https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: 1-800-882-1178. Two COVID-19 updates effective July 1, 2021: Change to telehealth cost share and authorization requirements, Update to bamlanivimab pharmaceutical treatment for COVID-19, Lab claims must include ordering clinician NPI starting July 1, Medicare sequestration suspended through December 31, 2021, Were committed to reducing health care inequities, Revised reimbursement for COVID-19 vaccination administration codes available, Monthly communications aim to reduce vaccine hesitancy, Updated coverage guidelines for COVID-19 testing, Medicare Advantage telehealth cost share & COVID-19 vaccine billing, Updates to vaccine and pharmaceutical treatment codes for COVID-19, Blue Cross Blue Shield of Massachusetts joins national effort to help vaccinate seniors in underserved communities, Were helping to fund free rides for COVID-19 vaccine access, Provider reimbursement for COVID-19 vaccination administration codes are available, Facts may help patients understand and embrace COVID-19 vaccine, COVID-19 Information page updates: Cognitive rehab, testing coverage, and diagnosis codes, Updated billing guidelines and fees for COVID-19 lab testing codes, Telehealth and telephonic codes billing reminder, Updates to COVID-19 vaccine administration codes and pharmaceutical treatment, COVID-19 - Authorization requirements waived until March 31, Vaccines and pharmaceutical treatment for COVID-19, Updates to Medicare Advantage services effective Jan 1, Claims with COVID diagnoses require positive test in chart, COVID-19: Inpatient acute care auth requirements waived until Dec 31, COVID-19: Use appropriate diagnoses when billing for COVID testing, COVID-19: Coverage guidelines for laboratory tests, COVID-19: Coverage guidelines for pharmaceutical treatments, COVID-19: Auths extended; non-emergent transport modifiers, Dental Blue will offer assistance for PPE costs for dentists, Telehealth & online digital codes for FEP & Medicare Advantage, New supports for our members mental health, COVID-19: Continued coverage for early intervention services, COVID-19: Resuming provider audits and claim reviews, Increased fees for COVID-19 lab & specimen collection codes, COVID-19-We're extending our prior authorization waiver, Dental care strategies in the age of COVID-19, How were helping during COVID-19 emergency, COVID-19 payment policy, lab testing codes, claim reminders, COVID-19: APR-DRG Grouper ICD-10 code update, Patients with asthma can get early refill of their controller med, COVID-19: Extending authorizations for specific services, COVID-19: Expedited credentialing process; provider audits on hold, Non-emergency ground ambulance transports covered temporarily, COVID-19: How to bill for drive-through testing, Medicare Advantage reimbursement will be temporarily adjusted, Blue Cross Blue Shield of Massachusetts Telehealth Claims Skyrocket During Coronavirus Pandemic, Member costs waived for inpatient COVID-19 services, Chloroquine, hydroxychloroquine coverage update, Coverage for dental telephone or video consultations, Dentists and oral surgeons: How were helping during COVID-19 emergency, the original hydroxychloroquine policy still applies, Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate (PDF, 125 KB), Massachusetts Standard Form for Medication Prior Authorization Requests, Medical Policy 660: Cognitive Rehabilitation, Notification of Enforcement Discretion for telehealth, 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, Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection, Public Health Emergency Credentialing Application, Contact your local plan. Be sure to seek non-emergency care from in-network providers if you have an HMO plan. 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. These may include fees for other tests or other services unrelated to the COVID-19 test. After that time, an authorization extension is required. If you purchased an OTC at-home test between March 11, 2021, and January 31, 2022, the Department of Health Care Services (DHCS) will reimburse beneficiaries the retail cost with a receipt. Kaiser's California Member Services hotline is (800) 464-4000. We expect providers to code for COVID-19 testing and treatment using guidelines provided by the CDC. To bill for telehealth/video services during the state of emergency. Then, complete and submit the online form. What should I do with it? We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For example: Viral testing You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, COVID-19 Testing Coverage Website: For Medicare Advantage plans, you must submit claims for COVID-19 vaccine and the administration of the vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. Network of Preferred Providers: As of April 1, for the duration of the COVID-19 public health emergency, we have added a 10-day supply limit to these medications for: This supply limit applies to members who use our standard Blue Cross Blue Shield of Massachusetts formulary. 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 you're a Medicare or Medicaid Participant: For information about insurance coverage for at-home COVID-19 tests, please see the Centers for Medicare and Medicaid Services FAQ. Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. The screenshot below shows the correct way to enter modifiers. If a test reader is required, reimbursement is limited to $12. Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak. Its important not to fall behind on preventive care visits. State-chartered Bank and State-chartered Savings Bank forms. According to the CDC, serologic testing: * Detection of specific antibody in serum, plasma, or whole blood that indicates new or recent infection provides presumptive laboratory evidence of COVID-19 illness, according to the Council of State and Territorial Epidemiologists (CSTE) interim case definition for COVID-19. Find out which COVID-19 tests are available to members and where to get tested. In a hospital (including emergency room). Standard out-of-pocket costs will apply for treatments received. SENIOR BLUE BASIC (HMO) BLUESAVER (HMO) SENIOR BLUE 601 (HMO) SENIOR BLUE SELECT (HMO) SENIOR BLUE 651 (HMO) FREEDOM NATION (PPO) FOREVER BLUE VALUE (PPO) FOREVER BLUE 751 (PPO) OPTIONAL SUPPLEMENTAL DENTAL PRESCRIPTION DRUG INFORMATION PLANNING FOR MEDICARE UNDERSTANDING BASICS 2022 RESOURCES 2022 RESOURCES MEDICARE CENTERS HEALTH PROGRAMS Claims for over-the-counter COVID-19 tests submitted for reimbursement will be reimbursed up to $12 per test. Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications. Coverage varies by plan type. Contact the company for the latest information. During the Public Health Emergency (PHE), over-the-counter (OTC) COVID-19 FDA-authorized test kits are covered for eligible members and will be reimbursed with no member cost share based on the federal guidance. Make informed decisions about your health and the health of your community. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. Questions about medical or prescription coverage? If you are submitting 1500 claims using Direct Data Entry in Online Services, please do not use separate fields for each character of the modifier. Your doctor may also be offering virtual visits if you prefer. Some examples of authorized tests include: See a complete list of authorized tests on the FDA's web page. The policy only covers over-the-counter Covid-19 tests authorized and approved by the U.S. Food and Drug Administration (FDA). Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Click Prescription and follow the prompts to submit your online claim. For more options to get free OTC tests. Updates as of January 11, 2023. COVID-19 Testing Coverage Website: Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). * Login to find out what options are available to you. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. https://www.humana.com/coronavirus/coverage-faqs. Members can register for Teladoc by visiting fepblue.org/coronavirus. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. The authorization process will officially resume for all products effective July 1, 2021. Please note that Blue Shield does not offer tax advice for HSAs. UB-04 billers do not need to enter a place of service when billing for services provided by phone. You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. A list of reports produced by our Department. Information requested will include: Reimbursement for tests purchased before January 15, 2022: We have removed member cost (copayments, co-insurance, and deductibles) for medically necessary telehealth (virtual video/audio) services or visits by phone for behavioral health services. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. My Turn What if I need treatment for COVID-19? We provide health insurance in Michigan. Availability and eligibility 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. As of April 4, 2022, members with BCBSRI Medicare Advantage and Plan 65 coverage can now receive COVID-19 home test kits at no cost under their Part B benefit. *UB-04 billers do not need to submit place of service code. For more resources, visit myturn.org and the CDC websites. See details for how to submit a claim for reimbursement for covered testing. Reimbursement Process Link or Description: Some may choose to cover screening tests for employment purposes, return to school, or sports. FEP to eliminate restrictions on prescription drug refills, waive pre-authorization, deductibles and copays for diagnostics, treatment, Blue Cross and Blue Shield Federal Employee Program Waives Cost Shares and Prior Authorization to Support Members Care for Coronavirus, Site-Neutral Payments Would Save Nearly $500 Billion Over 10 Years, Blue Cross Blue Shield Association Statement on Medicare Advantage Risk Adjustment Validation Rule, Blue Cross Blue Shield Association Policy Solutions Could Lower Health Care Costs by $767 Billion, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. These actions will apply to all FEP members of the 36 U.S. and Puerto Rico-based BCBS companies, including those members located overseas, when applicable. Beginning January 15, 2022, and until the end of the Public Health Emergency, Independence will cover up to eight FDA approved OTC COVID-19 tests per calendar month as directed by the Biden administrations program. Others may need a boost due to the vaccine becoming less effective over time. For Federal Employee Program members, we've removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. No, COVID-19 Testing Coverage Website: Members can register for Teladoc by visiting fepblue.org/coronavirus. If you purchased an OTC at-home test between March 11, 2021, and January 31, 2022, the Department of Health Care Services (DHCS) will reimburse beneficiaries the retail cost with a receipt. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. If you are not an FEP member and have questions about your health plan, please contact your local BCBS Company: bcbs.com/memberservices. 800-942-0954 (main). We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. 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 Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. We extended existing authorizations through December 31, 2020. However, insurers may choose to reimburse consumers for these tests. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Member Discounts Take advantage of member-only discounts on health-related products and services. For more details, please see fepblue.org. Which types of COVID-19 tests are covered? Effective March 10, 2020, we expanded the telehealth benefit and removed the member cost (copayments, co-insurance, and deductibles) for all COVID-19 related telehealth services, member cost will apply when billed with the appropriate modifiers. Practitioners must use modifier GT, 95, G0, or GQ to designate that that they are providing services via synchronous/asynchronous telehealth audio and/or video telecommunications systems rather than an in-person encounter. For HMO plans that do not have an out-of-network benefit, there is no coverage for non-emergency COVID-19 treatment received from out-of-network providers. Or, you can call Dental Provider Services at 1-800-882-1178. California Physicians' Service DBA Blue Shield of California 1999-2023. Doctors within your plans network may have virtual visits available. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. Losing your job doesnt have to mean losing your healthcare coverage. Bill for ambulance transport However, at-home COVID-19 tests are not qualified medical expenses when the costs are reimbursed by Blue Shield. In a statement, Blue Cross Blue Shield said, "We are also working on . OTC at-home tests must have been purchased on or after January 1, 2022. Reimbursement for tests purchased before January 15, 2022: 108950 0122R be the regular place of service as if you saw the patient in-person. Blue Shield of California. Note: These changes do not apply to our Medicare Advantage members. Your plan includes COVID-19 tests, treatment, and care. FEP will determine coverage for the vaccine once it becomes available. Centers for Disease Control and Preventions web page. Payment for COVID-19 testing services on or after January 1, 2022. Reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for the diagnosis of COVID-19 is covered 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. 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. Blue Shield and Blue Shield Promise cover these types of tests: 1Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. Effective January 1, 2021, AIM will return to standard processes and authorize services for 60 days. This page may have documents that can't be read by screen reader software. Please note that Blue Shield does not offer tax advice for HSAs. Under the rule, insurance providers are . This information is provided for informational purposes only. California Physicians' Service DBA Blue Shield of California 1999-2023. As of January 1, 2022, most members can get reimbursed for up to eight OTC at-home tests per member per month without a provider order. What to do if you think you have COVID-19. Follow the instructions below to submit your claim online. COVID-19 booster recommendations Log in to your member account on our website. Medi-Cal members: Do not submit any claims to Blue Shield Promise. Need to talk with DIFS? Please choosein-network locationsfor testing to avoid paying any extra fees. Members should call the number on the back of their ID card. Reimbursement for tests purchased before January 15, 2022 Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. Your insurance company will reimburse you for the full purchase price of each covered test. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. 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. Are at-home COVID-19 tests eligible items for reimbursement under an FSA, HSA, or HRA? Screening tests for domestic travel are covered for most plans. When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you access to the care you need during the COVID-19 pandemic. When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. Members are responsible for any fees or tests that are not covered by their plan. Contact the company for the latest information. You will only be reimbursed for the maximum allowable tests per member per month for your plan. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will. Proper documentation will need to be submitted. FEP will also encourage members to use 90-day mail order benefit. Anthem is waiving cost shares for COVID-19 treatment. See below for details. Contact your primary healthcare provider to find out if they have virtual visits available. Have more questions about testing coverage? Providing Support During the COVID-19 Pandemic Communities Leading through a public health crisis All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. Please enter the NDC or UPC number from the cash register receipt. UnitedHealthcare (UHC) 1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) . Providers should document ALL of the following for coverage: Inpatient cognitive rehabilitation for cognitive impairment resulting from COVID-19 is not covered unless the patient otherwise meets criteria for inpatient level of care. Learn more about the different types of tests. This applies to tests purchased on or after January 15. For more information, visit https://www.phpmichigan.com/?id=175&sid=1. If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. 5Self-funded group plans are not required to cover these costs. * Please refer to yourEvidence of Coverageor plan documents for information about standard out-of-pocket costs for your plan. For providers not in the Teladoc network, the applicable cost share will apply (unless COVID-19 related). Some people with weakened immune systems may need a boost just to get a response that most people get from the regular dose. The following drugs are not covered outside of the clinical trial setting: We lifted limits on early refills of most prescription medications, allowing members to obtain one additional fill of their existing prescription. 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. 100748 0521 R3 Page 1 . For example, if you purchase a package with two tests inside, that counts as two separate tests. 24/7 access is provided at no cost. We have shared the following July 1, 2021 changes with our providers: Blue Cross Blue Shield of Massachusetts follows federal and state-mandated requirements for COVID-19 treatment coverage. Get the Blue Shield at-home COVID test reimbursement claim form. COVID-19 test reimbursement. Members may now purchase through the preferred network online at CVS.com using their insurance card. Members can also contact Customer Service at 888-327-0671 (TTY: 711). Screening tests for domestic travel are covered for most plans. UB-04 billers do not need to enter place of service codes when billing for telephonic services. See which plans cover screening tests for travel. 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. We cover medically necessary telehealth services (COVID-19 and non-COVID-19-related) for in-network providers. Coverage for Medicare members. Get health advice 24/7 from a registered nurse over the phone. www.cigna.com/coronavirus. Members can also call the National Information Center at 1-800-411-BLUE (2583). If you purchased an at-home test previously, you may be able to get paid back. We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. "We are requiring insurers and group health. What virtual care options does my plan cover? Schedule your COVID-19 vaccine booster today.
