Please be aware that this statement is. Reimbursement Process Link or Description: With a BCBSTX health plan, you have access to care for COVID-19 related health issues. Purchase a COVID-19 at-home test kit and submit a claim through the paper-based OTC test claim form. 5Self-funded group plans are not required to cover these costs. This information is provided for informational purposes only. Covered investigational drugs You dont need to be part of a telehealth network of providers to offer this. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. Contact the company for the latest information. However, insurers may choose to reimburse consumers for these tests. In accordance with the Centers for Disease Control (CDC) and the MA Department of Public Health guidelines, covered scenarios include (but are not limited to): * Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes). Submit a claim online, or download the COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF] and submit via mail or fax using the instructions on the form. https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Reimbursement Process Link or Description: Authorization requirements will resume for Commercial, Federal Employee Program (FEP) and Medicare Advantage plans. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Licensing - Consumer Finance and Mortgage. The billing guidelines are included in the COVID-19 Temporary payment policy. If you're diagnosed as having COVID-19, you won't have any out-of-pocket costs to pay if you get treatment for COVID-19 from doctors, hospitals, and other health-care professionals in your plan's network through May 31, 2020. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. If you did not receive a refund from your provider, please contact their office. 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. Losing your job doesnt have to mean losing your healthcare coverage. How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. COVID-19 testing for routine travel does not qualify as urgent or emergency care. Members may now purchase through the preferred network online at CVS.com using their insurance card. For example: We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Payment for COVID-19 testing services on or after January 1, 2022. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. 2023 Blue Cross Blue Shield Association. After the vaccine: what to expect. An attending health care provider may order a 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. 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. 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. There are no prior approvals needed to receive COVID-19 treatment. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. If you are currently seeing a mental healthcare provider, you can continue to see that provider virtually. If you have any questions, call the number on the back of your Blue Cross ID . The program is . For some plans, only emergency and urgent care are covered outside of the United States. Members can call our dedicated coronavirus help line at 1-888-372-1970. Subscriber identification and dependent information, Legible copies of UPC codes and receipts including date purchased, An attestation stating for member use only, not for resale or work/school/travel related testing, has not and will not be reimbursed by another source, and. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Using a paper claim form allows you to submit reimbursement for multiple purchases and for multiple members at the same time. If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. You will be able to get an at-home test at no cost through these network pharmacies. Get the Kaiser Permanente at-home COVID test reimbursement claim form (will download PDF). 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. Blue Cross covers mental health visits by telehealth (video/virtual) or by telephone (telephonic visits) throughout the Massachusetts public health state of emergency. They have their own payment policy for telehealth services. The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. 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: The screenshot below shows the correct way to enter modifiers. 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. FEP will waive copays for telehealth services related to COVID-19. You are now leaving the blueshieldca.com website, Your coverage for COVID-19 | Blue Shield of CA. Legal | Privacy Policy, OptumRx Over-the-Counter Test Reimbursement Form. To bill for telehealth/video services during the state of emergency. What options do I have for at-home test kits at no cost? Proper documentation will need to be submitted. Information requested will include: Reimbursement for tests purchased before January 15, 2022: All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. Find out about COVID-19 vaccination, including side effectsand more. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. I paid out-of-pocket for a COVID-19 test that should be covered. This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. $0. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Members can also call the National Information Center at 1-800-411-BLUE (2583). Reimbursement for tests purchased before January 15, 2022: Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. It does not include care received at chronic care and long-term acute care hospitals, psychiatric facilities, rehabilitation hospitals, skilled nursing facilities, and substance use disorder facilities. My at-home test comes with more than one test per package. These may include fees for other tests or other services unrelated to the COVID-19 test. 6Neither diagnostic nor screening testing is covered through pharmacy benefits. Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit. Phone Number: Then, complete and submit the online form. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. Losing your job doesnt have to mean losing your healthcare coverage. Examples of such documentation could include the UPC code for the OTC COVID-19 test and/or a receipt from the seller of the test, documenting the date of purchase and the price of the OTC COVID-19 test. Be sure to bill using CPT A0426, A0428, A0433, or A0434 (non-emergent transports) and the appropriate modifier shown below to represent the direction of the transfer. To make sure the associated costs for getting diagnostic tests are covered by your BCBSIL plan: This update also includes the ICD-10 vaping-related disorder code. Please enter the NDC or UPC number from the cash register receipt. 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. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. HSAs are offered through financial institutions. COVID-19 booster recommendations Network of Preferred Providers: These may include fees for other tests or other services unrelated to the COVID-19 test. 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.