As previously communicated in a
Partners in Health UpdateSM article, AmeriHealth New Jersey made coding updates to Claim Payment Policy #00.10.42b: Telemedicine and Telehealth Services.
This policy is based on the State of New Jersey telemedicine law (P.L. 2017, c117) requiring insurance carriers to cover telemedicine services, which went into effect July 21, 2017.
Important information on collecting member copayments for telemedicine services
In accordance with the law, insurers may not charge a higher deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, than the amount that is applicable to an in-person consultation.
As of January 1, 2019, AmeriHealth New Jersey reduced the member copayment for telemedicine services to 50 percent of what the copayment amount would be for an in-office visit.
For AmeriHealth New Jersey plans with a coinsurance for office visits, the telemedicine coinsurance matches the office visit coinsurance.
Note: We are in the process of coding all of our systems to reflect this change for telemedicine services. Until then, providers will not be able to see that the copayment for telemedicine services is 50 percent of the in-office amount through the NaviNet® web portal (NaviNet Open) or on the 271 EDI electronic return. We will provide more information when this coding change is operational in our systems.
More information
To view this policy, visit our Medical Policy Portal.
If you have additional questions, please contact Provider Services at 1-888-YOUR-AH1![]( "Call: 1-888-YOUR-AH1")
.
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