COVID-19 Updates

Important Reminders

Booster shots: COVID-19 vaccine booster shots are available to all adults who have completed their primary vaccine series (6 months after the second dose of Moderna or Pfizer or 2 months after the first dose of Johnson & Johnson). Make an appointment here or call 312-864-0591.

COVID-19 vaccines are now available for kids ages 5 – 11: COVID-19 vaccines are now available for children ages 5 and up. We will add $25 to all members’ OTC Rewards Card when they get their vaccinations. Make an appointment here or call 312-864-0591. A parent or guardian must be present for children under 18.

Flu season is here: Getting a flu shot is more important than ever because of COVID-19. To find a no-cost flu shot location, click here. Children 18 and younger must get the flu shot from their doctor.

COVID-19 Updates for Members

The health and well-being of CountyCare members is our top priority. We have created this page to provide you with the most up-to-date information about COVID-19 and the best way to get needed services during this public health emergency. Please save this page and check back often.

COVID-19 Prevention

For more details on how to protect yourself and your family visit the Centers for Disease Control’s (CDC) Coronavirus prevention website. If you have additional questions, you can also call the Illinois Department of Public Health (IDPH) at 800-889-3931. Note that this phoneline is experiencing longer than normal hold times due to the COVID-19 crisis.

Wash your hands often with soap and water for 20 or more seconds.
If you don’t have soap and water nearby, you can also use a hand sanitizer. Hand sanitizer should contain at least 60 percent alcohol. Cover your hands & rub them together until dry.
Avoid touching your eyes, nose or mouth.
Use your arm or elbow to cover your mouth & nose when you cough or sneeze.
Stay home except to buy essential supplies.
Put distance of at least three to six feet between you and other people when in public.

It is important that you stay home except to get medical care and stay away from others in your home. More details are available on preventing the spread of the virus on the CDC’s website. If you have additional questions, you can also call the Illinois Department of Public Health (IDPH) at 800-889-3931. Note that this phoneline may be experiencing longer than normal hold times due to the COVID-19 crisis.

Social distancing is increasing the physical space between people to avoid spreading illness. Staying at least six feet away from other people lessens your chances of catching COVID-19. We encourage all members to practice social distancing to stop the spread of coronavirus disease (COVID‐19). Social distancing also includes limiting large groups of people coming together, closing buildings or canceling events

To limit trips to the pharmacy, you may be eligible for an early drug refill or to receive medicines by mail. The CountyCare Pharmacy Help Desk is available 24 Hours a day, 7 days a week at 1-888-402-1982 to help you access your medications.

If you would like to get your medicine by mail from MedImpact’s Mail Order Pharmacy please follow the steps outlined here.

Telehealth is a way of seeing your doctor without going to their office. Your visit could be over the telephone or by using an app like Facetime or Zoom. You should call your provider’s office to see if telehealth is available and ask them any questions you might have. CountyCare wants to keep you as safe and healthy as possible during the COVID-19 emergency and help prevent the further spread of Coronavirus.

COVID-19 Testing

If you have fever, a cough or problems breathing call your doctor.
Do not go to your doctor’s office or the emergency room without calling first. They will tell you where to go to be screened and tested if needed.
Stay home except for getting medical care.

The first thing you should do is call your doctor. Your doctor will determine whether it is appropriate for you to be tested based on guidance from the Centers for Disease Control, including your symptoms and your risk for complications. Do not go to your doctor’s office or the emergency room without calling first.

Call your doctor’s office to see if they are currently providing COVID-19 testing.
Your local pharmacy, such as CVS and Walgreens.
Illinois Department of Public health Community-Based Testing Sites.

COVID-19 Vaccines

All Cook County residents aged 5 years or older are eligible to receive the COVID-19 vaccine. Children under 18 can only receive the Pfizer vaccine and must be accompanied by a parent or guardian. Vaccinations are free, regardless of insurance or immigration status.

To learn more about the COVID-19 vaccine, how it was developed, side effects, and other frequently asked questions, visit one of the following reliable resources for vaccine information:

To find a vaccine location near you, visit one of the following websites:

COVID-19 Resources

Food assistance, financial assistance, clothing, and other resources due to the COVID-19 outbreak

The Centers for Disease Control and Prevention (CDC)

The World Health Organization (WHO)

Illinois Department of Public Health (IDPH)

Cook County Department of Public Health (CCDPH)

COVID-19 Updates for Providers

All of us at CountyCare want to extend our deep appreciation for the work our providers are doing under very challenging circumstances. Please note that we are communicating with our members on a frequent basis with regard to preventing the spread of COVID-19.

We are focused on ensuring the well-being of these members during this crisis, with a particular focus on the most vulnerable. In addition, we are adjusting our business processes to facilitate and simplify access to care.

Below you can find the most up-to-date information regarding how CountyCare is responding to the COVID-19 public health emergency. We have included COVID-19 related testing, coding and other general information for our health care providers. Please save this page and check back often for updates.

COVID-19 Testing

CountyCare will cover all diagnostic testing for in-network providers for medically necessary lab tests to diagnose COVID-19. Your CountyCare doctor doesn’t have to ask us for the OK to test for COVID-19.

There is a shortage of COVID-19 kits available nationally. We encourage you to verify that testing is available before having a patient travel to a test site. Note that all tests require a doctor’s order and that other requirements, such as severe symptoms, may be in effect until testing is more widely available.

Patients who have concerns that they may have been exposed to COVID-19 or may have symptoms of COVID-19 should contact their provider or local/state Department of Health for testing. The test specimens will be obtained and then sent to a laboratory.

CMS has adopted two Healthcare Common Procedure Coding System (HCPCS) codes(U0001) and (U0002), for COVID-19 testing. HFS is using these codes for Medicaid billing purposes.

U0001 -2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
U0002 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.

If the health plan receives notification of a positive result, we will notify the provider’s office via phone.

Please notify CountyCare of any positive cases at CountyCareQualityofCare@cookcountyhhs.org. Remember to send this communication via secure email to safeguard the privacy of the individual. Continued adherence to Privacy and Security Rules (HIPAA) is very important.

Please include the following information in your message:

Patient Name, DOB, RIN
Date of notification of confirmed case
Date of test
Date of positive test result
Current location of member
Primary Care Provider

COVID-19 Vaccines

To learn more about the COVID-19 vaccine, how it was developed, side effects, and other frequently asked questions, your patients may visit one of the following reliable resources for vaccine information:

To find a vaccine location, your patients may visit one of the following websites:

To find more provider information regarding the COVID-19 vaccinations, please the CDC’s Guidance for COVID-19 library.

COVID-19 & Treatment

Please see the CDC’s Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19).

Yes, we will allow out-of-network care, however, a prior authorization is required.

The Illinois Department of Healthcare and Family Services (HFS) has issued new telehealth administrative rules due to the COVID-19 public health emergency. These new rules were developed to enhance access and protect public health during the COVID-19 crisis by giving providers more flexibility to provide services via technology such as video conference or telephone.

Amongst other changes, HFS modified rules on “originating site” to include a patient’s place of residence. No licensed health care professional will be required to be present with the patient at the originating site. Additionally, the types of distant site providers were expanded to include new provider types such as Community Mental Health Centers (CMHCs) and certified Substance Use Disorder providers. In addition, there are new provisions for provider “virtual check-ins” and “E-visits”. These expansions are intended to provide remote access to care will help to keep members healthy and prevent further community transmission of COVID-19.

For more information, please see the Telehealth guidance issued by the Illinois Association of Medicaid Health Plans (IAMHP) in conjunction with HFS. This includes a Provider Noticeon Telehealth requirements and an updated Billing Guide.

To encourage social distancing, CountyCare is making the following changes to its pharmacy benefits.

Refill too Soon.Members or providers can request a one-time refill too soon override for each medication. Contact the Pharmacy Help Desk at 1-888-402-1982. Note that the pharmacy must state that the member has had to evacuate due to a disaster (e.g. COVID-19 pandemic).
90 Day Supplies.Members may now obtain up to 90 days’ supply of their medication.
Coverage for COVID-19.CountyCare will cover all COVID-19 related pharmacy products.
Mail Order.Members are eligible for free delivery of their medications to their primary shipping address. Members should call MedImpact Mail Order at 1-855-873-8739 Monday-Friday 7am-7pm CST and Saturday 8am-4pm CST. Note that an accommodation can be made to ship to a temporary or alternative address if the patient is quarantined in a different location other than their primary shipping address.

The Pharmacy Help Desk is being staffed to manage increased call volume from our members and providers. The Pharmacy Help Desk is available 24 Hours a day, 7 days a week at 1-888-402-1982.

When the procedure is rescheduled, the provider should contact CountyCare at 312-864-8200. The date range for the prior authorization will then be revised.

COVID-19 & Payment, Claims and Appeals Processing

CountyCare’s claims processing, call center and payment processing functions are fully operational.

The 180-day timely filing limit will be extended to 60 days after the end date of the public health emergency.

Awaiting further guidance and approval by CMS.

CountyCare’s appeals processing function is fully operational.

Not at this time. CountyCare’s concurrent review function continues to be fully operational.

COVID-19 Provider Resources

There are numerous relief options available for providers that are also small-business owners. For more information, visit the US Small Business Administration, the State of Illinois, Cook County and City of Chicago

HFS issued a provider noticeon applying for Medicaid coverage during the pandemic. As DHS offices are currently closed, the State of Illinois is encouraging applicants for medical coverage to apply online at www.ABE.Illinois.gov. Applicants are also encouraged to answer all application questions as completely as possible and to submit the application, even if that means the applicant can not submit verification documents at the time of application. To apply by phone, applicants can call the ABE call center at 1-800-843-6154 but may experience long wait times.

Providers who are working with uninsured patients who need testing or treatment for COVID-19 should help patients to promptly apply for medical coverage. For expedited processing, please assist the patient in submitting their application through ABE.Illinois.govand immediately send an email with the application tracking number to HFS.Priority19@illinois.gov. Providers are encouraged to have patients submit an application even if it is unclear as to whether a COVID-19 involved patient may be eligible for medical coverage.

9/14/2021 – COVID-19 Prior Authorization Temporary Changes – Updates

5/11/2021 – COVID-19 Vaccine Waste Guidance for Providers

4/28/2021 – COVID-19 Prior Authorization Temporary Changes – Updates

4/6/2021 – COVID-19 Prior Authorization Temporary Changes – Updates

3/4/2021 – COVID-19 Prior Authorization Temporary Changes – Updates

3/1/2021 – COVID-19 Vaccine and Administration Billing

1/14/2021 – COVID-19 Mass Vaccination Guidance for Providers

1/28/2021 – COVID-19 Prior Authorization Temporary Changes – Updates – February 2021

2021 Annual PA Changes – December 2020 [PDF]

Final Reminder – Authorization Reinstatement as of 9/1/20 – August 25, 2020 [PDF]

COVID-19 Prior Auth Temporary Changes – Updates June 2020 [PDF]

COVID-19 Prior Auth Temporary Changes [PDF]