The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. To bill for services by phone (Medical and Mental Health) Network Management and Credentialing Services Standard out-of-pocket costs will apply for treatments received. Blue Cross members with a COVID-19 diagnosis will be protected against balance billing. What to know about COVID tests | Coverage - Blue Cross Blue Shield of BLUE CROSS BLUE SHIELD OF MASSACHUSETTS ANNOUNCES NEW RESOURCES FOR AT-HOME COVID-19 TESTING FOR COMMERCIAL AND MEDICARE ADVANTAGE MEMBERS Commercial members can access tests at pharmacies or via mail order at no cost Company also providing coverage for 4 home tests per month for Medicare Advantage members For more information about HSAs, eligibility, and the laws current provisions, you should ask you financial or tax adviser, or check with your HSA administrator for more details. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. Ancillary and some behavioral health providers. Refund Management | Blue Cross and Blue Shield of Illinois Refund Management The following information does not apply to government programs (Medicare Advantage, Illinois Medicaid). Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. WASHINGTON The Blue Cross and Blue Shield Federal Employee Program (FEP) announced today that it will waive cost-sharing for coronavirus diagnostic testing, waive prior authorization requirements for treatment and take other steps to enhance access to care for those needing treatment for COVID-19 to ensure its members can swiftly access the right care in the right setting during the outbreak. Members will have the option of online submission through the secure member website or sending a paper submission. If you have any questions, call the number on the back of your Blue Cross ID . Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. https://www.humana.com/coronavirus/coverage-faqs. Claims submission and reimbursement for all COVID-19 testing. Log in to your member account on our website. Serologic testing for the presence of SARS-CoV-2 IgM/IgG antibodies is covered for FDA and Emergency Use Authorization tests (as described above) when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice, including the Centers for Disease Control (CDC) and Massachusetts Department of Public Health (DPH) guidelines. COVID-19 Update | Blue Cross and Blue Shield of Illinois - BCBSIL 800-942-0954 (main). Learn how to get free OTC at-home teststhrough the federal program. Varies by plan. Choose your plan type to learn more about the available no-cost options Individual & Family Medicare Medicaid Stay Healthy and Informed Please note: You cannot be reimbursed more than once for OTC at-home tests. COVID-19 Testing Coverage Website: Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you access to the care you need during the COVID-19 pandemic. If you mistakenly receive reimbursement from an FSA, HSA, or HRA for at-home test costs covered by Blue Shield, you should contact the FSA, HSA, or HRA administrator. If you purchase a test at a retailer or pharmacy that is outside your insurer's preferred provider network, your insurance company will reimburse you up to $12 per test, or the cost of the test if less than $12. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. Blue Cross and Blue Shield Companies Cover COVID-19 Testing and Treatment Find out which COVID-19 tests are available to members and where to get tested. These services can help you see if your symptoms may be related to COVID-19 or something else. For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. Blue Cross will identify patients presenting for evaluation of possible COVID-19 using the below codes*: If your patient has previously confirmed COVID-19 illness or tests positive for COVID-19, use the code below. This applies to both diagnostic and screening tests. COVID-19 Testing Coverage Website: Reimbursement Process Link or Description: Information from Anthem for Care Providers about COVID-19 - RETIRED as Should I still postpone preventive visits/routine checkups or specialist care? Ralphs Clinic Testing Services for Viral or Rapid Antigen Tests, contact Medi-Cal Rx to locate an in-network pharmacy, See details for how to submit a claim for reimbursement for covered testing, Find out what your coverage is for OTC at-home tests based on your plan, Medi-Cal members: Do not submit any claims to Blue Shield Promise, Yes for OTC at-home tests purchased on or after 1/15/22, Medicare Prescription Drug Plan (pharmacy benefit only), No, coverage for OTC at-home tests is covered by Original Medicare, Yes, for purchases between 1/1/22 4/3/22, None for covered tests during the public health emergency. High-technology radiology and obstructive sleep apnea testing and treatment https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. How to bill for telehealth and services by phone. Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. Type OTC or Home in the search bar to narrow the results for at-home tests. Insurance Coverage for Over-the-Counter COVID-19 Tests - Michigan They can advise you on how to return the money back into your account. Well allow the use of these modifiers for any service on your fee schedule. Consumers can either purchase the testing kits at no cost or submit receipts for. We resumed our usual 90-day timely filing limit for dates of service or dates of discharge on and after June 1, 2020. Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit. If you would like to find a new mental healthcare provider in your network, learnhow to find one. *Blue Plan members receiving care in Massachusetts are covered according to their Home plans benefits and coverage. If you have a plan with out-of-network covered benefits, Blue Shield will cover both in-network and out-of-network copays, coinsurance, and deductibles for COVID-19 covered treatment benefits during this time. Blue Cross Blue Shield of Massachusetts covers the following drugs when usedoutside a clinical trialfor patients who are in aninpatienthospital setting and require treatment beyond respiratory support, at the discretion of their treating provider: Please note that standard inpatient payment policy rules apply. Member cost will be the same as an in-person office visit, and cost will not be waived for a COVID-19 diagnosis. At-Home COVID Test Reimbursement: From Blue Shield to Kaiser - KQED If you intend to seek reimbursement from Blue Shield, it is recommended that you do not use an FSA, HSA, or HRA debit card to purchase at-home tests. For Federal Employee Program (FEP) members, member cost is removed for inpatient acute care hospitals, inpatient rehab facilities, long-term acute care hospitals, and skilled nursing facilities for services related to COVID-19. We will continue to monitor and assess potential impacts to our business and our provider partners as the state considers any further actions on measures established during the state of emergency. If your insurer has a network of preferred providers: If your insurer does not have a network of preferred providers: If you purchased at-home COVID-19 tests prior to January 15, 2022: Insurers are not required to provide coverage for COVID-19 tests that were purchased prior to January 15, 2022. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. What your Blue Shield plan covers Your health is our priority. Your health is our priority. Effective January 1, 2021, AIM will return to standard processes and authorize services for 60 days. Here's how you can get free home Covid-19 tests from retailers - CNN Independence Blue Cross(Independence) is implementing the Biden administrations over-the-counter (OTC) testing program finalized earlier this month. Network of Preferred Providers: All rights reserved. You can request an authorization to cover more. In keeping with CMS guidance issued September 2, 2020 and for the duration of the COVID-19 public health emergency, Blue Cross will cover, without a healthcare professionals order, the cost of one diagnostic test for COVID-19 and one diagnostic test each for influenza virus or similar respiratory condition for Medicare members when performed in conjunction with a COVID-19 test and needed to obtain a final COVID-19 diagnosis. COVID-19 Updates | Anthem Blue Cross California We are here to support you as you care for your patientsour members. However, if you fall ill with COVID-19 symptoms while traveling internationally, testing and treatment may be covered. *Reimbursement for these codes is included in the payment for an evaluation or management (E/M) service if reported by the same provider on the same day, for the same member. COVID-19 Temporary payment policy (includes telehealth). All rights reserved. We extended the filing limit for initial claim submissions. For example, over the phone or by video. Proper documentation will need to be submitted. Use an at-home antigen test, available over-the-counter (OTC) at many retail pharmacies, to screen for employment, school, events, or if you experience symptoms. Health plans are offered by Blue Shield of California. Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Questions about medical or prescription coverage? Get the Kaiser Permanente at-home COVID test reimbursement claim form (will download PDF). If a vaccine administration service is provided with an evaluation and management service that: This applies to professional and facility claims. See the information below to determine if your insurer is reimbursing for these tests. We cover medically necessary telehealth services (COVID-19 and non-COVID-19-related) for in-network providers. Only to be reported with use of high-throughput technologies. In addition, ground ambulance transport to and from the locations listed below is covered to help our healthcare delivery system optimize inpatient capacity. Want to get your at-home COVID test reimbursed? | kare11.com State-chartered Bank and State-chartered Savings Bank forms. about potential out-of-pocket costs from out-of-network providers. See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. Covered tests must be approved by the FDA or haveEmergency Use Authorization, or the developer must have requested, or intends to request Emergency Use Authorization approval. During the Massachusetts public health emergency, we reimburse all providers, including ancillary, behavioral health, and applied behavioral analysis providers, at the same rate they would receive for an in-person visit. Your plan includes COVID-19 tests, treatment, and care. This is in place for the duration of the Massachusetts state of emergency. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. Contact the company for the latest information. FAQs abour medication and treatment, COVID-19 coverage for testing FEP will waive copays for telehealth services related to COVID-19. In that case, you may be responsible for paying the difference. You can get up to 8 individual tests per calendar month from participating pharmacies and healthcare providers during the COVID-19 public health emergency. General Reimbursement Information | Blue Cross and Blue Shield of Texas We are making every effort to credential providers within seventy-two (72) hours of the date we receive your application. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. We will share additional information when available. How to Submit Your At-Home COVID Test to Your Insurance - Health This applies to all accounts except the Federal Employee Program (FEP). Please note that if you have previously visited an out-of-network provider and received a check payment from Blue Shield, our process has changed. Contact your primary healthcare provider to find out if they have virtual visits available. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment Losing your job doesnt have to mean losing your healthcare coverage. For more information, visit https://www.phpmichigan.com/?id=175&sid=1. Log in and to go Office Resources>Billing & Reimbursement>Fee schedules. All information below is required. Outside of an emergency situation, you should seek care from in-network providers to save money. When you provide any services by phone, do not bill the specific telephonic CPT codes. Your claim represents your attestation that you provided the service to the patient via telehealth. Coronavirus (COVID-19) Updates | Blue Cross Blue Shield Please choose, Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. At in-network pharmacies. *These modifiers do not apply to Federal Employee Program members. Health plans are offered by Blue Shield of California. Payment for COVID-19 testing services on or after January 1, 2022. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. The screenshot below shows the correct way to enter modifiers. Virtual visits are covered. COVID-19 Home Test Kits - For members | Blue Cross Blue Shield - BCBSRI Some restrictions apply. California Physicians' Service DBA Blue Shield of California 1999-2023. A diagnostic test is used to determine if a person has COVID-19. How can I continue seeing my mental health care provider? Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. Schedule an appointment in your area. OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered. 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. cRequired for employment purposes. FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance if diagnosed with COVID-19. COVID-19 Coverage for Members Your health is always our priority. This will enable us to pay you the same rate we pay you for in-person visits. For example, a physician, a nurse practitioner, or a physician assistant. As of Jan. 15, 2022, and through the end of the public health emergency, all individuals with pharmacy coverage through Blue Cross Blue Shield of Michigan and Blue Care Network have more ways to get at-home COVID-19 rapid diagnostic tests at no cost. Network of Preferred Providers: UB-04 billers do not need to enter a place of service when billing for services provided by phone. We have plans to help keep you covered. Were contacting them to suggest that they take advantage of our early refill policy during this public health emergency, so they can have a supply of their medication. The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Information requested will include: Reimbursement for tests purchased before January 15, 2022: I have a Medi-Cal plan. I received a check from Blue Shield. An attending health care provider may order a test. Blue Shield of California has neither reviewed nor endorsed this information. California Physicians' Service DBA Blue Shield of California 1999-2023. DIFS is not responsible for any costs incurred in reliance on this information. My at-home test comes with more than one test per package. There is no change to the timely filing guidelines for Indemnity claims. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield At-Home Rapid Tests Are Now Covered Over-the-counter COVID-19 tests are now covered for qualifying members. Call us at 877-352-5830 with questions about COVID-19 testing sites, navigating health care plans or for help connecting to local community resources for finding food, utility and rent assistance, and many other types of relief programs. To make this request, please submit theMassachusetts Standard Form for Medication Prior Authorization Requests(click the link and find the form by choosingAuthorization Pharmacy). How can I get a free OTC COVID-19 test? Reimbursement Process Link or Description: Claims must include proof of purchase (e.g. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. 7OTC at-home tests are only covered if used for personal use and not for resale. Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F The Blue Cross Blue Shield (BCBS) Association, a federation of 35 independent health insurance companies that collectively cover one in three Americans, has voiced concern with the COVID-19 test . . Phone Number: If you plan to provide a previously approved service to a patient in 2021, please call our. Extended authorizations for deferred services, Expiration of extended authorizations for deferred services on 12/31/20. Providers who are approved under this process will receive a Welcome Letter with their effective date. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. Coronavirus resources | Blue Shield of CA Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines. COVID-19 | Blue Cross and Blue Shield of Illinois - BCBSIL https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: As of Jan. 15, the federal government is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests. CNN . Your insurance company will reimburse you for the full purchase price of each covered test. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. Chloroquine and hydroxychloroquine (Plaquenil), On June 5, 2020, the FDA revoked the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine for the treatment of COVID-19 because the benefits of using them outweigh the known and potential risks for authorized use. HSAs are offered through financial institutions. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Reimbursement for tests purchased before January 15, 2022: Federal Employee Program I have a Medicare plan. Information Regarding Coronavirus (COVID-19) | Highmark BCBSWNY However, they will not be able to order a COVID-19 test for you. OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered. You can use Dental Connect for Providers to verify member eligibility and benefits. The use of reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for a diagnosis of COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. The authorization process will officially resume for all products effective July 1, 2021. Members should call the number on the back of their ID card. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. The policy only covers over-the-counter Covid-19 tests authorized and approved by the U.S. Food and Drug Administration (FDA). UB-04 billers do not need to enter place of service codes when billing for telephonic services. If you need to get tested or seek treatment for COVID-19, well help you know exactly what your plan covers.