You can request an authorization to cover more. Quantity c I had COVID-19 symptoms. Blue Cross recommends that members contact and work closely with their health care . For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. Rheumatological and dermatological use When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. 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. No, COVID-19 Testing Coverage Website: 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. 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. Reimbursement Process Link or Description: Why we made the change Follow the instructions below to submit your claim online. Does my plan cover COVID-19 screening and testing? https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Log in to find out your costs and if you have access. Find out what your coverage is for OTC at-home tests based on your plan. Have more questions about testing coverage? These may include fees for other tests or services. How to maintain coverage Call the customer service number on your member ID card. California Physicians' Service DBA Blue Shield of California 1999-2023. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms, https://dev.michigan.local/som/json?sc_device=json, Insurance Coverage for Over-the-Counter COVID-19 Tests, Go to Licensing - Consumer Finance and Mortgage, Go to Additional Financial and Insurance Services Forms, Go to DIFS Biographies and Public Officials. For example: Find out what your coverage is for OTC at-home tests. Consumers can either purchase the testing kits at no cost or submit receipts for. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: Reimbursement Process Link or Description: Authorization requirements will resume for Commercial, Federal Employee Program (FEP) and Medicare Advantage plans. 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. Below are the codes for providers and laboratories to test patients for 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. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. Anthem is waiving cost shares for COVID-19 treatment. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Can I get reimbursed for multiple packages? California Physicians' Service DBA Blue Shield of California 1999-2023. The program is . Here are some additional ways Horizon BCBSNJ members can receive advice and support: Members can talk to licensed nurses who can assist them with symptoms that are consistent with suspected COVID-19 infection. Note: These changes do not apply to our Medicare Advantage members. For more details please visit fepblue.org. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. See the Notification of Enforcement Discretion for telehealth. 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. You may also call the customer service phone number on your member ID card. Losing your job doesnt have to mean losing your healthcare coverage. 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. Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. * Please refer to yourEvidence of Coverageor plan documents for information about standard out-of-pocket costs for your plan. The COVID-19 Temporary payment policy applies. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, Phone Number: COVID-19 test Note: Cost share waive for to COVID-19 treatment expires on 08/31/2021. 102811 1021R October 2021 COVID-19 Update as of Oct. 21, 2021 As we move forward during the COVID-19 pandemic, we support the work of providers, and the guidelines set forth by the Florida Department of Health and the Centers for Disease Control and Prevention (CDC). COVID-19 Testing Coverage Website: https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: What should I do with it? Reimbursement Process Link or Description: Information requested will include: Reimbursement for tests purchased before January 15, 2022: Standard out-of-pocket costs will apply for treatments received. 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. How can I get a free OTC COVID-19 test? This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. 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 We resumed our usual 90-day timely filing limit for dates of service or dates of discharge on and after June 1, 2020. Blue Shield of California. These amounts not paid by the plan may be the responsibility of the member. The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost. Please remember that COVID-19 testing and vaccination requirements vary worldwide. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. We have plans to help keep you covered. Federal Agencies Extend Timely Filing and Appeals Deadlines - COVID 19 Producers | Blue Cross and Blue Shield of Illinois. Covered investigational drugs 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. Several changes regarding telehealth and COVID-related care and treatment made during State of Emergency became permanent on January 1, 2021 with the passage of the Patients First Act. COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. For tests provided by a health care provider, the original bill or claim for the services that includes: The laboratory or provider's name and address Licensees of the Blue Cross and Blue Shield Association. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. An antibody test determines whether the person has had COVID-19 and therefore may have some level of immunity. Reimbursement Process Link or Description: Phone Number: Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. 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. If you have a self-funded group plan, OTC at-home tests are not covered or reimbursable if purchased prior to January 15, 2022, without a healthcare provider order, or purchased at any time for employment purposes. These services can help you see if your symptoms may be related to COVID-19 or something else. Reimbursement Process Link or Description: Under the rule, insurance providers are . * Login to find out what options are available to you. Standard out-of-pocket costs will apply for treatments received. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. They can obtain the tests from pharmacies, retailers and online vendors. The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. Reimbursement for tests purchased before January 15, 2022: In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) has extended the suspension of the mandatory payment reductions known as sequestration through December 31, 2021. 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. HSAs are offered through financial institutions. All information below is required. Some people with weakened immune systems may need a boost just to get a response that most people get from the regular dose. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Update: BCBSTX Approach to OTC COVID-19 Testing Coverage - COVID 19 Producers | Blue Cross and Blue Shield of Texas This page may have documents that can't be read by screen reader software. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. Contact the company for the latest information. "We are requiring insurers and group health. Insurers must cover the cost of eight tests per insured individual. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. Reimbursement for tests purchased before January 15, 2022: Get the Kaiser Permanente at-home COVID test reimbursement claim form (will download PDF). Your plan may require you to sign an attestation that the test was purchased: Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. They have their own payment policy for telehealth services. If I need to get tested for travel, is that covered? For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076. 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. Some out-of-network providers may charge added fees. COVID-19 Temporary payment policy (includes telehealth). Reimbursement Process Link or Description: The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. This policy applies to Blue Cross Blue Shield of Massachusettsmembers*in the following plans: Note: Employers who are self-insured may choose not to offer waived cost share for their employees. Contact the company for the latest information. Note: Telephonic codes (98966-98968, 99441-99443) do not require the use of any telehealth modifier. Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard program. The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. At-home COVID-19 testing. For dates of service between March 1, 2020 and May 31, 2020, you had 150 days from the date of service or the date of discharge (for inpatient stays) to submit your claims for HMO/POS, Medicare Advantage, and PPO members. What virtual care options does my plan cover? The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. 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. Beginning on January 1, 2022, sequestration will be reinstituted. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) . See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. The authorization process will officially resume for all products effective July 1, 2021. 2023 Blue Cross Blue Shield Association. Log in and to go Office Resources>Billing & Reimbursement>Fee schedules. Free at-home COVID-19 tests To meet this requirement, insurers may choose to provide direct coverage for tests by: Network of Preferred Providers: California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Members will receive test kits from network pharmacies at no cost. 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. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Your insurance company will reimburse you for the full purchase price of each covered test. 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. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. 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. As announced on April 6, Blue Cross will also waive cost share for COVID 19 related inpatient care at both in- and out-of-network acute care facilities for our fully insured members. https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, COVID-19 Testing Coverage Website: You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. See which plans cover screening tests for travel. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: What options do I have for at-home test kits at no cost? Blue Shield of California has neither reviewed nor endorsed this information. Your health is our priority. The top things you should know about COVID-19 vaccines. Members can call our dedicated coronavirus help line at 1-888-372-1970. Yes, CVS Caremark Pharmacies, Reimbursement Process Link or Description: Medicare Advantage members This is at the discretion of the prescriber and/or dispensing pharmacist. (Medical and Mental Health) Network Management and Credentialing Services Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. Reimbursement Process Link or Description: For example, if you purchase a package with two tests inside, that counts as two separate tests. Members need to submit a separate claim form for each family member. 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. Members should call the number on the back of their ID card. Members can also call the National Information Center at 1-800-411-BLUE (2583). See details for how to submit a claim for reimbursement for covered testing. However, they will not be able to order a COVID-19 test for you. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. 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. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form 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. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. What's the difference between the booster shot and the additional 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. Reimbursement for tests purchased before January 15, 2022 Some restrictions apply. Please check your Original Medicare or Medicare Supplement plan for testing coverage under your medical benefits. For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. 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. 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. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. How can I continue seeing my mental health care provider? Get an in-person test at a Washington or Alaska testing location . 8*Self-funded group plan antibody tests are covered when ordered by a provider unless the group has opted in to offer coverage in alignment with SB 510. What to do if you think you have COVID-19. You will be reimbursed up to $12 per test by submitting a claim. If you would like to find a new mental healthcare provider in your network, learnhow to find one. There are new codes for these boosters. Contact the company for the latest information. High-technology radiology and obstructive sleep apnea testing and treatment We will share additional information when available. We do not have any restrictions on the video or voice platform the dentist can use. 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. 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. Referrals and prior authorizations are not required for medically necessary testing and treatment for COVID-19. Be sure to bill using CPT A0426, A0428, A0433, or A0434 (non-emergent transports) and the appropriate modifier shown below to represent the direction of the transfer. Member costs are being waived for all Teladoc visits (COVID-19 and non-COVID-19) during this emergency period. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. Please note that Blue Shield does not offer tax advice for HSAs. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Testing and Treatment Coverage Schedule your COVID-19 vaccine booster today. We have waived pre-authorization requirements for ground ambulance transport by a contracted provider. 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. At in-network pharmacies. As of April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) is covering up to eight free OTC COVID-19 at-home tests each calendar month at participating pharmacies and healthcare providers. Bill the same as you would for in-person visits, and include the following modifiers with the applicable place of service code*: modifier GT, 95, G0, or GQ via synchronous/asynchronous telehealth audio and/or video telecommunications systems to differentiate a telehealth (telemedicine) encounter from an in-person encounter with the patient. For more details, please see fepblue.org. To learn more about treatments and medications, visit the Centers for Disease Control and Preventions web page. For information about your insurer's network of preferred providers and reimbursement process, see the information below. UB-04 billers do not need to enter a place of service when billing for services provided by phone. How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? Your doctor may also offer virtual visits if you prefer. See below for details. My at-home test comes with more than one test per package. The system will not distinguish between a COVID visit and a non-COVID visit; therefore, we recommend that you bill the member for the applicable cost share once the claim has processed to ensure you do not have to reimburse the member. Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. Serologic testing for the presence of antibodies is not covered, Medicare HMO BlueSM and Medicare PPO BlueSM Members. In the case of a medical emergency, care provided by in-network and out-of-network providers will be covered for all plans. This page may have documents that can't be read by screen reader software. Plus learn how to safely resume healthcare visits. 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).