blue cross blue shield federal covid test reimbursement

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. Does my plan cover COVID-19 screening and testing? We will share additional information when available. https://covidtest.optumrx.com/covid-test-reimbursement. There is a limit of . Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. For Federal Employee Program members, we've removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Make informed decisions about your health and the health of your community. You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. Virtual visits are covered. For Medicare Advantage plans, you must submit claims for COVID-19 vaccine and the administration of the vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. 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. We removed all member cost for in-person doctor, urgent care, and emergency room visits related to the testing, counseling, vaccination, and treatment of COVID-19. Claims must include proof of purchase (e.g. 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. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020. . 1-800-882-1178. Leading the way in health insurance since 1929. Consumers can either purchase the testing kits at no cost or submit receipts for. 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). News & updates * Please refer to yourEvidence of Coverageor plan documents for information about standard out-of-pocket costs for your plan. COVID-19 testing for routine travel does not qualify as urgent or emergency care. 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 What virtual care options does my plan cover? Some out-of-network providers may charge added fees. FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Member costs are being waived for all Teladoc visits (COVID-19 and non-COVID-19) during this emergency period. If you purchased an at-home test previously, you may be able to get paid back. 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. When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. However, please note that out-of-network providers may charge more than the covered benefit amount. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Network of Preferred Providers: How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? 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 can register for Teladoc by visiting fepblue.org/coronavirus. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. 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. Find out which COVID-19 tests are available to members and where to get tested. The modifier should be 95 or GT. If you purchased an at-home test previously, you may be able to get paid back. 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 . Anthem is waiving cost shares for COVID-19 treatment. 419-887-2525 (main) *The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020. As of April 4, 2022, members with BCBSRI Medicare Advantage and Plan 65 coverage can now receive COVID-19 home test kits at no cost under their Part B benefit. Coverage for Medi-Cal and Cal MediConnect members Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. All Rights Reserved. We now give 180 days for services to be completed on new authorizations. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. COVID-19 test Note: Cost share waive for to COVID-19 treatment expires on 08/31/2021. 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 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. As of Jan. 15, 2022, and through the end of the public health emergency, all individuals with pharmacy coverage through Blue Cross Blue Shield of Michigan and Blue Care Network have more ways to get at-home COVID-19 rapid diagnostic tests at no cost. See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. FEP will also encourage members to use 90-day mail order benefit. Get health advice 24/7 from a registered nurse over the phone. For our Medicare Advantage members, coverage is through original Medicare. Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. Click Prescription and follow the prompts to submit your online claim. If you would like to find a new mental healthcare provider in your network, learnhow to find one. Viral testing For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). See details for how to submit a claim for reimbursement for covered testing. For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for treatment for COVID-19 infection. Many Americans can now get home Covid-19 tests at no cost through their private insurance. All rights reserved. I received a check from Blue Shield. Member Reimbursement: If members purchased an OTC COVID-19 test on or after January 15, 2022, they can submit for a reimbursement of up to $12 per test. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. Network of Preferred Providers: 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. Testing and Treatment Coverage Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. Keep your purchase receipt(s) to submit for reimbursement. FEP to eliminate restrictions on prescription drug refills, waive pre-authorization, deductibles and copays for diagnostics, treatment, Blue Cross and Blue Shield Federal Employee Program Waives Cost Shares and Prior Authorization to Support Members Care for Coronavirus, Site-Neutral Payments Would Save Nearly $500 Billion Over 10 Years, Blue Cross Blue Shield Association Statement on Medicare Advantage Risk Adjustment Validation Rule, Blue Cross Blue Shield Association Policy Solutions Could Lower Health Care Costs by $767 Billion, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. 100748 0521 R3 Page 1 . To avoid paying any extra fees, please use. Contact the company for the latest information. Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. NDC or UPC number Date purchased / / Quantity of tests. See which plans cover screening tests for travel. At in-network pharmacies. 2019. There are no age limits for members who need care through telehealth or phone services. High-technology radiology and obstructive sleep apnea testing and treatment 13Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. By doing this, we will be able to identify when members should receive the cost-share waiver for COVID-19 testing, and the claim will be . After the vaccine: what to expect. As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. 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. 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. Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. Bill all covered services that you render as if you are performing an in-person service using the codes that are currently on your fee schedule. Contact the company for the latest information. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. They apply to commercial, Federal Employee Program, and Medicare Advantage members. California Physicians' Service DBA Blue Shield of California 1999-2023. Reimbursement Process Link or Description: 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. During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: There are no prior approvals needed for COVID-19 screenings, evaluations, or testing. Members need to submit a separate claim form for each family member. 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. Not all plans have access to these services. CNN . 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. 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. You may also call the customer service phone number on your member ID card. Follow the instructions below to submit your claim online. Reimbursement for tests purchased before January 15, 2022 You can request an authorization to cover more. Find out which COVID-19 tests are available to members and where to get tested. In a hospital (including emergency room). 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. Coverage should always be confirmed with your plan prior to purchasing any tests. 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. Screening tests for domestic travel are covered for most plans. You dont need to be part of a telehealth network of providers to offer this. 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). When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. See the Notification of Enforcement Discretion for telehealth. During the Massachusetts public health emergency, we reimburse all providers, including ancillary, behavioral health, and applied behavioral analysis providers, at the same rate they would receive for an in-person visit. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. 12When the public health emergency ends, all out-of-network costs not paid by Blue Shield will be your responsibility. This applies to tests purchased on or after January 15. For information about your insurer's reimbursement process, see the information below. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. ", Adjustments to Medicare Advantage reimbursement. Reimbursement Process Link or Description: 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. Proper documentation will need to be submitted. You can bill all services for which you are contracted using the telehealth codes with the telehealth modifier. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. Assisted reproductive technology services This helps make sure you dont have to pay more out-of-pocket. 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. This will enable us to pay you the same rate we pay you for in-person visits. Reimbursement for tests purchased before January 15, 2022: Please note that Blue Shield does not offer tax advice for HSAs. How am I reimbursed for at-home tests if I use FSA, HSA, or HRA funds? Vaccine and vaccine administration codes for COVID-19. FEP will waive copays for telehealth services related to COVID-19. Insurers must cover the cost of eight tests per insured individual. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. COVID-19 TESTING AND REIMBURSEMENT Important information about expanded coverage Learn More EXPANDED BENEFITS You're covered with expanded access to care and benefits. Billing for partial hospitalization and intensive outpatient using telehealth. Learn more about the different types of tests. You may also call the customer service phone number on your member ID card. Some restrictions apply. You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Related fees may include specimen collection or processing fees. COVID-19 testing, counseling, vaccination & treatment. No, COVID-19 Testing Coverage Website: Cost share is waived for members with a COVID-19 diagnosis, Cost share will apply to members without a COVID-19 diagnosis, Skilled nursing, rehab, and long-term acute care, Commercial HMO/POS and PPO (fully insured accounts). See details on theState Medi-Cal websitefor how to submit a claim. What are the limits to reimbursement for OTC COVID-19 at-home tests? An antibody test determines whether the person has had COVID-19 and therefore may have some level of immunity. 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. This coverage applies to all BCBSRI health plans except Medicare. Members can also contact Customer Service at 888-327-0671 (TTY: 711). Members can register for Teladoc by visiting fepblue.org/coronavirus. 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. 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.

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