Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. FEP will waive copays for telehealth services related to COVID-19. https://www.phpmichigan.com/?id=175&sid=1. Federal Employee Program (FEP) members
COVID-19 Temporary payment policy (includes telehealth). You can request an authorization to cover more. 1-800-882-1178. Those payments will now go directly to the provider. *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. Under the rule, insurance providers are . 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. To make this request, please submit theMassachusetts Standard Form for Medication Prior Authorization Requests(click the link and find the form by choosingAuthorization Pharmacy). Some restrictions apply. Claims submission and reimbursement for testing. For more information, read these FAQs:Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate (PDF, 125 KB). You may also submit a digital claim online with a copy of your receipt. 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. If you purchased an at-home test previously, you may be able to get paid back. 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). You will be reimbursed via check, mailed to the address we have on file within 30 days of Blue Cross Blue Shield of Arizona (BCBSAZ) receiving your reimbursement information. Its important not to fall behind on preventive care visits. Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network. Claims must include proof of purchase (e.g. The authorization process will officially resume for all products effective July 1, 2021. Virtual visits are covered. 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. This helps make sure you dont have to pay more out-of-pocket. Payment for COVID-19 testing services on or after January 1, 2022. California Physicians' Service DBA Blue Shield of California 1999-2023. 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. 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. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. 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. Log in to find out your costs and if you have access. Additional doses are given to boost the immune response from the vaccine. These services can help you see if your symptoms may be related to COVID-19 or something else. Your health is our priority. In 2020, we extended time-limited authorizations through the end of the year for specific outpatient procedures that our members may not have been able to receive due to the COVID-19 emergency. See details on the. At-home COVID-19 testing. You must use one of the following telehealth modifiers (GT, 95, G0, and GQ) with the applicable place of service code. OTC at-home tests must have been purchased on or after January 1, 2022. Blue Shield of California has neither reviewed nor endorsed this information. For example, if four people are covered by your health plan, you can get up to 32 tests per month. This coverage applies to all BCBSRI health plans except Medicare. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Members will have the option of online submission through the secure member website or sending a paper submission. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: There are no additional credentialing or contracting processes you need to follow to offer telehealth services. To avoid paying any extra fees, please usenetwork locationsfor testing. Contact the company for the latest information. Or, you can call Dental Provider Services at 1-800-882-1178. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. 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. La compaa cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, pas de origen, identificacin con determinado grupo tnico, condicin mdica, informacin gentica, ascendencia, religin, sexo, estado civil, gnero, identidad de gnero, orientacin sexual, edad, ni discapacidad fsica ni mental. 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. Schedule an appointment in your area. We have plans to help keep you covered. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. 5Self-funded group plans are not required to cover these costs. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health plans are offered by Blue Shield of California. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. How can I get a free OTC COVID-19 test? As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. Please follow the billing instructions outlined in our COVID-19 Temporary payment policy. Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. Network of Preferred Providers: Licensees of the Blue Cross and Blue Shield Association. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. 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. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. FEP will determine coverage for the vaccine once it becomes available. Reimbursement Process Link or Description: $0. Some may choose to cover screening tests for employment purposes, return to school, or sports. 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. This page may have documents that can't be read by screen reader software. If you use the online form, you must file a separate digital claim for each member and for each receipt. After the vaccine: what to expect. You may also call the customer service phone number on your member ID card. Health plans are offered by Blue Shield of California. 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. The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost. For some plans, only emergency and urgent care are covered outside of the United States. Information requested will include: Reimbursement for tests purchased before January 15, 2022: 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. Bill all covered services that you render either by telehealth/video or telephone as if you are performing an in-person service using the codes that are currently on your fee schedule. What do I need to do? 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. Does BCBSIL cover at-home test kits? Also, there are some limitations to the number of tests that can be reimbursed without a provider order. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. Health plans are offered by Blue Shield of California. Some out-of-network providers may charge added fees. 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. Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. Contact the company for the latest information. Plus learn how to safely resume healthcare visits. Yes, CVS Caremark Pharmacies, Reimbursement Process Link or Description: You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. Click Prescription and follow the prompts to submit your online claim. See below for details. What will BCBSIL cover for COVID-19? OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered. How to get at-home test costs covered: Submit a reimbursement claim form by mail. Leading the way in health insurance since 1929. This includes at-home over-the-counter test kits. FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance if diagnosed with COVID-19. Members will receive test kits from network pharmacies at no cost. Call the customer service number on your member ID card. See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. This will enable us to pay you the same rate we pay you for in-person visits. Learn moreabout potential out-of-pocket costs from out-of-network providers. 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. Reimbursement Process Link or Description: That being said, I called my insurance provider, Blue Cross Blue Shield of Texas (BCBSTX) to ask if I could submit a claim for my test from last week. My at-home test comes with more than one test per package. For example, if you purchase a package with two tests inside, that counts as two separate tests. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our Medicare coverage and Medi-Cal coverage pages to learn more. Medicare Advantage members
Annual exams can help you: These exams also help your primary doctor see any health issues early on. All rights reserved. Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. Ralphs Clinic Testing Services for Viral or Rapid Antigen Tests, contact Medi-Cal Rx to locate an in-network pharmacy, See details for how to submit a claim for reimbursement for covered testing, Find out what your coverage is for OTC at-home tests based on your plan, Medi-Cal members: Do not submit any claims to Blue Shield Promise, Yes for OTC at-home tests purchased on or after 1/15/22, Medicare Prescription Drug Plan (pharmacy benefit only), No, coverage for OTC at-home tests is covered by Original Medicare, Yes, for purchases between 1/1/22 4/3/22, None for covered tests during the public health emergency. Members should call the number on the back of their ID card. 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. Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. 11Medicare members can get up to eight OTC COVID-19 home tests each calendar monththrough the Centers for Medicare and Medicaid Services. If you would like to find a new mental healthcare provider in your network, learn. Medicare Advantage, Federal Employee Program . 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). All rights reserved. Federal Agencies Extend Timely Filing and Appeals Deadlines - COVID 19 Producers | Blue Cross and Blue Shield of Illinois. Will it be covered? 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. *Blue Plan members receiving care in Massachusetts are covered according to their Home plans benefits and coverage. Use an at-home antigen test, available over-the-counter (OTC) at many retail pharmacies, to screen for employment, school, events, or if you experience symptoms. Patient symptoms are expected to improve with cognitive rehabilitation. Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. 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: Questions about medical or prescription coverage? We will continue to waive the authorization requirement for commercial and Medicare Advantageinitial requestsfor the following serviceswith a COVID diagnosis: If you arent already, please submit clinical information for all authorization requests with the exceptions noted above. 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. 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. No. prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. This update also includes the ICD-10 vaping-related disorder code. You can use Dental Connect for Providers to verify member eligibility and benefits. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. Make choices that are right for you based on the latest information. 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. 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. Additional information about COVID-19 testing and vaccines can be found in these FAQs. ", Adjustments to Medicare Advantage reimbursement. 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. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. 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. The Federal Employee Program (FEP) covers COVID-19 testing and antibody testing with no member cost share, regardless of provider status, including testing for: Note: There are no limits on frequency of testing. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. FAQs about resuming "regular" care All rights reserved. Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. If you are interested in a rewarding position helping Michiganders apply today! As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. continue to monitor and will be responsive to state and federal guidance. People may also access free or affordably priced testing in the community. 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). 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 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. I have BCBSIL insurance, but don't live in Illinois. Then, complete and submit the online form. There is no change to the timely filing guidelines for Indemnity claims. National vaccine finder. Your doctor may also be offering virtual visits if you prefer. Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. Contact your primary healthcare provider to find out if they have virtual visits available. Member Discounts Take advantage of member-only discounts on health-related products and services. 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. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12meaning that even if your COVID test costs upwards of $30, you will. Otherwise, contact your employer, plan sponsor, or benefits administrator. Coverage varies by plan type. We have waived pre-authorization requirements for ground ambulance transport by a contracted provider. Estimated reimbursement is within 30 calendar days. A list of reports produced by our Department. A diagnostic test is used to determine if a person has COVID-19. They can obtain the tests from pharmacies, retailers and online vendors. Starting Saturday, private health plans are required to cover the over-the-counter tests at up to $12 per test. COVID-19 test reimbursement. Coverage is available when the pharmacy offers OTC COVID-19 tests and has them in stock. We are here to support you as you care for your patientsour members. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. Varies by plan. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. See details on theState Medi-Cal websitefor how to submit a claim. But I called @BCBSTX as a consumer, and asked . What virtual care options does my plan cover? Vaccine and vaccine administration codes for COVID-19. I paid out-of-pocket for a COVID-19 test that should be covered. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing
Extended authorizations for deferred services, Expiration of extended authorizations for deferred services on 12/31/20. 24/7 access is provided at no cost. Americans with private insurance will be able to ask for reimbursement for rapid COVID-19 tests beginning Saturday but any tests purchased before January 15 will not qualify. 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. Virtual visits are covered. 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. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. 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. Your claim represents your attestation that you provided the service to the patient via telehealth. I have a Medicare plan. With a BCBSTX health plan, you have access to care for COVID-19 related health issues. What's the difference between the booster shot and the additional dose? Licensees of the Blue Cross and Blue Shield Association. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Screening tests for domestic travel are covered for most plans. Please check your Original Medicare or Medicare Supplement plan for testing coverage under your medical benefits. For example: Find out what your coverage is for OTC at-home tests. Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. What should I do with it? For more details please visit fepblue.org. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html, https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, : https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdf, https://covidtest.optumrx.com/covid-test-reimbursement, In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA, COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF], https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, https://www.humana.com/coronavirus/coverage-faqs, https://www.mclarenhealthplan.org/mhp/are-you-a-member, https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049, https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, https://www.hioscar.com/at-home-covid-test-reimbursement, https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F, https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, https://www.phpmichigan.com/?id=175&sid=1, https://www.priorityhealth.com/covid-19/vaccine, https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Life Insurance and Annuity Search Service (LIAS), Health Insurer FIS 322 Submission Application, Financial Education (Banking, Credit Union and Credit Information), Establishing a program to have tests mailed directly to you upon request, or.