Questions about medical or prescription coverage? What should I do with it? Here's how to get reimbursed: Submit a claim form Members can also call the National Information Center at 1-800-411-BLUE (2583). Your plan includes COVID-19 tests, treatment, and care. Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. To avoid paying any extra fees, please use. Some restrictions apply. Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. Coverage for Medi-Cal and Cal MediConnect members We now give 180 days for services to be completed on new authorizations. This information is provided for informational purposes only. As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. Well allow the use of these modifiers for any service on your fee schedule. Federal Employee Program you purchased the test. People may also access free or affordably priced testing in the community. Your plan may require you to sign an attestation that the test was purchased: Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. What if I seek care from an out-of-networkprovider for COVID-19? I have a Medi-Cal plan. 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. Get an in-person test at a Washington or Alaska testing location . Type OTC or Home in the search bar to narrow the results for at-home tests. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. Where can I go for more details about COVID-19? You can use Dental Connect for Providers to verify member eligibility and benefits. If you purchased an at-home test previously, you may be able to get paid back. As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) has extended the suspension of the mandatory payment reductions known as sequestration through December 31, 2021. You can have telehealth video or phone visits with children, adolescents, and adults. 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: If you would like to find a new mental healthcare provider in your network, learn. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). COVID-19 Testing Coverage Website: You will have to pay for your tests up front and should save your receipts and test boxes for submission to your insurance company for reimbursement. Phone Number: To learn more about treatments and medications, visit the Centers for Disease Control and Preventions web page. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. Beginning on January 1, 2022, sequestration will be reinstituted. It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. https://www.humana.com/coronavirus/coverage-faqs. Members will receive test kits from network pharmacies at no cost. California Physicians' Service DBA Blue Shield of California 1999-2023. Serologic testing for the presence of antibodies is not covered, Medicare HMO BlueSM and Medicare PPO BlueSM Members. Note: These changes do not apply to our Medicare Advantage members. 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. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. Also, there are some limitations to the number of tests that can be reimbursed without a provider order. 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 change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. My at-home test comes with more than one test per package. We continue to monitor the outbreak of the new coronavirus (COVID-19) in Alabama. Reimbursement for tests purchased before January 15, 2022: For more information, read these FAQs:Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate (PDF, 125 KB). We take pride in the vastly diverse cultures, backgrounds, interests, and expertise of the people who work here. You can also purchase an FDA-authorized over the counter COVID-19 test kit at other stores or online retailers. Assisted reproductive technology services 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. Check with your insurer for the most up-to-date information for your specific plan. 2023 Blue Cross Blue Shield Association. 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. Learn how to get free OTC at-home teststhrough the federal program. Members can call our dedicated coronavirus help line at 1-888-372-1970. You will be reimbursed up to $12 per test by submitting a claim. Rheumatological and dermatological use Please note that if you have previously visited an out-of-network provider and received a check payment from Blue Shield, our process has changed. rt-pcr diagnostic panel, Effective April 1, 2020 for dates of service on or after February 4, 2020, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets),non-CDC. 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. Cost share is waived for members with a COVID-19 diagnosis, Cost share will apply to members without a COVID-19 diagnosis, Skilled nursing, rehab, and long-term acute care, Commercial HMO/POS and PPO (fully insured accounts). Getting a vaccine: what to expect Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. 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. As announced on April 6, Blue Cross will also waive cost share for COVID 19 related inpatient care at both in- and out-of-network acute care facilities for our fully insured members. Bill for ambulance transport You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. To access your member services, please visit your BCBS company. Contact the company for the latest information. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Standard out-of-pocket costs will apply for treatments received. 24/7 access is provided at no cost. Schedule your COVID-19 vaccine booster today. We resumed our usual 90-day timely filing limit for dates of service or dates of discharge on and after June 1, 2020. FEP will waive copays for telehealth services related to COVID-19. All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. Reimbursable for dates of service on or after April 14, 2020. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. BinaxNOW COVID-19 Antigen Self-Test (Abbott), BD Veritor At-Home COVID-19 Test (Becton Dickinson), CareStart COVID-19 Antigen Home Test (Access Bio), Celltrion DiaTrust COVID-19 Ag Home-Test (Celltrion), CLINITEST Rapid COVID-19 Antigen Self-Test (Siemens), Flowflex COVID-19 Antigen Home Test (ACON), iHealth COVID-19 Antigen Rapid Test (iHealth Labs), QuickVue At-Home OTC COVID-19 Test (Quidel), SCoV-2 Ag Detect Rapid Self-Test (InBios), See a complete list of authorized tests on the FDA's web page. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. 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. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. 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. 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. During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: There are no prior approvals needed for COVID-19 screenings, evaluations, or testing. What's the difference between the booster shot and the additional dose? For in-network outpatient professional behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule. Screening tests for domestic travel are covered for most plans. However, please note that out-of-network providers may charge more than the covered benefit amount. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. 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. You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. Have more questions about testing coverage? 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. We take our members health very seriously and want to make sure there are no barriers to their seeking appropriate care if they become sick.. 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. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. We are here to support you as you care for your patientsour members. If you mistakenly receive reimbursement from an FSA, HSA, or HRA for at-home test costs covered by Blue Shield, you should contact the FSA, HSA, or HRA administrator. Bill as if you are performing an in-person service, using the revenue and HCPCS/CPT code combinations that you would normally bill on a facility claim. 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. See details on theState Medi-Cal websitefor how to submit a claim. What your Blue Shield plan covers Your health is our priority. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. No, COVID-19 Testing Coverage Website: If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. These amounts not paid by the plan may be the responsibility of the member. Billing for partial hospitalization and intensive outpatient using telehealth. Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed. To meet this requirement, insurers may choose to provide direct coverage for tests by: 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. State-chartered Bank and State-chartered Savings Bank forms. Patient symptoms impair daily functioning and are unlikely to resolve on their own over time. Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. Test kit cost $ Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. How you will bill for services by phone depends upon your specialty. for tests purchased on or after January 15, 2022. 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. These may include fees for other tests or other services unrelated to the COVID-19 test. Diagnosis Codes: B97.29 Z03.818 Z20.822 We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. Reimbursement Process Link or Description: For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. I received a check from Blue Shield. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, COVID-19 Testing Coverage Website: For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. Or, you can call Dental Provider Services at 1-800-882-1178. If you use the online form, you must file a separate digital claim for each member and for each receipt. Please be aware that this statement isnota bill. COVID-19 Coverage for Members Your health is always our priority. $0. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. . Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: 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. Reimbursement Process Link or Description: We extended existing authorizations through December 31, 2020. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. What if I need treatment for COVID-19? Licensing - Consumer Finance and Mortgage. Or, contact our Clinical Pharmacy Operations area. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. For example: Find out what your coverage is for OTC at-home tests. Recent COVID-19 updates for providers Protect children from COVID-19 as they go back to school: An open letter to parents Acute care transfer prior authorizations resume COVID-19 over the counter testing reimbursement Vaccine coverage and reimbursement General COVID-19 information Visit the newsroom for the latest Independence news on COVID-19 Learn more about potential out-of-pocket costs from out-of-network providers. 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. Those payments will now go directly to the provider. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Members will have the option of online submission through the secure member website or sending a paper submission. COVID-19 testing, counseling, vaccination & treatment. Doctors within your plans network may have virtual visits available. Call the customer service number on your member ID card. This update also includes the ICD-10 vaping-related disorder code. When you provide any services by phone, do not bill the specific telephonic CPT codes. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form Standard office visit copay may apply. 2019. These services can help you see if your symptoms may be related to COVID-19 or something else. Varies by plan. 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. We extended the filing limit for initial claim submissions. * Please refer to yourEvidence of Coverageor plan documents for information about standard out-of-pocket costs for your plan. You may also call the customer service phone number on your member ID card. The authorization process will officially resume for all products effective July 1, 2021. https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: 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. They are basically the same. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. The modifier should be 95 or GT. Contact your primary healthcare provider to find out if they have virtual visits available. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. Click Online Form. This is at the discretion of the prescriber and/or dispensing pharmacist. 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 applies to tests purchased on or after January 15. For more details please visit fepblue.org. Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Click Prescription and follow the prompts to submit your online claim. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for the diagnosis of COVID-19 is covered when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice. CNN . Toll free: 800-462-3589, Reimbursement Process Link or Description: Blue Shield of California has neither reviewed nor endorsed this information. BLUE CROSS BLUE SHIELD OF MASSACHUSETTS ANNOUNCES NEW RESOURCES FOR AT-HOME COVID-19 TESTING FOR COMMERCIAL AND MEDICARE ADVANTAGE MEMBERS Commercial members can access tests at pharmacies or via mail order at no cost Company also providing coverage for 4 home tests per month for Medicare Advantage members If you need to get tested or seek treatment for COVID-19, well help you know exactly what your plan covers. *For the Federal Employee Program, benefits and cost share are applicable according to the members plan. In keeping with CMS guidance issued September 2, 2020 and for the duration of the COVID-19 public health emergency, Blue Cross will cover, without a healthcare professionals order, the cost of one diagnostic test for COVID-19 and one diagnostic test each for influenza virus or similar respiratory condition for Medicare members when performed in conjunction with a COVID-19 test and needed to obtain a final COVID-19 diagnosis. When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html, https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, : https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdf, https://covidtest.optumrx.com/covid-test-reimbursement, In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA, COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF], https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, https://www.humana.com/coronavirus/coverage-faqs, https://www.mclarenhealthplan.org/mhp/are-you-a-member, https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049, https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, https://www.hioscar.com/at-home-covid-test-reimbursement, https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F, https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, https://www.phpmichigan.com/?id=175&sid=1, https://www.priorityhealth.com/covid-19/vaccine, https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Life Insurance and Annuity Search Service (LIAS), Health Insurer FIS 322 Submission Application, Financial Education (Banking, Credit Union and Credit Information), Establishing a program to have tests mailed directly to you upon request, or. Members need to submit a separate claim form for each family member. 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. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. Get the Blue Shield at-home COVID test reimbursement claim form. 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. For example, if you purchase a package with two tests inside, that counts as two separate tests. Blue Cross recommends that members contact and work closely with their health care . Get health advice 24/7 from a registered nurse over the phone. 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. Members should call the number on the back of their ID card. You will be able to get an at-home test at no cost through these network pharmacies. 102811 1021R October 2021 COVID-19 Update as of Oct. 21, 2021 As we move forward during the COVID-19 pandemic, we support the work of providers, and the guidelines set forth by the Florida Department of Health and the Centers for Disease Control and Prevention (CDC). If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. Reimbursement for tests purchased before January 15, 2022: Please be advised that, while awaiting further guidance from the Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS) regarding SB510, Anthem Blue Cross will pay Medi-Cal claims for COVID-19 testing incurred on or after January 1, 2022, according . about potential out-of-pocket costs from out-of-network providers. You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and the applicable place of service code. If you purchased an at-home test previously, you may be able to get paid back. For our Medicare Advantage members, coverage is through original Medicare. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. "We are requiring insurers and group health. 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. NDC or UPC number Date purchased / / Quantity of tests. To bill for telehealth/video services during the state of emergency. Reimbursement Process Link or Description: For eligible plans, you can fill out and mail a paper claim form. 8 At-Home Rapid tests per 30 days. Additional information about COVID-19 testing and vaccines can be found in these FAQs. For more details, please see fepblue.org. Reimbursement for tests purchased before January 15, 2022: www.cigna.com/coronavirus. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. 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. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find.