General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). Network of Preferred Providers: 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. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. We expect providers to code for COVID-19 testing and treatment using guidelines provided by the CDC. Blue Cross members with a COVID-19 diagnosis will be protected against balance billing. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. Virtual visits are covered. FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance if diagnosed with COVID-19. 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. We extended the filing limit for initial claim submissions. We've remove dmember cost(copayments, co-insurance, and deductibles) for all telehealth services, including behavioral health. Federal Employee Program 4These can be group plans from employers, associations, trusts, etc. Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. However, they will not be able to order a COVID-19 test for you. Health plans are offered by Blue Shield of California. Call the customer service number on your member ID card. Your plan will provide this coverage through reimbursement to you. 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. Get health advice 24/7 from a registered nurse over the phone. For information about your insurer's reimbursement process, see the information below. COVID-19 Resources | Blue Shield of CA You can request an authorization to cover more. Does BCBSIL cover at-home test kits? This applies to all accounts except the Federal Employee Program (FEP). See the Notification of Enforcement Discretion for telehealth. Viral testing Over-the-Counter COVID-19 Testing | Producer | Premera Blue Cross 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. See details on theState Medi-Cal websitefor how to submit a claim. Those payments will now go directly to the provider. Find out about COVID-19 vaccination, including side effectsand more. At in-network pharmacies. Learn more about potential out-of-pocket costs from out-of-network providers. We are making every effort to credential providers within seventy-two (72) hours of the date we receive your application. There is a limit of . How can I submit a claim form for my OTC COVID-19 at-home tests? 24/7 access is provided at no cost. Why we made the change Keep your purchase receipt(s) to submit for reimbursement. 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. 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. COVID-19 test Note: Cost share waive for to COVID-19 treatment expires on 08/31/2021. "We are requiring insurers and group health. https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits. Please remember that COVID-19 testing and vaccination requirements vary worldwide. 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. 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 Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. Health Insurance Alabama | Blue Cross and Blue Shield of Alabama Please choosein-network locationsfor testing to avoid paying any extra fees. Please note: You cannot be reimbursed more than once for OTC at-home tests. 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. UB-04 billers do not need to enter a place of service when billing for services provided by phone. However, at-home COVID-19 tests are not qualified medical expenses when the costs are reimbursed by Blue Shield. 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. Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. 11Medicare members can get up to eight OTC COVID-19 home tests each calendar monththrough the Centers for Medicare and Medicaid Services. 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. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. 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 kit cost $ 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. We have added these codes to our COVID-19 Temporary payment policy. Everyone qualifies. Your plan includes COVID-19 tests, treatment, and care. You will be reimbursed up to $12 per test by submitting a claim. Coverage varies by plan type. Choose your plan type to learn more about the available no-cost options Individual & Family Medicare Medicaid Stay Healthy and Informed My Turn Federal Employee Program (FEP) members Use an at-home antigen test, available over-the-counter (OTC) at many retail pharmacies, to screen for employment, school, events, or if you experience symptoms. To avoid paying any extra fees, please usenetwork locationsfor testing. Health plans are offered by Blue Shield of California. Members can register for Teladoc by visiting fepblue.org/coronavirus. PDF Who is eligible for COVID testing - BCBSM I have BCBSIL insurance, but don't live in Illinois. However, please note that out-of-network providers may charge more than the covered benefit amount. A diagnostic test is used to determine if a person has COVID-19. Coronavirus (COVID-19) Updates | Blue Cross Blue Shield Your insurance company will reimburse you for the full purchase price of each covered test. . Reimbursement Process Link or Description: 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. They can obtain the tests from pharmacies, retailers and online vendors. After that time, an authorization extension is required. This will enable us to pay you the same rate we pay you for in-person visits. 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. 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. When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. 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. Otherwise, contact your employer, plan sponsor, or benefits administrator. In that case, you may be responsible for paying the difference. Your claim represents your attestation that you provided the service to the patient via telehealth. bill the test on a separate claim from the rest of the services being rendered. When you provide any services by phone, do not bill the specific telephonic CPT codes. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. 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. What to know about COVID tests | Coverage - Blue Cross Blue Shield of State-chartered Bank and State-chartered Savings Bank forms. To make this request, please submit theMassachusetts Standard Form for Medication Prior Authorization Requests(click the link and find the form by choosingAuthorization Pharmacy). you purchased the test. Find out which COVID-19 tests are available to members and where to get tested. Members covered through Medicaid plans: 1-800-711-5952. Over-the-Counter Tests | CareFirst BlueCross BlueShield 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. Provider Information on COVID-19 Coverage | Blue Cross and Blue Shield If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. For example, if you purchase a package with two tests inside, that counts as two separate tests. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. All Blue Cross Blue Shield of Massachusetts contracted doctors and health care providers can provide care remotely, using any technology, for medically necessary covered services (COVID-19 AND non-COVID-19 related) to our members. National vaccine finder. How can I get a free OTC COVID-19 test? We want to help ease stress during these uncertain times. 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. Medi-Cal members: Do not submit any claims to Blue Shield Promise. Here are some additional ways Horizon BCBSNJ members can receive advice and support: Members can talk to licensed nurses who can assist them with symptoms that are consistent with suspected COVID-19 infection. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Yes, CVS Caremark Pharmacies, Reimbursement Process Link or Description: Outside of an emergency situation, you should seek care from in-network providers to save money. www.hioscar.com%2Fsearch%2F%3FnetworkId%3D017%26year%3D2022, Reimbursement Process Link or Description: We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. What virtual care options does my plan cover? Some examples of authorized tests include: See a complete list of authorized tests on the FDA's web page. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. 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.

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