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. Reimbursement Process Link or Description: See the information below to determine if your insurer is reimbursing for these tests. To learn more about treatments and medications, visit the Centers for Disease Control and Preventions web page. 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. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. Reimbursement Process Link or Description: Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Others may need a boost due to the vaccine becoming less effective over time. You may also call the customer service phone number on your member ID 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. You will be reimbursed up to $12 per test by submitting a claim. Screening tests for domestic travel are covered for most plans. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. 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. After that time, an authorization extension is required. Blue Cross recommends that members contact and work closely with their health care . 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. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. The federal government has officially launched a program requiring health insurance companies to cover the cost of at-home COVID-19 testing kits. To make this request, please submit theMassachusetts Standard Form for Medication Prior Authorization Requests(click the link and find the form by choosingAuthorization Pharmacy). Assisted reproductive technology services Standard office visit copay may apply. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. An attending health care provider may order a test. You can use Dental Connect for Providers to verify member eligibility and benefits. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Access to COVID-19 testing is critically important as we work to limit the spread of COVID-19 variants. All Rights Reserved. $0. Serologic testing for the presence of SARS-CoV-2 IgM/IgG antibodies is covered for FDA and Emergency Use Authorization tests (as described above) 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, including the Centers for Disease Control (CDC) and Massachusetts Department of Public Health (DPH) guidelines. Referrals and prior authorizations are not required for medically necessary testing and treatment for COVID-19. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. If you have a self-funded group plan, OTC at-home tests are not covered or reimbursable if purchased prior to January 15, 2022, without a healthcare provider order, or purchased at any time for employment purposes. Your insurance company will reimburse you for the full purchase price of each covered test. 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. SECTION 2 - PATIENT INFORMATION Reason for the test cI was exposed to someone with COVID-19. 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. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms, https://dev.michigan.local/som/json?sc_device=json, Insurance Coverage for Over-the-Counter COVID-19 Tests, Go to Licensing - Consumer Finance and Mortgage, Go to Additional Financial and Insurance Services Forms, Go to DIFS Biographies and Public Officials. They are basically the same. You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. Verify your contact information. COVID-19 Testing Coverage Website: Please choosein-network locationsfor testing to avoid paying any extra fees. Here's how to get reimbursed: Submit a claim form But I called @BCBSTX as a consumer, and asked . 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. It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. Please note: You cannot be reimbursed more than once for OTC at-home tests. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, COVID-19 Testing Coverage Website: All rights reserved. Blue Cross will identify patients presenting for evaluation of possible COVID-19 using the below codes*: If your patient has previously confirmed COVID-19 illness or tests positive for COVID-19, use the code below. For members with pharmacy coverage through another company, they should contact the phone number on their prescription drug card for information on how OTC COVID-19 test coverage applies. You can be reimbursed for up to 8 tests per covered member, per month without a prescription. These may include fees for other tests or other services unrelated to the COVID-19 test. For our Medicare Advantage members, coverage is through original Medicare. You are now leaving the blueshieldca.com website, Coverage information for general COVID-19 testing. Members can call our dedicated coronavirus help line at 1-888-372-1970. For example: FEP will determine coverage for the vaccine once it becomes available. COVID-19 testing for routine travel does not qualify as urgent or emergency care. Refund Management | Blue Cross and Blue Shield of Illinois Refund Management The following information does not apply to government programs (Medicare Advantage, Illinois Medicaid). These tests can be ordered by visiting covidtests.gov. Vaccine and vaccine administration codes for COVID-19. Blue Cross and Blue Shield companies (BCBS) will also increase access to prescription drugs, enhanced telehealth and other clinical support . 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: . Contact your primary healthcare provider to find out if they have virtual visits available. If you plan to provide a previously approved service to a patient in 2021, please call our. Your plan will provide this coverage through reimbursement to you. . The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. 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. Rheumatological and dermatological use 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. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Losing your job doesnt have to mean losing your healthcare coverage. If you are not an FEP member and have questions about your health plan, please contact your local BCBS Company: bcbs.com/memberservices. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Members can register for Teladoc by visiting fepblue.org/coronavirus. Medi_22_194_LS_IA_092722 We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. State-chartered Bank and State-chartered Savings Bank forms. I received a check from Blue Shield. Covered investigational drugs Blue Shield and Blue Shield Promise cover these types of tests: 1Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. Reimbursement Process Link or Description: 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. 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. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. Follow the instructions below to submit your claim online. Test kit cost $ COVID-19 TESTING AND REIMBURSEMENT Important information about expanded coverage Learn More EXPANDED BENEFITS You're covered with expanded access to care and benefits. If you're a Medicare or Medicaid Participant: For information about insurance coverage for at-home COVID-19 tests, please see the Centers for Medicare and Medicaid Services FAQ. 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. 8 At-Home Rapid tests per 30 days. This applies to both diagnostic and screening tests. Some restrictions apply. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. Why we made the change 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. *These modifiers do not apply to Federal Employee Program members. This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. 1-800-882-1178. There are no prior approvals needed to receive COVID-19 treatment. 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. Yes, but coverage for testing varies by plan. This includes the Centers for Disease Control (CDC) and the Massachusetts Department of Public Health (DPH) guidelines. If you did not receive a refund from your provider, please contact their office. Ralphs Clinic Testing Services for Viral or Rapid Antigen Tests, contact Medi-Cal Rx to locate an in-network pharmacy, See details for how to submit a claim for reimbursement for covered testing, Find out what your coverage is for OTC at-home tests based on your plan, Medi-Cal members: Do not submit any claims to Blue Shield Promise, Yes for OTC at-home tests purchased on or after 1/15/22, Medicare Prescription Drug Plan (pharmacy benefit only), No, coverage for OTC at-home tests is covered by Original Medicare, Yes, for purchases between 1/1/22 4/3/22, None for covered tests during the public health emergency. www.hioscar.com%2Fsearch%2F%3FnetworkId%3D017%26year%3D2022, Reimbursement Process Link or Description: If your insurer has a network of preferred providers: If your insurer does not have a network of preferred providers: If you purchased at-home COVID-19 tests prior to January 15, 2022: Insurers are not required to provide coverage for COVID-19 tests that were purchased prior to January 15, 2022. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Members may now purchase through the preferred network online at CVS.com using their insurance card. See the Notification of Enforcement Discretion for telehealth. All rights reserved. COVID-19 Testing Coverage Website: 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. Should I still postpone preventive visits/routine checkups or specialist care? No. Blue Shield of California. 14Self-funded plans may not cover all of an out-of-network providers charges for services related to COVID-19 testing. To avoid paying any extra fees, please use. No, COVID-19 Testing Coverage Website: Your health is our priority. For Medicare Advantage plans, you must submit claims for COVID-19 drug and the administration of the drug to the CMS Medicare Administrative Contractor (MAC) for payment. Find out about COVID-19 vaccination, including side effectsand more. 100748 0521 R3 Page 1 . For providers not in the Teladoc network, the applicable cost share applies (unless COVID-19 related). Each individual test within a package counts as one test. 7OTC at-home tests are only covered if used for personal use and not for resale. Network of Preferred Providers: How can I find pharmacies near me? Reimbursement Process Link or Description: 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. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. 13Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. If you havent yet paid the provider, the check goes to the provider. 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. 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, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. The screenshot below shows the correct way to enter modifiers. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. 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. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Neuropsychological testing services This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. Estimated reimbursement is within 30 calendar days. A diagnostic test is used to determine if a person has COVID-19. The authorization process will officially resume for all products effective July 1, 2021. How to maintain coverage My Turn Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. www.bcbsm.com/coronavirus. Medi-Cal members: Do not submit any claims to Blue Shield Promise. CNN . The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). Reimbursement for tests purchased before January 15, 2022: See details on theState Medi-Cal websitefor how to submit a claim. 800-942-0954 (main). They apply to commercial, Federal Employee Program, and Medicare Advantage members. For tests provided by a health care provider, the original bill or claim for the services that includes: The laboratory or provider's name and address See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. What to do if you think you have COVID-19. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. 5Self-funded group plans are not required to cover these costs. Contact the company for the latest information. Please follow the billing instructions outlined in our COVID-19 Temporary payment policy. Effective January 1, 2021, AIM will return to standard processes and authorize services for 60 days. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. HSAs are offered through financial institutions. Reimbursement Process Link or Description: We have removed member cost (copayments, co-insurance, and deductibles) for medically necessary telehealth (virtual video/audio) services or visits by phone for behavioral health services. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. Note: Telephonic codes (98966-98968, 99441-99443) do not require the use of any telehealth modifier. 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. For information about your insurer's reimbursement process, see the information below. For more resources, visit myturn.org and the CDC websites. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: COVID-19 testing, counseling, vaccination & treatment. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. Find additional coding information on Provider Central. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. Independence Blue Cross(Independence) is implementing the Biden administrations over-the-counter (OTC) testing program finalized earlier this month. Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. Coverage for Medi-Cal and Cal MediConnect members, Local updates on COVID-19 from the State of California, Vaccine information from the Centers for Disease Control and Prevention (CDC). Contact the company for the latest information. Screening tests for domestic travel are covered for most plans. 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. We want to help ease stress during these uncertain times. Learn more about potential out-of-pocket costs from out-of-network providers. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. In a statement, Blue Cross Blue Shield said, "We are also working on . There are no prior approvals needed to receive COVID-19 treatment. For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. All rights reserved. Get the Blue Shield at-home COVID test reimbursement claim form. Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). 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. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. Individuals, Families, and Group customers with FutureScripts (OptumRx) can use this coverage in three ways: Independence and OptumRx do not control the supply of at-home tests. 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. See details for how to submit a claim for reimbursement for covered testing. Can I get reimbursed for multiple packages? These changes, which have been approved by the Office of Personnel Management, will ensure that nearly 6 million federal employees, retirees and their families have comprehensive, accessible care. Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you access to the care you need during the COVID-19 pandemic. Getting a vaccine: what to expect To meet this requirement, insurers may choose to provide direct coverage for tests by: https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. California Physicians' Service DBA Blue Shield of California 1999-2023. Seewhichtestsarecoveredforyourplan. Some people with weakened immune systems may need a boost just to get a response that most people get from the regular dose. For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for COVID vaccines and COVID vaccine administration. Please bill members for their cost share once the claim has processed When you are checking eligibility, Online Services will show the standard telehealth cost share. What virtual care options does my plan cover? You can find a list of community-based testing sites here. Blue Cross and Blue Shield of Texas (BCBSTX) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). Network of Preferred Providers: Reimbursement Process Link or Description: 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 can get up to 8 individual tests per calendar month from participating pharmacies and healthcare providers during the COVID-19 public health emergency. 1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Payment for COVID-19 testing services on or after January 1, 2022. For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076. Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. How you will bill for services by phone depends upon your specialty. Member cost share continues to be waived for COVID-19 related telehealth visits provided by in-network providers. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Click Online Form. See OTC at-home test sectionfor more details. * Login to find out what options are available to you. Network of Preferred Providers: The policy only covers over-the-counter Covid-19 tests authorized and approved by the U.S. Food and Drug Administration (FDA). Or, you can call Dental Provider Services at 1-800-882-1178. Centers for Disease Control and Preventions web page. Use the telephonic CPT codes as indicated in the telehealth billing guidelines with the applicable place of service code*. Contact your primary healthcare provider to find out if they have virtual visits available. To bill for telehealth, follow the same telehealth billing guidelines as you would for an in-person visit and include the following modifiers with the applicable place of service as outlined in the COVID-19 Temporary payment policy: Bill fortelephonicservices using the additional billing guidelines and applicable place of service codes in our COVID-19 Temporary payment policy. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Yes. COVID-19 Temporary payment policy (includes telehealth). Log in to find out your costs and if you have access. Bill the same as you would for in-person visits, and include the following modifiers with the applicable place of service code*: modifier GT, 95, G0, or GQ via synchronous/asynchronous telehealth audio and/or video telecommunications systems to differentiate a telehealth (telemedicine) encounter from an in-person encounter with the patient.