Each individual test within a package counts as one test. Health plans are offered by Blue Shield of California. *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. You will be able to get an at-home test at no cost through these network pharmacies. COVID-19 Temporary payment policy (includes telehealth). For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. COVID-19 Testing Coverage Website: This benefit is available to Anthem members in Fully Insured . National vaccine finder. 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. 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. Talk to board-certified doctors24/7 by phone or video. Some out-of-network providers may charge added fees. 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. You may be aware that on March 30, 2020, the Food and Drug Administration (FDA) issued an emergency authorization to use chloroquine and hydroxychloroquine as experimental coronavirus treatment. 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. Does my plan cover COVID-19 screening and testing? Claims submission and reimbursement for testing. Network of Preferred Providers: 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 . *UB-04 billers do not need to submit a place of service code. This includes visits by phone and your communication platform of choice. Coverage for out-of-network testing will change when the public health emergency ends. Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. continue to monitor and will be responsive to state and federal guidance. Neuropsychological testing services We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. For information about your insurer's reimbursement process, see the information below. The provider should mail you a refund check. To bill for services by phone FEP will also encourage members to use 90-day mail order benefit. You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. Click Prescription and follow the prompts to submit your online claim. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. *These modifiers do not apply to Federal Employee Program members. For providers not in the Teladoc network, the applicable cost share applies (unless COVID-19 related). How many at-home test kits can I purchase each month? Learn about what coverage and care you can receive through your Medi-Cal benefits. COVID-19 Testing Coverage Website: Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. Please bill members for their cost share once the claim has processed When you are checking eligibility, Online Services will show the standard telehealth cost share. Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage. If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. If you plan to provide a previously approved service to a patient in 2021, please call our Clinical Intake Department at the appropriate number and we will create a new authorization or update the existing one. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. In accordance with the Centers for Disease Control (CDC) and the MA Department of Public Health guidelines, covered scenarios include (but are not limited to): * Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes). Insurers must cover the cost of eight tests per insured individual. For help with these documents, please call 1-800-975-6314. . 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. We provide health insurance in Michigan. Testing and Treatment Coverage Yes. Health plans are offered by Blue Shield of California. 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. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. SECTION 2 - PATIENT INFORMATION Reason for the test cI was exposed to someone with COVID-19. 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. 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 live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. You can find a list of community-based testing sites here. To meet this requirement, insurers may choose to provide direct coverage for tests by: What are the limits to reimbursement for OTC COVID-19 at-home tests? 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. Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. Starting Saturday, private insurers must cover the cost of up to eight at-home Covid-19 tests per month, the Biden administration announced on Tuesday. Need to talk with DIFS? Federal Employee Program prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. These may include fees for other tests or other services unrelated to the COVID-19 test. You do not need health insurance to receive your free tests. There are new codes for these boosters. Centers for Medicare and Medicaid Services FAQ. Find out about COVID-19 vaccination, including side effectsand more. See details for how to submit a claim for reimbursement for covered testing. All rights reserved. All information below is required. Coverage for Medi-Cal and Cal MediConnect members Contact your primary healthcare provider to find out if they have virtual visits available. These may include fees for other tests or other services unrelated to the COVID-19 test. 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. How you will bill for services by phone depends upon your specialty. For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. Medi-Cal members: Do not submit any claims to Blue Shield Promise. As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan.Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. The U.S. Department of Health and Human Services and the Office of Civil Rights have relaxed HIPAA requirements related to the use of telehealth services during the COVID-19 nationwide public health emergency. For eligible plans, you can fill out and mail a paper claim form. If you havent used Dental Connect before, youll need toregister for Dental Connect using partner codeBCMA01DPS(this is an important step for registration; Blue Cross Blue Shield of Massachusetts sponsors monthly fees for this service. 419-887-2525 (main) If you are currently seeing a mental healthcare provider, you can continue to see that provider virtually. Reimbursement for tests purchased before January 15, 2022: * Login to find out what options are available to you. They are basically the same. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. 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. 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. Many Americans can now get home Covid-19 tests at no cost through their private insurance. Learn more about the different types of tests. Toll free: 800-462-3589, Reimbursement Process Link or Description: Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. 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. 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. Reimbursement Process Link or Description: Contact the company for the latest information. Coverage for Medi-Cal and Cal MediConnect members, Local updates on COVID-19 from the State of California, Vaccine information from the Centers for Disease Control and Prevention (CDC). 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). Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells), Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors), Other therapies currently under investigation without published supporting evidence. For example, a physician, a nurse practitioner, or a physician assistant. We have plans to help keep you covered. Click Reimbursement Form. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. 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, making use of high throughput technologies as described by CMS-2020-01-R. Reimbursable for dates of service on or after April 14, 2020. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. Standard out-of-pocket costs will apply for treatments received. Licensees of the Blue Cross and Blue Shield Association. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. 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. 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. Blue Cross recommends that members contact and work closely with their health care . This information is provided for informational purposes only. You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. You dont need to be part of a telehealth network of providers to offer this. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Shield of California PO Box 272540 Chico, CA 95927-2540 COVID-19 laboratory tests (PCR tests) If you paid out of pocket for a test that was sent to a laboratory, follow the steps below to file a reimbursement claim. 5Self-funded group plans are not required to cover these costs. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. 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. How can I submit a claim form for my OTC COVID-19 at-home tests? Members should call the number on the back of their ID card. 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. Serologic testing for the presence of antibodies is not covered, Medicare HMO BlueSM and Medicare PPO BlueSM Members. Or, you can call Dental Provider Services at 1-800-882-1178. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Patient symptoms are expected to improve with cognitive rehabilitation. Blue Cross also removes all referral and authorization requirements for outpatient care if a member is being evaluated or treated for suspected or confirmed COVID-19. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. Retroactive to March 6, 2020, we waive member cost (copayments, deductible, co-insurance) for medically necessaryinpatient acute care hospital serviceswhen the claim includes a diagnosis of COVID-19. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. Virtual visits are covered. Similarly, for at-home tests paid for or reimbursed by Blue Shield, you should not seek reimbursement from an FSA, HSA, or HRA for the cost (or the portion of the cost). Can I get reimbursed for multiple packages? Then have an authorized representative of the group you are joining sign the form and send it back to PHEexpeditedCred@BCBSMA.com. https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdf, To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer after January 15, 2022, submit this form: Contact the company for the latest information. Members are responsible for any fees or tests that are not covered by their plan. Anthem is waiving cost shares for COVID-19 treatment. $0. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. This is in place for the duration of the Massachusetts state of emergency. 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. Get the Kaiser Permanente at-home COVID test reimbursement claim form (will download PDF). Learn more about potential out-of-pocket costs from out-of-network providers. Members can register for Teladoc by visiting fepblue.org/coronavirus. Kaiser's California Member Services hotline is (800) 464-4000. Get health advice 24/7 from a registered nurse over the phone. Reimbursement Process Link or Description: https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, COVID-19 Testing Coverage Website: Does BCBSIL cover at-home test kits? Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. If your tests cost more than $12 per test, you will not be reimbursed for the difference. FEP will waive copays for telehealth services related to COVID-19. What virtual care options does my plan cover? How can I continue seeing my mental health care provider? Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. To learn more about Teladoc, visit https://www.teladoc.com/providers/. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. For Medicare Advantage plans, you must submit claims for COVID-19 drug and the administration of the drug to the CMS Medicare Administrative Contractor (MAC) for payment. A diagnostic test is used to determine if a person has COVID-19. COVID-19 Testing Coverage Website: https://www.mclarenhealthplan.org/mhp/are-you-a-member. Blue Shield of California has neither reviewed nor endorsed this information. If you use the online form, you must file a separate digital claim for each member and for each receipt. Please note that Blue Shield does not offer tax advice for HSAs. What's the difference between the booster shot and the additional dose? The instructions and form are provided on the COVID-19 home test kit page: https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Network of Preferred Providers: Find out which COVID-19 tests are available to members and where to get tested. (Medical and Mental Health) Network Management and Credentialing Services FEP will determine coverage for the vaccine once it becomes available. Please note that tests are currently in short supply and some retailers may impose limits on the number of tests you can purchase. For example, if four people are covered by your health plan, you can get up to 32 tests per month. Y0118_22_338A1_C 09272022 Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. 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 OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered. Legal | Privacy Policy, OptumRx Over-the-Counter Test Reimbursement 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. Questions about medical or prescription coverage? Members can call our dedicated coronavirus help line at 1-888-372-1970. Member Discounts Take advantage of member-only discounts on health-related products and services. You can bill all services for which you are contracted using the telehealth codes with the telehealth modifier. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. c I had COVID-19 symptoms. Please enter the NDC or UPC number from the cash register receipt. bill the test on a separate claim from the rest of the services being rendered. Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. After the vaccine: what to expect. What if I seek care from an out-of-networkprovider for COVID-19? Viral testing UnitedHealthcare (UHC) Please be aware that this statement isnota bill. Standard out-of-pocket costs will apply for treatments received. See details on theState Medi-Cal websitefor how to submit a claim. Blue Cross and Blue Shield companies (BCBS) will also increase access to prescription drugs, enhanced telehealth and other clinical support . 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for 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. Everyone qualifies. 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. 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.