We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. 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. Claims submission and reimbursement for testing. How to get at-home test costs covered: Submit a reimbursement claim form by mail. For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). Network of Preferred Providers: You will be reimbursed up to $12 per test by submitting a claim. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. News & updates 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. Medi-Cal members: Do not submit any claims to Blue Shield Promise. Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. Yes. If you would like to find a new mental healthcare provider in your network, learn. All rights reserved. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. For help with these documents, please call 1-800-975-6314. . COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. Reimbursement for tests purchased before January 15, 2022: You will be able to get an at-home test at no cost through these network pharmacies. FEP will also eliminate any cost share for prescriptions for up to a 14-day supply. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. 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. Contact the company for the latest information. 7OTC at-home tests are only covered if used for personal use and not for resale. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. Coverage is available when the pharmacy offers OTC COVID-19 tests and has them in stock. 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. 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. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. 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. Please follow the billing instructions outlined in our COVID-19 Temporary payment policy. Members should call the number on the back of their ID card. However, insurers may choose to reimburse consumers for these tests. 2019. What do I need to do? For example: I paid out-of-pocket for a COVID-19 test that should be covered. Diagnosis Codes: B97.29 Z03.818 Z20.822 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: 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). 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. Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. Authorization requirements will resume for Commercial, Federal Employee Program (FEP) and Medicare Advantage plans. Talk to board-certified doctors24/7 by phone or video. Toll free: 800-462-3589, Reimbursement Process Link or Description: You do not need health insurance to receive your free tests. COVID-19 Testing Coverage Website: See details for how to submit a claim for reimbursement for covered testing. Contact the company for the latest information. Learn more about potential out-of-pocket costs from out-of-network providers. These may include fees for other tests or other services unrelated to the COVID-19 test. Referrals and prior authorizations are not required for medically necessary testing and treatment for COVID-19. Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard program. Under the rule, insurance providers are . To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer between January 15, 2022 and January 31, 2022, submit this form: We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Its important not to fall behind on preventive care visits. 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. Also, there are some limitations to the number of tests that can be reimbursed without a provider order. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. However, please note that out-of-network providers may charge more than the covered benefit amount. At in-network pharmacies. 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. 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. This will enable us to pay you the same rate we pay you for in-person visits. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? No, COVID-19 Testing Coverage Website: DIFS is not responsible for any costs incurred in reliance on this information. We now give 180 days for services to be completed on new authorizations. Member cost share continues to be waived for COVID-19 related telehealth visits provided by in-network providers. Others may need a boost due to the vaccine becoming less effective over time. 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. Testing and Treatment Coverage 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. For members with pharmacy coverage through another company, they should contact the phone number on their prescription drug card for information on how OTC COVID-19 test coverage applies. 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. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. Network of Preferred Providers: 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. prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. UPDATE: COVID-19 over the counter testing reimbursement - IBX Newsroom The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. Please see our COVID-19 Temporary payment policy for more information. Only to be reported with use of high-throughput technologies. They apply to commercial, Federal Employee Program, and Medicare Advantage members. This will enable us to pay you the same rate we pay you for in-person visits. Vaccine and vaccine administration codes for COVID-19. https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, Phone Number: This page may have documents that can't be read by screen reader software. Coverage for Medi-Cal and Cal MediConnect members Coverage for Medicare members Find out what's covered Stay informed about COVID-19 COVID-19 LEARNING CENTER In-depth information about choices that affect you This will apply to in- and out-of-network services received at an acute care hospital. Contact your primary healthcare provider to find out if they have virtual visits available. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Seewhichtestsarecoveredforyourplan. Insurers must cover the cost of eight tests per insured individual. What's the difference between the booster shot and the additional dose? You can use Dental Connect for Providers to verify member eligibility and benefits. In a hospital (including emergency room). 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. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. For example, a physician, a nurse practitioner, or a physician assistant. If you intend to seek reimbursement from Blue Shield, it is recommended that you do not use an FSA, HSA, or HRA debit card to purchase at-home tests. You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and the applicable place of service code. 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. Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. However, at-home COVID-19 tests are not qualified medical expenses when the costs are reimbursed by Blue Shield. 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. With limited lead time, Mass. private health insurers create new COVID * Login to find out what options are available to you. Covered tests must be approved by the FDA or haveEmergency Use Authorization, or the developer must have requested, or intends to request Emergency Use Authorization approval. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. Coverage should always be confirmed with your plan prior to purchasing any tests. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. *For the Federal Employee Program, benefits and cost share are applicable according to the members plan. Standard office visit copays may apply based on your plan benefits. See which plans cover screening tests for travel. 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. Health plans are offered by Blue Shield of California. PDF COVID-19 Testing Member Reimbursement Form Non-Medicare Advantage - BCBSM 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. Losing your job doesnt have to mean losing your healthcare coverage. Prescription Drug Reimbursement Claim Forms | Help Center - BCBSM COVID-19 testing for routine travel does not qualify as urgent or emergency care. High-technology radiology and obstructive sleep apnea testing and treatment
3. Who can order a test? COVID-19 Testing Coverage Website: Please also use one of the following applicable place of service codes that describes the location of the drive-through or temporary testing site. Network of Preferred Providers: For more information about HSAs, eligibility, and the laws current provisions, you should ask your financial or tax adviser, or check with your HSA administrator for more details. If your insurer has a network of preferred providers: If your insurer does not have a network of preferred providers: If you purchased at-home COVID-19 tests prior to January 15, 2022: Insurers are not required to provide coverage for COVID-19 tests that were purchased prior to January 15, 2022. You may also call the customer service phone number on your member ID card. ", Adjustments to Medicare Advantage reimbursement. Contact the company for the latest information. 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. 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. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. You can also log in to your online account to learn what benefits your plan covers or call the customer service number at the number on your ID card. 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. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. Access+ HMO is a registered trademark of Blue Shield of California. Reimbursement Process Link or Description: HSAs are offered through financial institutions. They can advise you on how to return the money back into your account. Blue Cross Blue Shield of Massachusetts Announces New Resources for At These tests can be ordered by visiting covidtests.gov. Information requested will include: Reimbursement for tests purchased before January 15, 2022: Click Reimbursement Form. Please remember that COVID-19 testing and vaccination requirements vary worldwide. 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. Blue Shield of California. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage. Kaiser's California Member Services hotline is (800) 464-4000. All rights reserved. All rights reserved. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. That form will be replaced on Jan. 23 once the insurer develops . Outside of an emergency situation, you should seek care from in-network providers to save money. Legal | Privacy Policy, OptumRx Over-the-Counter Test Reimbursement Form. If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. California Physicians' Service DBA Blue Shield of California 1999-2023. 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). In the case of a medical emergency, care provided by in-network and out-of-network providers will be covered for all plans. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. Refund Management | Blue Cross and Blue Shield of Illinois - BCBSIL Information Regarding Coronavirus (COVID-19) | Highmark BCBSWNY Please bill members for their cost share once the claim has processed When you are checking eligibility, Online Services will show the standard telehealth cost share. Coronavirus (COVID-19) Updates | Blue Cross Blue Shield Members can register for Teladoc by visiting fepblue.org/coronavirus. Quantity
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 you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. FEP and Blue Cross and Blue Shield (BCBS) companies are following CDC prevention guidelines and other federal recommendations and will continue to support and protect the health and well-being of its members, their families and the community. Members can register for Teladoc by visiting fepblue.org/coronavirus. FEP will also encourage members to use 90-day mail order benefit. Getting a vaccine: what to expect 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. Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. 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. This includes at-home over-the-counter test kits. However, if you fall ill with COVID-19 symptoms while traveling internationally, testing and treatment may be covered. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. *These modifiers do not apply to Federal Employee Program members. Varies by plan. I received a check from Blue Shield. Contact the company for the latest information. We extended the filing limit for initial claim submissions. See which plans cover screening tests for travel. 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). Network of Preferred Providers: Per state mandate Chapter 260 of the Acts of 2020 Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting.1. For information about your insurer's reimbursement process, see the information below. What to do if you think you have COVID-19. 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. We will share additional information when available. Health plans are offered by Blue Shield of California. Screening tests for domestic travel are covered for most plans. Coverage for Medi-Cal and Cal MediConnect members What should I do with it? Reimbursement for tests purchased before January 15, 2022: See the Notification of Enforcement Discretion for telehealth. Find out which COVID-19 tests are available to members and where to get tested. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. Learn more about the COVID-19 vaccine booster. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our Medicare coverage and Medi-Cal coverage pages to learn more. 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. 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. This benefit is available to Anthem members in Fully Insured . California Physicians' Service DBA Blue Shield of California 1999-2023. Members should call the number on the back of their ID card. Your standard coverage and out-of-pocket costs apply. 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. 5Self-funded group plans are not required to cover these costs. General Reimbursement Information | Blue Cross and Blue Shield of Texas Assisted reproductive technology services
Reimbursement for tests purchased before January 15, 2022: All rights reserved. for tests purchased on or after January 15, 2022. COVID-19 Testing Coverage Website: The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost. Contact the company for the latest information. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. All rights reserved. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. Members can also call the National Information Center at 1-800-411-BLUE (2583). Which types of COVID-19 tests are covered?