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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). If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) . Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage. Learn about what coverage and care you can receive through your Medi-Cal benefits. The top things you should know about COVID-19 vaccines. How to get at-home test costs covered: Submit a reimbursement claim form by mail. Starting Saturday, private health plans are required to cover the over-the-counter tests at up to $12 per test. Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines. At in-network pharmacies. 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. You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. To make sure the associated costs for getting diagnostic tests are covered by your BCBSIL plan: Members need to submit a separate claim form for each family member. All rights reserved. Please note: You cannot be reimbursed more than once for OTC at-home tests. Call us at 877-352-5830 with questions about COVID-19 testing sites, navigating health care plans or for help connecting to local community resources for finding food, utility and rent assistance, and many other types of relief programs. Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. Health plans are offered by Blue Shield of California. 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. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. Losing your job doesnt have to mean losing your healthcare coverage. 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 our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for treatment for COVID-19 infection. Need to talk with DIFS? Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. HSAs are offered through financial institutions. Some people with weakened immune systems may need a boost just to get a response that most people get from the regular dose. Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. Losing your job doesnt have to mean losing your healthcare coverage. Your insurance company will reimburse you for the full purchase price of each covered test. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. c I had COVID-19 symptoms. Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. If you purchased an at-home test previously, you may be able to get paid back. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing 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. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. This information is provided for informational purposes only. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). We are making every effort to credential providers within seventy-two (72) hours of the date we receive your application. 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. Contact the company for the latest information. Symptoms consistent with COVID-19, such as fever, cough, shortness of breath, chills, muscle pain, sore throat, anosmia, and gastrointestinal distress, Asymptomatic patients with direct exposure and/or close contact to another individual with a confirmed case of COVID-19, Close contact is defined by the CDC as someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated, Asymptomatic patients who have been identified by contact tracing, Symptomatic or asymptomatic patients who require testing prior to a medical procedure or surgery, Admission to a facility including but not limited to a hospital operated or licensed by the Department of Public Health or Mental Health, a long-term acute care hospital, or a skilled nursing facility, The patients home (using a testing kita patient self-swab), For public health or surveillance purposes, For periodic or serial testing of asymptomatic high-risk individuals (examples include congregate housing and occupational safety), Tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, Member transportation to or from testing sites (unless the member meets requirements for ambulance services), for public health or surveillance purposes, for periodic or serial testing of asymptomatic individuals (examples include congregate housing such as dormitories and residential facilities, and occupational safety), For tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, For member transportation to or from testing sites (unless the member meets requirements for ambulance services), To screen for eligibility to donate plasma, pre-surgical testing for elective and non-elective procedures, We extended existing authorizations issued for the first six months of 2020 to December 31, 2020. Virtual visits are covered. 419-887-2525 (main) Virtual visits are covered. This coverage applies to all BCBSRI health plans except Medicare. Members may now purchase through the preferred network online at CVS.com using their insurance card. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. Consumers who have questions or concerns that cannot be directly resolved with their insurer can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or file a complaint online at Michigan.gov/DIFScomplaints. We have added these codes to our COVID-19 Temporary payment policy. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. 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. Reimbursement for tests purchased before January 15, 2022: UB-04 billers do not need to enter place of service codes when billing for telephonic services. Federal Agencies Extend Timely Filing and Appeals Deadlines - COVID 19 Producers | Blue Cross and Blue Shield of Illinois. Y0118_22_338A1_C 09272022 This includes visits by phone and your communication platform of choice. Please note that Blue Shield does not offer tax advice for HSAs. In alignment with guidance from the Division of Insurance, we have resumed the normal authorization processes forall servicesfor our commercial and Federal Employee Program members, and will start requiring authorization for Medicare Advantage members on July 1, 2021. 108950 0122R be the regular place of service as if you saw the patient in-person. What options do I have for at-home test kits at no cost? Contact your primary healthcare provider to find out if they have virtual visits available. All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. There are no additional credentialing or contracting processes you need to follow to offer telehealth services. Only to be reported with use of high-throughput technologies. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. To meet this requirement, insurers may choose to provide direct coverage for tests by: Members can also contact Customer Service at 888-327-0671 (TTY: 711). 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. There are no prior approvals needed to receive COVID-19 treatment. Phone Number: Can I get reimbursed for multiple packages? The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Blue Shield of California has neither reviewed nor endorsed this information. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. Yes. For example, a physician, a nurse practitioner, or a physician assistant. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. FEP will also encourage members to use 90-day mail order benefit. What are the limits to reimbursement for OTC COVID-19 at-home tests? To learn more about Teladoc, visit https://www.teladoc.com/providers/. CHICAGO -- Blue Cross Blue Shield Association (BCBSA) announced today that its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations and increase coverage for COVID-19 as described below. Reimbursement Process Link or Description: Contact the company for the latest information. 7OTC at-home tests are only covered if used for personal use and not for resale. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. Network of Preferred Providers: Be sure to seek non-emergency care from in-network providers if you have an HMO plan. Blue Shield of California has neither reviewed nor endorsed this information. 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. When you provide any services by phone, do not bill the specific telephonic CPT codes. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. If you havent yet paid the provider, the check goes to the provider. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. 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. prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. 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. When testing patients in a drive-through or other temporary setting (such as a tent), please use the following codes for claims with dates of service on or after March 1, 2020.These codes apply to all commercial, Medicare Advantage, and Federal Employee Program (FEP) members. If your tests cost more than $12 per test, you will not be reimbursed for the difference. You may also submit a digital claim online with a copy of your receipt. Viral testing The 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 is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. Bill all covered services that you render either by telehealth/video or telephone as if you are performing an in-person service using the codes that are currently on your fee schedule. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. What's the difference between the booster shot and the additional dose? When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. See the information below to determine if your insurer is reimbursing for these tests. I have BCBSIL insurance, but don't live in Illinois. If you use the online form, you must file a separate digital claim for each member and for each receipt. The provider should mail you a refund check. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. What will BCBSIL cover for COVID-19? We've remove dmember cost(copayments, co-insurance, and deductibles) for all telehealth services, including behavioral health. National vaccine finder. Note: These changes do not apply to our Medicare Advantage members. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Reimbursement for tests purchased before January 15, 2022: Coverage for out-of-network testing will change when the public health emergency ends. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. News & updates Choose your plan type to learn more about the available no-cost options Individual & Family Medicare Medicaid Stay Healthy and Informed 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. 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. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. 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. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Make choices that are right for you based on the latest information. To make this request, please submit theMassachusetts Standard Form for Medication Prior Authorization Requests(click the link and find the form by choosingAuthorization Pharmacy). Diagnosis Codes: B97.29 Z03.818 Z20.822 These services can help you see if your symptoms may be related to COVID-19 or something else. Please enter the NDC or UPC number from the cash register receipt. You can have telehealth video or phone visits with children, adolescents, and adults. FEP will also eliminate any cost share for prescriptions for up to a 14-day supply. Call the customer service number on your member ID card. There are no prior approvals needed to receive COVID-19 treatment. Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. For information about your insurer's reimbursement process, see the information below. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. 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. If you would like to find a new mental healthcare provider in your network, learn. 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. On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. California Physicians' Service DBA Blue Shield of California 1999-2023. There is no change to the timely filing guidelines for Indemnity claims. Kaiser's California Member Services hotline is (800) 464-4000. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. 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. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. These may include fees for other tests or other services unrelated to the COVID-19 test. Log in to your member account on our website. How can I submit a claim form for my OTC COVID-19 at-home tests? California Physicians' Service DBA Blue Shield of California 1999-2023. Find out when Blue Shield covers COVID-19 tests and whether or not you'll have a copay. 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. Contact the company for the latest information. Contact the provider to find out how they want to be reimbursed. This includes at-home over-the-counter test kits. Blue Shield Coverage for COVID-19 Testing. Check with your insurer for the most up-to-date information for your specific plan. Phone Number: Coverage for Medicare members. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). These tests can be ordered by visiting covidtests.gov. If a vaccine administration service is provided with an evaluation and management service that: This applies to professional and facility claims. You may also call the customer service phone number on your member ID card. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: That form will be replaced on Jan. 23 once the insurer develops . You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Seewhichtestsarecoveredforyourplan. 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. Please note that tests are currently in short supply and some retailers may impose limits on the number of tests you can purchase. 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. They apply to commercial, Federal Employee Program, and Medicare Advantage members. Reimbursement Process Link or Description: 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. If you receive your health insurance through your employer, plan sponsor, or benefits administrator, review your Blue Shield member ID card for the letters ASO (Administrative Services Only) to learn if you are on a self-funded or self-insured plan.