Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. This makes it easier to treat and improve the outcome. Follow the instructions below to submit your claim online. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Health plans are offered by Blue Shield of California. Medi-Cal members: Do not submit any claims to Blue Shield Promise. 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. Its important not to fall behind on preventive care visits. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Please be aware that this statement is. How can I get a free OTC COVID-19 test? for tests purchased on or after January 15, 2022. Phone Number: If you plan to provide a previously approved service under an authorization that expired on December 31, 2020 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. Network of Preferred Providers: For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076. This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Please note that Blue Shield does not offer tax advice for HSAs. State-chartered Bank and State-chartered Savings Bank forms. See details for how to submit a claim for reimbursement for covered testing. How many at-home test kits can I purchase each month? You can have telehealth video or phone visits with children, adolescents, and adults. We do not have any restrictions on the video or voice platform the dentist can use. Need to talk with DIFS? In a hospital (including emergency room). For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). Additional information about COVID-19 testing and vaccines can be found in these FAQs. To avoid paying any extra fees, please usenetwork locationsfor testing. To bill for telehealth/video services during the state of emergency. COVID-19 Coverage for Members Your health is always our priority. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form Health plans are offered by Blue Shield of California. See the Notification of Enforcement Discretion for telehealth. Antibody testing Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). 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. Health plans are offered by Blue Shield of California. Members can also call the National Information Center at 1-800-411-BLUE (2583). You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer between January 15, 2022 and January 31, 2022, submit this form: No, COVID-19 Testing Coverage Website: Please note: You cannot be reimbursed more than once for OTC at-home tests. Members need to submit a separate claim form for each family member. Medicare Advantage members See details on theState Medi-Cal websitefor how to submit a claim. When testing patients in a drive-through or other temporary setting (such as a tent), please use the following codes for claims with dates of service on or after March 1, 2020.These codes apply to all commercial, Medicare Advantage, and Federal Employee Program (FEP) members. 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. https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: Those payments will now go directly to the provider. We are here to support you as you care for your patientsour members. Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. In that case, you would be able to submit reimbursement for up to four packages, or eight tests total, for each member on your plan. Effective May 1, 2021, for members of our fully-insured employer and individual plans, as well as self-funded plans, Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines at a rate of $40 per administration. Seewhichtestsarecoveredforyourplan. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed. *UB-04 billers do not need to submit place of service code. 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. Bill as if you are performing an in-person service, using the revenue and HCPCS/CPT code combinations that you would normally bill on a facility claim. SECTION 2 - PATIENT INFORMATION Reason for the test cI was exposed to someone with COVID-19. Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. To meet this requirement, insurers may choose to provide direct coverage for tests by: Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. If your tests cost more than $12 per test, you will not be reimbursed for the difference. The screenshot below shows the correct way to enter modifiers. 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. Updates as of January 11, 2023. All rights reserved. Network of Preferred Providers: I have BCBSIL insurance, but don't live in Illinois. *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. When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. c I had COVID-19 symptoms. High-technology radiology and obstructive sleep apnea testing and treatment FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance 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. 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. How can I continue seeing my mental health care provider? You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. 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. 800-942-0954 (main). Neuropsychological testing services You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. To make sure the associated costs for getting diagnostic tests are covered by your BCBSIL plan: Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Everyone qualifies. 5Self-funded group plans are not required to cover these costs. Members will have the option of online submission through the secure member website or sending a paper submission. Members are responsible for any fees or tests that are not covered by their plan. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. Get an in-person test at a Washington or Alaska testing location . COVID-19 Testing Coverage Website: Please be advised that, while awaiting further guidance from the Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS) regarding SB510, Anthem Blue Cross will pay Medi-Cal claims for COVID-19 testing incurred on or after January 1, 2022, according . This update also includes the ICD-10 vaping-related disorder code. Keep your purchase receipt(s) to submit for reimbursement. Why we made the change California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Find out which COVID-19 tests are available to members and where to get tested. Reimbursement Process Link or Description: COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. Note: These changes do not apply to our Medicare Advantage members. Similarly, FEP will waive any copays or deductibles for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. COVID-19 test reimbursement. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. 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. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. Reimbursement Process Link or Description: I have a Medicare plan. Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our Medicare coverage and Medi-Cal coverage pages to learn more. Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. Talk to board-certified doctors24/7 by phone or video. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. My Turn 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. This will enable us to pay you the same rate we pay you for in-person visits. 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. Reimbursement for tests purchased before January 15, 2022: 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. 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. Get the Kaiser Permanente at-home COVID test reimbursement claim form (will download PDF). "We are requiring insurers and group health. An antibody test determines whether the person has had COVID-19 and therefore may have some level of immunity. 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. To access your member services, please visit your BCBS company. All rights reserved. 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: Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. 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. If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. California Physicians' Service DBA Blue Shield of California 1999-2023. https://www.mclarenhealthplan.org/mhp/are-you-a-member. Effective March 16, 2020, Blue Cross and Blue Shield of Alabama is expanding telehealth coverage. Health plans are offered by Blue Shield of California. California Physicians' Service DBA Blue Shield of California 1999-2023. Coverage for Medicare members. 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 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. Licensees of the Blue Cross and Blue Shield Association. Type OTC or Home in the search bar to narrow the results for at-home tests. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Blue Shield of California has neither reviewed nor endorsed this information. This helps make sure you dont have to pay more out-of-pocket. Licensees of the Blue Cross and Blue Shield Association. Licensees of the Blue Cross and Blue Shield Association. That form will be replaced on Jan. 23 once the insurer develops . ", Adjustments to Medicare Advantage reimbursement. COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. Some may choose to cover screening tests for employment purposes, return to school, or sports. Toll free: 800-462-3589, Reimbursement Process Link or Description: Yes, CVS pharmacies. Coverage for Medi-Cal and Cal MediConnect members If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342. They are basically the same. All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. If you are interested in a rewarding position helping Michiganders apply today! If you havent yet paid the provider, the check goes to the provider. This is in place for the duration of the Massachusetts state of emergency. Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). Centers for Disease Control and Preventions web page. Members can register for Teladoc by visiting fepblue.org/coronavirus. 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. 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. Licensed independent clinical social worker, Psychiatric and state psychiatric hospital. Note: Telephonic codes (98966-98968, 99441-99443) do not require the use of any telehealth modifier. Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. The authorization process will officially resume for all products effective July 1, 2021. Outside of an emergency situation, you should seek care from in-network providers to save money. Get health advice 24/7 from a registered nurse over the phone. 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. 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. Virtual visits are covered. Federal Employee Program The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. Submit a claim online, or download the COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF] and submit via mail or fax using the instructions on the form. H0148_22_161_C_IA_092722. Visit an in-network testing location, like one of these retail pharmacies: Diagnostic testing performed by out-of-network health care providers is also covered at no cost to members during the. Commercial members: Managed care (HMO and POS), PPO, and Indemnity.