Medica Administrative Manual >Supplementary Contracting and Regulatory Requirements> Telehealth
Telehealth
Telehealth is the delivery of health care services or consultations through electronic communication while the patient is at one site (an originating site) and the licensed health care provider is at a distant site.
Commercial, Medica Health Plan SolutionsSM (MHPS), Individual & Family Business (IFB), and Medicare
To be eligible for reimbursement of telehealth services, the requirements found in the below policy apply to telehealth services provided to Medica members enrolled in coverage under Medica's commercial, MHPS, IFB, and Medicare benefit plans.
Telehealth for Commercial, MHPS, IFB and Medicare (PDF)
Minnesota Health Care Programs (MHCP)
To be eligible for reimbursement of telehealth under MHCP, providers must attest to the criteria established by the Minnesota Department of Human Services to demonstrate the safety and efficacy of delivering a particular service via telehealth. The provider assurance requirements set forth below include those criteria and are incorporated by reference, as administrative requirements, into the Medica provider participation agreements. The requirements pertain to services rendered by Medica participating providers to Medica members covered under MHCP.
Provider Assurance Statement Requirements
As a provider billing for telehealth services in accordance with Medica's policy for services rendered to MHCP members, you attest to compliance with the following requirements and acknowledge that you will maintain documentation proving compliance with the requirements:
- Maintenance of written policies and procedures specific to telehealth services that are reviewed and updated regularly;
- Maintenance of policies and procedures that adequately address patient safety before, during and after the telehealth service is rendered;
- Establishment of protocols addressing how and when to discontinue telehealth services;
- Establishment of a quality assurance process related to telehealth services which includes, without limitation, all applicable Health Insurance Portability and Accountability Act and regulations promulgated thereunder, as amended ("HIPAA") requirements; and
- Documentation of each occurrence of a health care service provided by telehealth that includes all of the following:
- The type of service provided,
- The time the service began and the time the service ended,
- A description of the provider's basis for determining that telehealth is an appropriate and effective means for delivering service to the recipient,
- The mode of transmission of the telehealth service, and
- The location of the originating and the distant site.
Refer to the below reimbursement policy for Medica members enrolled in coverage under MHCP for additional information including specific billing and coding requirements, such as the use of modifiers.
Telehealth for Minnesota Health Care Programs (MHCP) – (PDF)
REV 2/2024