Please be aware that this statement isnota bill. Click Forms. This page may have documents that can't be read by screen reader software. Keep your purchase receipt(s) to submit for reimbursement. Providers should document ALL of the following for coverage: Inpatient cognitive rehabilitation for cognitive impairment resulting from COVID-19 is not covered unless the patient otherwise meets criteria for inpatient level of care. Blue Cross Blue Shield of Massachusetts covers the following drugs when usedoutside a clinical trialfor patients who are in aninpatienthospital setting and require treatment beyond respiratory support, at the discretion of their treating provider: Please note that standard inpatient payment policy rules apply. This information is provided for informational purposes only. No. Billing for partial hospitalization and intensive outpatient using telehealth. 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. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. 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. 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. 3If you receive your health insurance through your employer, association, trust, etc., please contact your employer, plan sponsor, or benefits administrator to see whether you have a fully-insured or a flex-funded group plan. Annual exams can help you: These exams also help your primary doctor see any health issues early on. Log in to your member account on our website. There are no additional credentialing or contracting processes you need to follow to offer telehealth services. We will share additional information when available. 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. For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment SENIOR BLUE BASIC (HMO) BLUESAVER (HMO) SENIOR BLUE 601 (HMO) SENIOR BLUE SELECT (HMO) SENIOR BLUE 651 (HMO) FREEDOM NATION (PPO) FOREVER BLUE VALUE (PPO) FOREVER BLUE 751 (PPO) OPTIONAL SUPPLEMENTAL DENTAL PRESCRIPTION DRUG INFORMATION PLANNING FOR MEDICARE UNDERSTANDING BASICS 2022 RESOURCES 2022 RESOURCES MEDICARE CENTERS HEALTH PROGRAMS How to get at-home test costs covered: Submit a reimbursement claim form by mail. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. 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. What if I need treatment for COVID-19? Which types of COVID-19 tests are covered? 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. What virtual care options does my plan cover? 2023 Blue Cross Blue Shield Association. I have a Medicare plan. Contact your primary healthcare provider to find out if they have virtual visits available. Only to be reported with use of high-throughput technologies. Not all plans have access to these services. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. We will reimburse medically necessary telehealth and visits by phone at the same rate as an in-person visit, for all providers, including behavioral health providers. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Bill for ambulance transport For example, if four people are covered by your health plan, you can get up to 32 tests per month. All information below is required. See OTC at-home test sectionfor more details. 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. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. These changes, which have been approved by the Office of Personnel Management, will ensure that nearly 6 million federal employees, retirees and their families have comprehensive, accessible care. 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. Under the rule, insurance providers are . Or, you can call Dental Provider Services at 1-800-882-1178. Independence Blue Cross(Independence) is implementing the Biden administrations over-the-counter (OTC) testing program finalized earlier this month. 1-800-316-BLUE (2583), Dental Network Management Commercially insured members: 1-888-624-3096. Plus learn how to safely resume healthcare visits. 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. 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. Learn about what coverage and care you can receive through your Medi-Cal benefits. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). These services can help you see if your symptoms may be related to COVID-19 or something else. Similarly, for at-home tests paid for or reimbursed by Blue Shield, you should not seek reimbursement from an FSA, HSA, or HRA for the cost (or the portion of the cost). Your plan includes COVID-19 tests, treatment, and care. High-technology radiology and obstructive sleep apnea testing and treatment According to the CDC, serologic testing: * Detection of specific antibody in serum, plasma, or whole blood that indicates new or recent infection provides presumptive laboratory evidence of COVID-19 illness, according to the Council of State and Territorial Epidemiologists (CSTE) interim case definition for COVID-19. If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) . Assisted reproductive technology services Virtual visits are covered. 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 . Members are responsible for any fees or tests that are not covered by their plan. As of Jan. 15, the federal government is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests. How you will bill for services by phone depends upon your specialty. Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form Log in to find out if you have access. We will continue to monitor and assess potential impacts to our business and our provider partners as the state considers any further actions on measures established during the state of emergency. You can get up to 8 individual tests per calendar month from participating pharmacies and healthcare providers during the COVID-19 public health emergency. Screening tests for domestic travel are covered for most plans. You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost. Authorization requirements will resume for Commercial, Federal Employee Program (FEP) and Medicare Advantage plans. www.bcbsm.com/coronavirus. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. 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. Simply fill out our Public Health Emergency Credentialing Application (PHE App). 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. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. 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. ", Adjustments to Medicare Advantage reimbursement. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). No, COVID-19 Testing Coverage Website: Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. 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 . With a BCBSTX health plan, you have access to care for COVID-19 related health issues. Reimbursement Process Link or Description: We extended existing authorizations through December 31, 2020. At the same time, Blue Cross Blue Shield of Massachusetts continues to monitor and comply with all applicable state and federal regulations, including regulation of opioid prescribing and dispensing. *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. Effective January 1, 2021, AIM will return to standard processes and authorize services for 60 days. rt-pcr diagnostic panel, Effective April 1, 2020 for dates of service on or after February 4, 2020, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets),non-CDC. Claims submission and reimbursement for all COVID-19 testing. FEP will also eliminate any cost share for prescriptions for up to a 14-day supply. Members may now purchase through the preferred network online at CVS.com using their insurance card. This coverage applies to all BCBSRI health plans except Medicare. For thehigh-technology radiologyandsleep testing and treatment servicesthat require prior authorization with AIM Specialty Health, during the public health emergency, we authorized new requests for 180 days to allow time to have services performed.
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