In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. Learn more about potential out-of-pocket costs from out-of-network providers. 14Self-funded plans may not cover all of an out-of-network providers charges for services related to COVID-19 testing. Others may need a boost due to the vaccine becoming less effective over time. All rights reserved. 5Self-funded group plans are not required to cover these costs. We take pride in the vastly diverse cultures, backgrounds, interests, and expertise of the people who work here. You may also call the customer service phone number on your member ID card. Get reimbursed for your over-the-counter COVID-19 tests OTC tests purchased at retail locations cost, on average, $12 for a single test and $24 for a double test kit. If you are interested in a rewarding position helping Michiganders apply today! Reimbursement Process Link or Description: You have a few options for where to get a test: Diagnostic testing performed by out-of-network health care providers is also covered at no cost to members during thepublic health emergency. Type OTC or Home in the search bar to narrow the results for at-home tests. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. 6Neither diagnostic nor screening testing is covered through pharmacy benefits. . Below are the codes for providers and laboratories to test patients for COVID-19. 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. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. Please also use one of the following applicable place of service codes that describes the location of the drive-through or temporary testing site. 04:20. See details on the. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Many Americans can now get home Covid-19 tests at no cost through their private insurance. 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 . Network of Preferred Providers: When you provide any services by phone, do not bill the specific telephonic CPT codes. For more information about HSAs, eligibility, and the laws current provisions, you should ask you financial or tax adviser, or check with your HSA administrator for more details. Some restrictions apply. We extended existing authorizations through December 31, 2020. 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. To bill for telehealth, follow the same telehealth billing guidelines as you would for an in-person visit and include the following modifiers with the applicable place of service as outlined in the COVID-19 Temporary payment policy: Bill fortelephonicservices using the additional billing guidelines and applicable place of service codes in our COVID-19 Temporary payment policy. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. Choose your plan type to learn more about the available no-cost options Individual & Family Medicare Medicaid Stay Healthy and Informed How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? Make choices that are right for you based on the latest information. We do not have any restrictions on the video or voice platform the dentist can use. *These modifiers do not apply to Federal Employee Program members. 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. To avoid paying any extra fees, please usenetwork locationsfor testing. 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. Coverage for out-of-network testing will change when the public health emergency ends. For our Medicare Advantage members, coverage is through original Medicare. Member cost share continues to be waived for COVID-19 related telehealth visits provided by in-network providers. https://www.humana.com/coronavirus/coverage-faqs. COVID-19 TESTING AND REIMBURSEMENT Important information about expanded coverage Learn More EXPANDED BENEFITS You're covered with expanded access to care and benefits. 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. 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. The member will be responsible for any unrelated fees charged by an out-of-network provider. Talk to board-certified doctors24/7 by phone or video. Simply fill out our Public Health Emergency Credentialing Application (PHE App). 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. Please consult your local Blue plan you are contracted with. Proper documentation will need to be submitted. This applies to both diagnostic and screening tests. Testing sites: Not all testing sites are the same. Get health advice 24/7 from a registered nurse over the phone. Those payments will now go directly to the provider. OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. 12When the public health emergency ends, all out-of-network costs not paid by Blue Shield will be your responsibility. As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. Federal Employee Program (FEP) members 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. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. Neuropsychological testing services All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. 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. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. Blue Shield of California has neither reviewed nor endorsed this information. 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. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, COVID-19 Testing Coverage Website: 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. Get an in-person test at a Washington or Alaska testing location . Find out about COVID-19 vaccination, including side effectsand more. Member cost will be the same as an in-person office visit, and cost will not be waived for a COVID-19 diagnosis. Federal Agencies Extend Timely Filing and Appeals Deadlines - COVID 19 Producers | Blue Cross and Blue Shield of Illinois. We will share additional information when available. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. Please choosein-network locationsfor testing to avoid paying any extra fees. Medicare members can get up to eight OTC COVID-19 home tests each calendar month. Medicare Advantage, Federal Employee Program . Your plan includes COVID-19 tests, treatment, and care. Contact the company for the latest information. These services can help you see if your symptoms may be related to COVID-19 or something else. Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. Blue Cross members with a COVID-19 diagnosis will be protected against balance billing. 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. Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Learn more about the different types of tests. If you purchased an at-home test previously, you may be able to get paid back. https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. All Blue Cross Blue Shield of Massachusetts contracted doctors and health care providers can provide care remotely, using any technology, for medically necessary covered services (COVID-19 AND non-COVID-19 related) to our members. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. 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. This applies to all accounts except the Federal Employee Program (FEP). Click Online Form. 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. Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Reimbursement Process Link or Description: All information below is required. Starting Saturday, private health plans are required to cover the over-the-counter tests at up to $12 per test. COVID-19 Testing Coverage Website: Some may choose to cover screening tests for employment purposes, return to school, or sports. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield At-Home Rapid Tests Are Now Covered Over-the-counter COVID-19 tests are now covered for qualifying members. 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. These may include fees for other tests or other services unrelated to the COVID-19 test. 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. Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. 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. 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. If you havent yet paid the provider, the check goes to the provider. Does BCBSIL cover at-home test kits? If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. If you have any questions, call the number on the back of your Blue Cross ID . You can request an authorization to cover more. 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 . prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: Your claim represents your attestation that you provided the service to the patient via telehealth. For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342. Y0118_22_338A1_C 09272022 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. What options do I have for at-home test kits at no cost? All rights reserved. 2Tests obtained for employment purposes, return to school, or sports are those requested at the direction of an employer, school, or sports league/facility or are for group testing rather than for individual assessment. Schedule your COVID-19 vaccine booster today. 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). There are no prior approvals needed to receive COVID-19 treatment. Will it be covered? This page may have documents that can't be read by screen reader software. Standard office visit copays may apply based on your plan benefits. HSAs are offered through financial institutions. An attending health care provider may order a test. continue to monitor and will be responsive to state and federal guidance. Medicare Advantage members *For the Federal Employee Program, benefits and cost share are applicable according to the members plan. 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. Please note that tests are currently in short supply and some retailers may impose limits on the number of tests you can purchase. You will be able to get an at-home test at no cost through these network pharmacies. We have added these codes to our COVID-19 Temporary payment policy. What virtual care options does my plan cover? DIFS has surveyed health insurers operating in Michigan and prepared the information below to help Michiganders understand this benefit and how it will be offered. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. 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. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. What's the difference between the booster shot and the additional dose? For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment https://www.mclarenhealthplan.org/mhp/are-you-a-member. Licensees of the Blue Cross and Blue Shield Association. High-technology radiology and obstructive sleep apnea testing and treatment 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. The top things you should know about COVID-19 vaccines. Find out which COVID-19 tests are available to members and where to get tested. No. How can I continue seeing my mental health care provider? For tests provided by a health care provider, the original bill or claim for the services that includes: The laboratory or provider's name and address 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. Effective for claims with discharge dates or dates of service on or after April 1, 2020, for all commercial products, we have updated our APR-DRG grouper with the ICD-10 diagnosis codes below. COVID-19 testing, counseling, vaccination & treatment. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Or, you can call Dental Provider Services at 1-800-882-1178. 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. 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, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. We want to help ease stress during these uncertain times. Covered investigational drugs There are new codes for these boosters. Virtual visits are covered. https://www.humana.com/coronavirus/coverage-faqs. https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F Kaiser's California Member Services hotline is (800) 464-4000. Payment for COVID-19 testing services on or after January 1, 2022. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. 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. Purchase a COVID-19 at-home test kit and submit a claim through the paper-based OTC test claim form. Centers for Disease Control and Preventions web page. 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. Type OTC or Home in the search bar to narrow the results for at-home tests. Questions about medical or prescription coverage? If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. A direct link to the Ambetter provider search tool is given for members to find a pharmacy from the COVID-19 home test kit page: https://guide.ambetterhealth.com. Access to COVID-19 testing is critically important as we work to limit the spread of COVID-19 variants. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: COVID-19 screenings or evaluations done: Virtually using telehealth, In a doctor's office, At an urgent care center, or In a hospital (including emergency room). Health plans are offered by Blue Shield of California. 7OTC at-home tests are only covered if used for personal use and not for resale. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. 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: 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. Members should call the number on the back of their ID card. Contact the company for the latest information. cRequired for employment purposes. The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. There are no additional credentialing or contracting processes you need to follow to offer telehealth services. Using a paper claim form allows you to submit reimbursement for multiple purchases and for multiple members at the same time. 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. But I called @BCBSTX as a consumer, and asked . For information about your insurer's reimbursement process, see the information below. Have more questions about testing coverage? Learn more about potential out-of-pocket costs from out-of-network providers. bill the test on a separate claim from the rest of the services being rendered. Reimbursement for tests purchased before January 15, 2022: They can advise you on how to return the money back into your account. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ.