Coding Guidelines

 

Prior Approval Codes

Medical Prior Approval Requirements for COVID-19 related illnesses are based on the CDC’s official coding guidelines related to COVID-19.  The CDC guidelines may be found on our site or on the CDC site. 

 

Premium payment policy change and remittance code

Health Options is temporarily adjusting our individual payment policy to help ease the financial stress some Members may be feeling. Effective April 1, 2020, individual Members’ one-month grace period has been extended to a three-month period, as follows:

  • During the first month of the grace period, the Member’s coverage will remain in effect and claims will be paid.
  • During the next two consecutive one-months of the grace period, the Member will keep his or her coverage, but any pharmacy and medical claims incurred throughout this timeframe will be denied until all outstanding premium is paid in full.

Any denied claims for Members in this extended grace period will include a Remittance Advice Remark Code (RARC) N618, “Alert: This claim will be automatically reprocessed if the enrollee pays their premiums.”

If you have questions, please contact Provider Relations at (207) 402-3347 or provider@healthoptions.org