the normal way.
Note that some health plans and plan sponsors are covering these types of telemedicine visits with lower or no out of pocket expense for enrollees. This is to encourage compliance with “social distancing” recommendations while supporting continued access to care. Note that the Coronavirus Aid, Relief, and Economic Security Act (the ‘‘CARES Act’’) allows High Deductible Health Plans (HDHPs) with a Health Savings Account (HSA) to cover telemedicine services with no deductible amount (Section 3701 (a) of the CARES Act).
If you or your TPA would like additional information about the billing codes and repricing methodology for telemedicine visits by FrontPath in-providers with their existing patients or if you have other questions, please contact Jeannie Dohrmann at: [email protected].
Posted: Monday, June 8, 2020