* Login to find out what options are available to you. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. This includes at-home over-the-counter test kits. Will it be covered? 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. We provide health insurance in Michigan. Network of Preferred Providers: Losing your job doesnt have to mean losing your healthcare coverage. Please note: You cannot be reimbursed more than once for OTC at-home tests. You dont need to be part of a telehealth network of providers to offer this. These may include fees for other tests or other services unrelated to the COVID-19 test. Some restrictions apply. These may include fees for other tests or services. Getting a vaccine: what to expect There are no age limits for members who need care through telehealth or phone services. Then have an authorized representative of the group you are joining sign the form and send it back to PHEexpeditedCred@BCBSMA.com. You can have telehealth video or phone visits with children, adolescents, and adults. Members will receive test kits from network pharmacies at no cost. FAQs about resuming "regular" care 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. Billing for partial hospitalization and intensive outpatient using telehealth. Coverage for out-of-network testing will change when the public health emergency ends. Members can submit a direct member reimbursement claim to McLaren using the form found by following the link: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049. For more details please visit fepblue.org. I have a Medicare plan. We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Access+ HMO is a registered trademark of Blue Shield of California. As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan.Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. Questions about medical or prescription coverage? For example, a physician, a nurse practitioner, or a physician assistant. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage. Or, contact our Clinical Pharmacy Operations area. https://covidtest.optumrx.com/covid-test-reimbursement. 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. For eligible plans, you can fill out and mail a paper claim form. For information about your insurer's reimbursement process, see the information below. All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. At in-network pharmacies. As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. Members should call the number on the back of their ID card. Standard office visit copays may apply based on your plan benefits. You can request an authorization to cover more. Click Online Form. An antibody test determines whether the person has had COVID-19 and therefore may have some level of immunity. Most diagnostic and screening tests are covered for the majority of Blue Shield members. To learn more about treatments and medications, visit the Centers for Disease Control and Preventions web page. 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. Find out which COVID-19 tests are available to members and where to get tested. Coverage varies by plan type. My at-home test comes with more than one test per package. OTC at-home tests must have been purchased on or after January 1, 2022. The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. (Medical and Mental Health) Network Management and Credentialing Services 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 you regularly visit a specialist to manage a chronic condition, you should keep those appointments. 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. Standard out-of-pocket costs will apply for treatments received. How am I reimbursed for at-home tests if I use FSA, HSA, or HRA funds? 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. 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). We reimburse providers at the same rate as we reimburse a face-to-face visit, as long as it meets clinical standards, for the duration of the Massachusetts public health emergency. 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. Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. If you are interested in a rewarding position helping Michiganders apply today! Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Members can also call the National Information Center at 1-800-411-BLUE (2583). How to get at-home test costs covered: Submit a reimbursement claim form by mail. Health plans are offered by Blue Shield of California. Medicare Advantage, Federal Employee Program . We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. For providers not in the Teladoc network, the applicable cost share applies (unless COVID-19 related). The member will be responsible for any unrelated fees charged by an out-of-network provider. You can find a list of community-based testing sites here. 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. Get the Blue Shield at-home COVID test reimbursement claim form. Starting Saturday, private health plans are required to cover the over-the-counter tests at up to $12 per test. Below are the codes for providers and laboratories to test patients for COVID-19. Keep your purchase receipt(s) to submit for reimbursement. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. 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. However, insurers may choose to reimburse consumers for these tests. Otherwise, contact your employer, plan sponsor, or benefits administrator. 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. Reimbursement for tests purchased before January 15, 2022: The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. Licensees of the Blue Cross and Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. bill the test on a separate claim from the rest of the services being rendered. 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. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020. . 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. Losing your job doesnt have to mean losing your healthcare coverage. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: If you are not an FEP member and have questions about your health plan, please contact your local BCBS Company: bcbs.com/memberservices. How to maintain coverage Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. Some examples of authorized tests include: See a complete list of authorized tests on the FDA's web page. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. Check with your insurer for the most up-to-date information for your specific plan. Reimbursement Process Link or Description: For help with these documents, please call 1-800-975-6314. . Well allow the use of these modifiers for any service on your fee schedule. What if I need treatment for COVID-19? How can I get a free OTC COVID-19 test? How can I get a free OTC COVID-19 test? For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342. What are the limits to reimbursement for OTC COVID-19 at-home tests? Or, you can call Dental Provider Services at 1-800-882-1178. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Were contacting them to suggest that they take advantage of our early refill policy during this public health emergency, so they can have a supply of their medication. Anthem is waiving cost shares for COVID-19 treatment. To bill for services by phone Which types of COVID-19 tests are covered? However, if you fall ill with COVID-19 symptoms while traveling internationally, testing and treatment may be covered. If you're a Medicare or Medicaid Participant: For information about insurance coverage for at-home COVID-19 tests, please see the Centers for Medicare and Medicaid Services FAQ. Coverage for Medicare members. There is a limit of . To access your member services, please visit your BCBS company. Does BCBSIL cover at-home test kits? Reimbursement Process Link or Description: 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. Please also use one of the following applicable place of service codes that describes the location of the drive-through or temporary testing site. This benefit is available to Anthem members in Fully Insured . Members will have the option of online submission through the secure member website or sending a paper submission. Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. Follow the instructions below to submit your claim online. There are no prior approvals needed to receive COVID-19 treatment. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Please see our COVID-19 Temporary payment policy for more information. If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. Some restrictions apply. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. 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. 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. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. 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. If you would like to find a new mental healthcare provider in your network, learn. Additional doses are given to boost the immune response from the vaccine. 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. Neuropsychological testing services Make informed decisions about your health and the health of your community. 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. 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. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard program. 14Self-funded plans may not cover all of an out-of-network providers charges for services related to COVID-19 testing. You may also submit a digital claim online with a copy of your receipt. *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. If you plan to provide a previously approved service to a patient in 2021, please call our. Your standard coverage and out-of-pocket costs apply. If you are currently seeing a mental healthcare provider, you can continue to see that provider virtually. The screenshot below shows the correct way to enter modifiers. 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 . 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. 2019. 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. For help with these documents, please call 1-800-975-6314. . Contact the company for the latest information. Get health advice 24/7 from a registered nurse over the phone. Log in to find out your costs and if you have access. Please remember that COVID-19 testing and vaccination requirements vary worldwide. For COVID-19-related diagnoses, they asked insurers to add quantity limits. Extended authorizations for deferred services, Expiration of extended authorizations for deferred services on 12/31/20. It does not include care received at chronic care and long-term acute care hospitals, psychiatric facilities, rehabilitation hospitals, skilled nursing facilities, and substance use disorder facilities. 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).
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