For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. Coverage for Medi-Cal and Cal MediConnect members Coverage for Medicare members Find out what's covered Stay informed about COVID-19 COVID-19 LEARNING CENTER In-depth information about choices that affect you Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. Members need to submit a separate claim form for each family member. 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. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. UnitedHealthcare (UHC) Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. COVID-19 Testing Coverage Website: Members should call the number on the back of their ID card. Learn more about the COVID-19 vaccine booster. Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network. Find out when Blue Shield covers COVID-19 tests and whether or not you'll have a copay. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. 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. Members will be required to fill out a COVID-19 self-test claim submission sheet and submit it via us mail along with UPC packaging label and receipt. Claims submission and reimbursement for testing. Leading the way in health insurance since 1929. Please choosein-network locationsfor testing to avoid paying any extra fees. 8 At-Home Rapid tests per 30 days. https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, COVID-19 Testing Coverage Website: All rights reserved. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Reimbursement Process Link or Description: www.cigna.com/coronavirus. Note: These changes do not apply to our Medicare Advantage members. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. The modifier should be 95 or GT. Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. Seewhichtestsarecoveredforyourplan. Please note that tests are currently in short supply and some retailers may impose limits on the number of tests you can purchase. You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. This makes it easier to treat and improve the outcome. 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. For example: Find out what your coverage is for OTC at-home tests. However, please note that out-of-network providers may charge more than the covered benefit amount. Network of Preferred Providers: If you purchased an at-home test previously, you may be able to get paid back. 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. For our Medicare Advantage members, coverage is through original Medicare. In alignment with guidance from the Division of Insurance, we have resumed the normal authorization processes forall servicesfor our commercial and Federal Employee Program members, and will start requiring authorization for Medicare Advantage members on July 1, 2021. They include: As Americans continue to monitor the coronavirus outbreak, one thing they should not be concerned with is whether Blue Cross and Blue Shield will be there for them, saidWilliam A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association. Effective July 1, 2021, we reinstated member cost copayments, co-insurance, and deductibles for non-COVID telehealth visits, including all mental and behavioral health services. In addition, Independence continues to cover FDA-approved COVID-19 diagnostic tests, such as PCR tests, with no cost share for any member when ordered or administered by a health care provider following an individualized clinical assessment. See the information below to determine if your insurer is reimbursing for these tests. 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. Some restrictions apply. 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. Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and the applicable place of service code. Per state mandate Chapter 260 of the Acts of 2020 Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting.1. There are no additional credentialing or contracting processes you need to follow to offer telehealth services. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Medi_22_194_LS_IA_092722 Claim Forms - Blue Cross and Blue Shield's Federal Employee Program Claim Forms Here are helpful Service Benefit Plan brochures, claim forms, reference guides and videos. In Massachusetts, call, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring, Injection, casirivimab and imdevimab, 2400 mg, Injection, bamlanivimab and etesevimab, 2100 mg, Blue Cross Blue Shield of Massachusetts is temporarily allowing reimbursement for this code for drive-through testing specimen collection*, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source*, CDC 2019 novel coronavirus (2019-ncov) real-time
*UB-04 billers do not need to submit a place of service code. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. Licensed independent clinical social worker, Psychiatric and state psychiatric hospital. Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard program. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. All Blue Cross Blue Shield of Massachusetts contracted doctors and health care providers can provide care remotely, using any technology, for medically necessary covered services (COVID-19 AND non-COVID-19 related) to our members. Please note: You cannot be reimbursed more than once for OTC at-home tests. Reimbursement for tests purchased before January 15, 2022 This benefit is available to Blue Shield and Blue Shield Promise members in the following plans: You should bring your red, white, and blue Medicare card to get your free OTC COVID-19 tests. Proper documentation will need to be submitted. If you're diagnosed as having COVID-19, you won't have any out-of-pocket costs to pay if you get treatment for COVID-19 from doctors, hospitals, and other health-care professionals in your plan's network through May 31, 2020. 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. Its important not to fall behind on preventive care visits. Testing sites: Not all testing sites are the same. Log in to find out your costs and if you have access. 04:20. Questions about medical or prescription coverage? Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. When reporting modifier GT, 95, G0, or GQ, the practitioner is attesting that services were provided via synchronous/asynchronous telehealth audio and/or video telecommunications systems. 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. Members will receive test kits from network pharmacies at no cost. Bill for administration of first dose of CPT 91300 (Pfizer-BioNtech COVID-19 vaccine), Bill for administration of second dose of CPT 91300 (Pfizer-BioNTech COVID-19 vaccine), Bill for administration of first dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of second dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine). We have plans to help keep you covered. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. We resumed our usual 90-day timely filing limit for dates of service or dates of discharge on and after June 1, 2020. Talk to board-certified doctors24/7 by phone or video. FAQs about resuming "regular" care We continue to monitor the outbreak of the new coronavirus (COVID-19) in Alabama. This will enable us to pay you the same rate we pay you for in-person visits. Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. 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. For eligible plans, you can fill out and mail a paper claim form. You dont need to be part of a telehealth network of providers to offer this. Check with your insurer for the most up-to-date information for your specific plan. "We are requiring insurers and group health. The screenshot below shows the correct way to enter modifiers. To meet this requirement, insurers may choose to provide direct coverage for tests by: If your insurer does not provide direct coverage, or if you purchase tests outside of your insurer's preferred provider network, you can request reimbursement for some or all of your out-of-pocket expense. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. Not all plans have access to these services. Plus learn how to safely resume healthcare visits. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. Federal Employee Program (FEP) members
2023 Blue Cross Blue Shield Association. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. Claims for laboratory services including COVID-19 testing, On or after July 1, 2021, the ordering clinician NPI will be a required field on your claim to indicate that the lab test is medically necessary. This helps make sure you dont have to pay more out-of-pocket. Your plan includes COVID-19 tests, treatment, and care. 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. How to maintain coverage Some out-of-network providers may charge added fees. BinaxNOW COVID-19 Antigen Self-Test (Abbott), BD Veritor At-Home COVID-19 Test (Becton Dickinson), CareStart COVID-19 Antigen Home Test (Access Bio), Celltrion DiaTrust COVID-19 Ag Home-Test (Celltrion), CLINITEST Rapid COVID-19 Antigen Self-Test (Siemens), Flowflex COVID-19 Antigen Home Test (ACON), iHealth COVID-19 Antigen Rapid Test (iHealth Labs), QuickVue At-Home OTC COVID-19 Test (Quidel), SCoV-2 Ag Detect Rapid Self-Test (InBios), See a complete list of authorized tests on the FDA's web page. Blue Shield Coverage for COVID-19 Testing. Be sure to seek non-emergency care from in-network providers if you have an HMO plan. 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. How many at-home test kits can I purchase each month? Subscriber identification and dependent information, Legible copies of UPC codes and receipts including date purchased, An attestation stating for member use only, not for resale or work/school/travel related testing, has not and will not be reimbursed by another source, and. 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. Patient symptoms are expected to improve with cognitive rehabilitation. Many Americans can now get home Covid-19 tests at no cost through their private insurance. I have BCBSIL insurance, but don't live in Illinois. Log in to find out if you have access. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. For in-network outpatient professional behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule. For example: 2Tests obtained for employment purposes, return to school, or sports are those requested at the direction of an employer, school, or sports league/facility or are for group testing rather than for individual assessment. Reimbursement Process Link or Description: Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. These may include fees for other tests or services. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. All rights reserved. No, COVID-19 Testing Coverage Website: For COVID-19-related diagnoses, they asked insurers to add quantity limits. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Claims submission and reimbursement for all COVID-19 testing. Members can also contact Customer Service at 888-327-0671 (TTY: 711). Network of Preferred Providers: If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our Medicare coverage and Medi-Cal coverage pages to learn more. Members are responsible for any fees or tests that are not covered by their plan. Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. It does not include care received at chronic care and long-term acute care hospitals, psychiatric facilities, rehabilitation hospitals, skilled nursing facilities, and substance use disorder facilities. Everyone qualifies. Commercially insured members: 1-888-624-3096. Only to be reported with use of high-throughput technologies. If you were not reimbursed correctly, or your advisory shows that a member is responsible for a copayment, you can either: At this time, there are no changes to our licensure requirements. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. https://www.humana.com/coronavirus/coverage-faqs. Reimbursement Process Link or Description: 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 I have a Medi-Cal plan. Some restrictions apply. Independence does not cover tests that are needed for return to work, a condition of employment, return to school, or travel. That form will be replaced on Jan. 23 once the insurer develops . Reimbursement for tests purchased before January 15, 2022: Please remember that COVID-19 testing and vaccination requirements vary worldwide. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. Then, complete and submit the online form. 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. Under the rule, insurance providers are . Well allow the use of these modifiers for any service on your fee schedule. The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. For thehigh-technology radiologyandsleep testing and treatment servicesthat require prior authorization with AIM Specialty Health, during the public health emergency, we authorized new requests for 180 days to allow time to have services performed. There is a limit of . COVID-19 Temporary payment policy (includes telehealth). Antiviral therapy (such as hydroxychloroquine; Members who are newly prescribed the medication for rheumatological and dermatological use (for example, to treat lupus, malaria, rheumatoid arthritis). Centers for Disease Control and Preventions web page. We have waived pre-authorization requirements for ground ambulance transport by a contracted provider. Network of Preferred Providers: Member cost will be the same as an in-person office visit, and cost will not be waived for a COVID-19 diagnosis. Which types of COVID-19 tests are covered? Members can submit a direct member reimbursement claim to McLaren using the form found by following the link: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049. Please be aware that this statement is. For providers not in the Teladoc network, the applicable cost share will apply (unless COVID-19 related). 5Self-funded group plans are not required to cover these costs. You can request an authorization to cover more. If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. See details on the. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). 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. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. How to bill for telehealth and services by phone. To learn more about treatments and medications, visit the Centers for Disease Control and Preventions web page. Get health advice 24/7 from a registered nurse over the phone. *Blue Plan members receiving care in Massachusetts are covered according to their Home plans benefits and coverage. Availability and eligibility Updates as of January 11, 2023. There are no prior approvals needed to receive COVID-19 treatment. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. Members can call our dedicated coronavirus help line at 1-888-372-1970. If I need to get tested for travel, is that covered? Symptoms consistent with COVID-19, such as fever, cough, shortness of breath, chills, muscle pain, sore throat, anosmia, and gastrointestinal distress, Asymptomatic patients with direct exposure and/or close contact to another individual with a confirmed case of COVID-19, Close contact is defined by the CDC as someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated, Asymptomatic patients who have been identified by contact tracing, Symptomatic or asymptomatic patients who require testing prior to a medical procedure or surgery, Admission to a facility including but not limited to a hospital operated or licensed by the Department of Public Health or Mental Health, a long-term acute care hospital, or a skilled nursing facility, The patients home (using a testing kita patient self-swab), For public health or surveillance purposes, For periodic or serial testing of asymptomatic high-risk individuals (examples include congregate housing and occupational safety), Tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, Member transportation to or from testing sites (unless the member meets requirements for ambulance services), for public health or surveillance purposes, for periodic or serial testing of asymptomatic individuals (examples include congregate housing such as dormitories and residential facilities, and occupational safety), For tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, For member transportation to or from testing sites (unless the member meets requirements for ambulance services), To screen for eligibility to donate plasma, pre-surgical testing for elective and non-elective procedures, We extended existing authorizations issued for the first six months of 2020 to December 31, 2020. Learn more about potential out-of-pocket costs from out-of-network providers. All Rights Reserved. Call the customer service number on your member ID card. Federal Employee Program
When reporting modifier GT, 95, G0, or GQ, you are attesting that services were rendered to a patient via synchronous/asynchronous telehealth audio and/or video telecommunications systems. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing