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COVID-19 General Guidance Updates 

Last updated: June 18, 2021

The health of our members and the safety of those who deliver care are our top priorities. Optum is taking action and providing resources to support our members and providers during this challenging time. We are working to help people access health care to the fullest extent possible as we come together to address this national emergency. We’re adopting measures that will reduce administrative burden for physicians and facilities, helping members more easily access the care they need under their benefit plan, and adjusting programs and services, as needed, to protect members and help limit the spread of the COVID-19 virus in communities.

Providers are encouraged to confirm member benefits and coverage provided by their health plan at the time of service due to the rapidly changing situation.

  • Optum will review claims that may be impacted by cost-sharing waivers and reprocess them automatically. The provider will not need to request a claim adjustment or appeal.
  • Due to the rapidly changing environment around patient cost-sharing waivers, providers may want to allow their claim to be fully processed before collecting any patient cost-sharing responsibility.

CARES Act Relief Funds

On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.  Because payment amounts and eligibility are determined in accordance with the CARES Act, please visit: https://www.hhs.gov/provider-relief/index.html for additional information or any questions you may have.

Additional Provider Relief Funding available. Please visit the Health and Human Services website for more information.

Timely Filing Waiver or Tolling

During the COVID-19 public health emergency, Optum is extending the timely filing requirement for members covered through Medicare Advantage  and commercial managed plans.

Commercial Membership

  • Optum is following the Internal Revenue Service/U.S. Department of Labor (“IRS/DOL”) regulation related to the national emergency declared by the President, which began on March 1, 2020*. This regulation pauses the timely filing requirements timeclock for claims and appeal requests, submitted by members, that would otherwise exceed the timely filing limitation during the national emergency period.
  • These timely filing requirements will be extended an additional 60 days following the last day of the national emergency period*. This regulatory guidance has been issued by the IRS/DOL (Employee Benefits Security Administration).

*The national emergency, as declared by President Trump, is distinct from the national public health emergency declared by the U.S. Department of Health and Human Services.

Medicare Advantage

  • Claims with a 2020 date of service, submitted on or after January 1, 2020 through June 30, 2020 will not be denied for failure to meet timely filing deadlines.

We’re listening.

We are monitoring the inquires we’re receiving on an ongoing basis and working hard to answer your questions. We will be making frequent updates to this page. Please be sure to check back often for the latest information. 

Disclaimer:

The benefits described within this website describe federal and state requirements and Optum and its managed payors’ national policies. Additional benefits may be available in some states and under some plans, and applicable state insurance and similar laws and regulations are followed as indicated.