Have more questions about testing coverage? Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. Click Prescription and follow the prompts to submit your online claim. For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342. To bill for telehealth/video services during the state of emergency. 5Self-funded group plans are not required to cover these costs. However, they will not be able to order a COVID-19 test for you. The screenshot below shows the correct way to enter modifiers. They are basically the same. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. Please choose, Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. What virtual care options does my plan cover? If you have any questions, call the number on the back of your Blue Cross ID . 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 Covered testing sites include (but are not limited to): Whats not covered Coverage for Medi-Cal and Cal MediConnect members Claims for laboratory services including COVID-19 testing, On or after July 1, 2021, the ordering clinician NPI will be a required field on your claim to indicate that the lab test is medically necessary. If you purchased an at-home test previously, you may be able to get paid back. In a statement, Blue Cross Blue Shield said, "We are also working on . When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. Call the customer service number on your member ID card. Virtual visits are covered. Can I get reimbursed for multiple packages? Please note: You cannot be reimbursed more than once for OTC at-home tests. Talk to board-certified doctors24/7 by phone or video. To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer between January 15, 2022 and January 31, 2022, submit this form: 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. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. We will share additional information when available. COVID-19 Testing Coverage Website: This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone. During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: COVID-19 screenings or evaluations done: Virtually using telehealth, In a doctor's office, At an urgent care center, or In a hospital (including emergency room). For information about your insurer's network of preferred providers and reimbursement process, see the information below. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. 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. 100748 0521 R3 Page 1 . All rights reserved. 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. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing Learn more about the COVID-19 vaccine booster. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. These tests can be for diagnostic or screening purposes, such as a screening before a procedure. All Rights Reserved. Click Online Form. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: I have a Medicare plan. If you havent yet paid the provider, the check goes to the provider. Contact your primary healthcare provider to find out if they have virtual visits available. continue to monitor and will be responsive to state and federal guidance. 13Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. 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. If you have Medicare, Medi-Cal or Cal-MediConnect plans, visit our, To learn more about treatments and medications, visit the. In the case of a medical emergency, care provided by in-network and out-of-network providers will be covered for all plans. OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered. Insurers must cover the cost of eight tests per insured individual. 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. 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. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Effective March 16, 2020, Blue Cross and Blue Shield of Alabama is expanding telehealth coverage. Phone Number: Will it be covered? . What are the limits to reimbursement for OTC COVID-19 at-home tests? 2019. Some out-of-network providers may charge added fees. 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. UnitedHealthcare (UHC) 6Neither diagnostic nor screening testing is covered through pharmacy benefits. As of April 4, 2022, members with BCBSRI Medicare Advantage and Plan 65 coverage can now receive COVID-19 home test kits at no cost under their Part B benefit. DIFS Prohibition Orders for Consumer Finance and Credit Union. Learn moreabout potential out-of-pocket costs from out-of-network providers. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). 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. https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, COVID-19 Testing Coverage Website: Schedule your COVID-19 vaccine booster today. about potential out-of-pocket costs from out-of-network providers. Bill all covered services that you render as if you are performing an in-person service using the codes that are currently on your fee schedule. Referrals and prior authorizations are not required for medically necessary testing and treatment for COVID-19. Please choosein-network locationsfor testing to avoid paying any extra fees. Testing sites: Not all testing sites are the same. For more resources, visit myturn.org and the CDC websites. To bill for services by phone Health plans are offered by Blue Shield of California. Patient symptoms are expected to improve with cognitive rehabilitation. Licensed independent clinical social worker, Psychiatric and state psychiatric hospital. 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. Contact the provider to find out how they want to be reimbursed. Members will be required to fill out a COVID-19 self-test claim submission sheet and submit it via us mail along with UPC packaging label and receipt. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. This will enable us to pay you the same rate we pay you for in-person visits. For more information on FEPs policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. 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. 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. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. Your doctor may also offer virtual visits if you prefer. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Which types of COVID-19 tests are covered? Coverage varies by plan type. OTC at-home tests must have been purchased on or after January 1, 2022. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Members need to submit a separate claim form for each family member. If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. Blue Shield of California has neither reviewed nor endorsed this information. Plus learn how to safely resume healthcare visits. https://www.humana.com/coronavirus/coverage-faqs. Learn more about potential out-of-pocket costs from out-of-network providers. Under the rule, insurance providers are . Several changes regarding telehealth and COVID-related care and treatment made during State of Emergency became permanent on January 1, 2021 with the passage of the Patients First Act. Members will have the option of online submission through the secure member website or sending a paper submission. Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. Updates as of January 11, 2023. In addition, ground ambulance transport to and from the locations listed below is covered to help our healthcare delivery system optimize inpatient capacity. Members should call the number on the back of their ID card. Patient symptoms impair daily functioning and are unlikely to resolve on their own over time. How can I submit a claim form for my OTC COVID-19 at-home tests? Some restrictions apply. An antibody test determines whether the person has had COVID-19 and therefore may have some level of immunity. You can also purchase an FDA-authorized over the counter COVID-19 test kit at other stores or online retailers. 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. 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. 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. For eligible plans, you can fill out and mail a paper claim form. Network of Preferred Providers: NDC or UPC number Date purchased / / Quantity of tests. You can request an authorization to cover more. Please see our COVID-19 Temporary payment policy for more information. 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. 4These can be group plans from employers, associations, trusts, etc. Questions about medical or prescription coverage? National vaccine finder. They can advise you on how to return the money back into your account. Reimbursement for tests purchased before January 15, 2022: 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. The authorization process will officially resume for all products effective July 1, 2021. Standard out-of-pocket costs will apply for treatments received. Medicare Advantage, Federal Employee Program . At the same time, Blue Cross Blue Shield of Massachusetts continues to monitor and comply with all applicable state and federal regulations, including regulation of opioid prescribing and dispensing. We will share additional information when available. To meet this requirement, insurers may choose to provide direct coverage for tests by: For more details please visit fepblue.org. 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. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information. To avoid paying any extra fees, please usenetwork locationsfor testing. 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: Your standard coverage and out-of-pocket costs apply. 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. 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). 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. Members can submit a direct member reimbursement claim to McLaren using the form found by following the link: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049. Need to talk with DIFS? You will be able to get an at-home test at no cost through these network pharmacies. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html. Access+ HMO is a registered trademark of Blue Shield of California. Contact the company for the latest information. Why we made the change Yes. 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. For example, if you purchase a package with two tests inside, that counts as two separate tests. 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. COVID-19 Testing Coverage Website: 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. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. In Massachusetts, call, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring, Injection, casirivimab and imdevimab, 2400 mg, Injection, bamlanivimab and etesevimab, 2100 mg, Blue Cross Blue Shield of Massachusetts is temporarily allowing reimbursement for this code for drive-through testing specimen collection*, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source*, CDC 2019 novel coronavirus (2019-ncov) real-time

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