Learn more about the different types of tests. The provider should mail you a refund check. An attending health care provider may order a test. Your standard coverage and out-of-pocket costs apply. For example, a physician, a nurse practitioner, or a physician assistant. Below are the codes for providers and laboratories to test patients for COVID-19. They are basically the same. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. Contact your primary healthcare provider to find out if they have virtual visits available. 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. Blue Shield and Blue Shield Promise will cover most COVID-19 tests at no out-of-pocket cost to you for specified plans noted below. Rheumatological and dermatological use However, they will not be able to order a COVID-19 test for you. *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. https://www.mclarenhealthplan.org/mhp/are-you-a-member. Members should call the number on the back of their ID card. They have their own payment policy for telehealth services. The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. 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. I have a Medi-Cal plan. If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. The top things you should know about COVID-19 vaccines. 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. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells), Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors), Other therapies currently under investigation without published supporting evidence. You dont need to be part of a telehealth network of providers to offer this. To bill for services by phone Reimbursement Process Link or Description: 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. All rights reserved. Some out-of-network providers may charge added fees. 4These can be group plans from employers, associations, trusts, etc. All rights reserved. Reimbursement for tests purchased before January 15, 2022: Contact the company for the latest information. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. If you have any questions, call the number on the back of your Blue Cross ID . Commercially insured members: 1-888-624-3096. COVID-19 TESTING AND REIMBURSEMENT Important information about expanded coverage Learn More EXPANDED BENEFITS You're covered with expanded access to care and benefits. There are no additional credentialing or contracting processes you need to follow to offer telehealth services. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Log in to blueshieldca.com (Engagement Point users at engagementpoint.com) Choose "Claims" Select "File a claim" 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. Find out what your coverage is for OTC at-home tests based on your plan. Seewhichtestsarecoveredforyourplan. Learn more about the COVID-19 vaccine booster. This is in place for the duration of the Massachusetts state of emergency. We want to help ease stress during these uncertain times. Important note: This information only applies to the ancillary and behavioral health specialties on this list. UB-04 billers do not need to enter place of service codes when billing for telephonic services. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. Some people with weakened immune systems may need a boost just to get a response that most people get from the regular dose. If a vaccine administration service is provided with an evaluation and management service that: This applies to professional and facility claims. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. Your plan will provide this coverage through reimbursement to you. Reimbursement for tests purchased before January 15, 2022: Coverage for COVID-19 testing outside of the United States depends on your plan benefits and the reason for testing. Wait for our systems to identify the claim and correct it, Call Provider Service and ask us to reprocess the claim at one of the following toll-free numbers. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. See details on theState Medi-Cal websitefor how to submit a claim. 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. Similarly, FEP will waive any copays or deductibles for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. 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. Reimbursement Process Link or Description: 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. Each individual test within a package counts as one test. CNN . Standard office visit copays may apply based on your plan benefits. Log in to your member account on our website. Blue Cross and Blue Shield of Texas (BCBSTX) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). 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 . If you have a plan with out-of-network covered benefits, Blue Shield will cover both in-network and out-of-network copays, coinsurance, and deductibles for COVID-19 covered treatment benefits during this time. "We are requiring insurers and group health. If you were not reimbursed correctly, or your advisory shows that a member is responsible for a copayment, you can either: At this time, there are no changes to our licensure requirements. 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 Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. 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). Ancillary and some behavioral health providers. 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. Network of Preferred Providers: Contact the company for the latest information. Medicare Advantage, Federal Employee Program . What are the limits to reimbursement for OTC COVID-19 at-home tests? This makes it easier to treat and improve the outcome. For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. Standard out-of-pocket costs will apply for treatments received. 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. Or, you can call Dental Provider Services at 1-800-882-1178. At-home COVID-19 testing. 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. Yes. To meet this requirement, insurers may choose to provide direct coverage for tests by: If your insurer does not provide direct coverage, or if you purchase tests outside of your insurer's preferred provider network, you can request reimbursement for some or all of your out-of-pocket expense. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. you purchased the test. Call the customer service number on your member ID card. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. COVID-19 Testing Coverage Website: Covered testing sites include (but are not limited to): Whats not covered OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered. Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. * Login to find out what options are available to you. Estimated reimbursement is within 30 calendar days. I have BCBSIL insurance, but don't live in Illinois. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. Licensees of the Blue Cross and Blue Shield Association. Reimbursement for tests purchased before January 15, 2022: 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. Standard office visit copays may apply based on your plan benefits. 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. This benefit is available to Blue Shield and Blue Shield Promise members in the following plans: You should bring your red, white, and blue Medicare card to get your free OTC COVID-19 tests. 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. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. FEP will waive copays for telehealth services related to COVID-19. Please also use one of the following applicable place of service codes that describes the location of the drive-through or temporary testing site. COVID-19 Temporary payment policy (includes telehealth). These services can help you see if your symptoms may be related to COVID-19 or something else. COVID-19 Testing Coverage Website: But I called @BCBSTX as a consumer, and asked . Most diagnostic and screening tests are covered for the majority of Blue Shield members. DIFS Prohibition Orders for Consumer Finance and Credit Union. Medicare members can get up to eight OTC COVID-19 home tests each calendar month. Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. Blue Cross also removes all referral and authorization requirements for outpatient care if a member is being evaluated or treated for suspected or confirmed COVID-19. Coverage for out-of-network testing will change when the public health emergency ends. No, COVID-19 Testing Coverage Website: COVID-19 testing, counseling, vaccination & treatment. You can find a list of community-based testing sites here. *These modifiers do not apply to Federal Employee Program members. 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. This applies to tests purchased on or after January 15. There are no prior approvals needed to receive COVID-19 treatment. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. www.bcbsm.com/coronavirus. For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). 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. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. Covered investigational drugs Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. All rights reserved. National vaccine finder. If you purchased an at-home test previously, you may be able to get paid back. Virtual visits are covered. Standard office visit copay may apply. Network of Preferred Providers: They can obtain the tests from pharmacies, retailers and online vendors. . Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. For Federal Employee Program (FEP) members, member cost is removed for inpatient acute care hospitals, inpatient rehab facilities, long-term acute care hospitals, and skilled nursing facilities for services related to COVID-19. 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. 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. 6Neither diagnostic nor screening testing is covered through pharmacy benefits. If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) . For example, if four people are covered by your health plan, you can get up to 32 tests per month. Talk to board-certified doctors24/7 by phone or video. FEP will also encourage members to use 90-day mail order benefit. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. 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. If you're diagnosed as having COVID-19, you won't have any out-of-pocket costs to pay if you get treatment for COVID-19 from doctors, hospitals, and other health-care professionals in your plan's network through May 31, 2020. If you did not receive a refund from your provider, please contact their office. When you provide any services by phone, do not bill the specific telephonic CPT codes. Find out which COVID-19 tests are available to members and where to get tested. 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. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. Screening tests for domestic travel are covered for most plans. This policy applies to Blue Cross Blue Shield of Massachusettsmembers*in the following plans: Note: Employers who are self-insured may choose not to offer waived cost share for their employees. FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications. For some plans, only emergency and urgent care are covered outside of the United States. We are here to support you as you care for your patientsour members. 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. These amounts not paid by the plan may be the responsibility of the member. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Losing your job doesnt have to mean losing your healthcare coverage. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. Blue Shield of California has neither reviewed nor endorsed this information. Free at-home COVID-19 tests 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. 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. You can request an authorization to cover more. If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. Network of Preferred Providers: We take pride in the vastly diverse cultures, backgrounds, interests, and expertise of the people who work here. Therefore, Medicare PDP plans do not cover medical testing. If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. Some restrictions apply. 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. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. 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. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. 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. 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. Reimbursement for tests purchased before January 15, 2022: Please enter the NDC or UPC number from the cash register receipt. For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment If a test reader is required, reimbursement is limited to $12. I paid out-of-pocket for a COVID-19 test that should be covered. Centers for Medicare and Medicaid Services FAQ. You will be able to get an at-home test at no cost through these network pharmacies. 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. 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. Assisted reproductive technology services Will it be covered? We have waived pre-authorization requirements for ground ambulance transport by a contracted provider. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage. 9PCR tests (polymerase chain reaction) tests which are generally sent to a lab, but may also include rapid tests such asNucleic Acid Amplification Tests(NAAT). California Physicians' Service DBA Blue Shield of California 1999-2023. If you plan to provide a previously approved service under an authorization that expired on December 31, 2020 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. If you havent used Dental Connect before, youll need toregister for Dental Connect using partner codeBCMA01DPS(this is an important step for registration; Blue Cross Blue Shield of Massachusetts sponsors monthly fees for this service. For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076. Yes, you can use your HSA, FSA, or HRA funds to purchase at-home tests. Examples of such documentation could include the UPC code for the OTC COVID-19 test and/or a receipt from the seller of the test, documenting the date of purchase and the price of the OTC COVID-19 test. https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits. Coverage varies by plan type. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. Find out about COVID-19 vaccination, including side effectsand more. For more resources, visit myturn.org and the CDC websites. No, COVID-19 Testing Coverage Website: Simply fill out our Public Health Emergency Credentialing Application (PHE App). Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak. 8*Self-funded group plan antibody tests are covered when ordered by a provider unless the group has opted in to offer coverage in alignment with SB 510. You can have telehealth video or phone visits with children, adolescents, and adults. Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. Your claim represents your attestation that you provided the service to the patient via telehealth. These may include fees for other tests or other services unrelated to the COVID-19 test. 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. 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: Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. 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. Effective May 1, 2021, for members of our fully-insured employer and individual plans, as well as self-funded plans, Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines at a rate of $40 per administration. Reimbursement for tests purchased before January 15, 2022: People may also access free or affordably priced testing in the community. Plus learn how to safely resume healthcare visits. Health plans are offered by Blue Shield of California. 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. Medicare Advantage members We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Keep your purchase receipt(s) to submit for reimbursement. 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. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. Contact the company for the latest information. Click Online Form. Find out which COVID-19 tests are available to members and where to get tested. 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. California Physicians' Service DBA Blue Shield of California 1999-2023. Schedule your COVID-19 vaccine booster today. Beginning January 15, 2022, and until the end of the Public Health Emergency, Independence will cover up to eight FDA approved OTC COVID-19 tests per calendar month as directed by the Biden administrations program.