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. Then, complete and submit the online form. Providers should document ALL of the following for coverage: Inpatient cognitive rehabilitation for cognitive impairment resulting from COVID-19 is not covered unless the patient otherwise meets criteria for inpatient level of care. 7OTC at-home tests are only covered if used for personal use and not for resale. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. Reimbursement Process Link or Description: These tests can be for diagnostic or screening purposes, such as a screening before a procedure. When reporting modifier GT, 95, G0, or GQ, you are attesting that services were rendered to a patient via synchronous/asynchronous telehealth audio and/or video telecommunications systems. Get the Blue Shield at-home COVID test reimbursement claim form. The Blue Cross Blue Shield (BCBS) Association, a federation of 35 independent health insurance companies that collectively cover one in three Americans, has voiced concern with the COVID-19 test . For example: Find out what your coverage is for OTC at-home tests. 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. 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. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. There are no prior approvals needed to receive COVID-19 treatment. * Please refer to yourEvidence of Coverageor plan documents for information about standard out-of-pocket costs for your plan. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: Reimbursement Process Link or Description: 24/7 access is provided at no cost. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. Member cost share continues to be waived for COVID-19 related telehealth visits provided by in-network providers. Bill for ambulance transport Please be aware that this statement isnota bill. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. CHICAGO -- Blue Cross Blue Shield Association (BCBSA) announced today that its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations and increase coverage for COVID-19 as described below. Many Americans can now get home Covid-19 tests at no cost through their private insurance. https://www.humana.com/coronavirus/coverage-faqs. News & updates Please remember that COVID-19 testing and vaccination requirements vary worldwide. This benefit is available to Anthem members in Fully Insured . COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. 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. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. The member will be responsible for any unrelated fees charged by an out-of-network provider. Make informed decisions about your health and the health of your community. No, COVID-19 Testing Coverage Website: If you are submitting 1500 claims using Direct Data Entry in Online Services, please do not use separate fields for each character of the modifier. https://www.humana.com/coronavirus/coverage-faqs. Contact the company for the latest information. 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. The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. That being said, I called my insurance provider, Blue Cross Blue Shield of Texas (BCBSTX) to ask if I could submit a claim for my test from last week. Health plans are offered by Blue Shield of California. Therefore, Medicare PDP plans do not cover medical testing. Independence does not cover tests that are needed for return to work, a condition of employment, return to school, or travel. We have shared the following July 1, 2021 changes with our providers: Blue Cross Blue Shield of Massachusetts follows federal and state-mandated requirements for COVID-19 treatment coverage. For more resources, visit myturn.org and the CDC websites. This policy applies to Blue Cross Blue Shield of Massachusettsmembers*in the following plans: Note: Employers who are self-insured may choose not to offer waived cost share for their employees. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020. . What should I do with it? Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. 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. Plus learn how to safely resume healthcare visits. Blue Shield of California has neither reviewed nor endorsed this information. 3. Who can order a test? HSAs are offered through financial institutions. Most diagnostic and screening tests are covered for the majority of Blue Shield members. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. I have BCBSIL insurance, but don't live in Illinois. Tests are available at the pharmacy counters of Meijer, Walmart, Walgreens, Rite Aid and Sam's Club stores. COVID-19 Coverage for Members Your health is always our priority. 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 . For eligible plans, you can fill out and mail a paper claim form. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, COVID-19 Testing Coverage Website: Federal Employee Program 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. 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. We've remove dmember cost(copayments, co-insurance, and deductibles) for all telehealth services, including behavioral health. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Please check your Original Medicare or Medicare Supplement plan for testing coverage under your medical benefits. $0. UB-04 billers do not need to enter a place of service when billing for services provided by phone. See details for how to submit a claim for reimbursement for covered testing. There is a limit of . Yes, CVS pharmacies. Blue Shield Coverage for COVID-19 Testing. For HMO plans that do not have an out-of-network benefit, there is no coverage for non-emergency COVID-19 treatment received from out-of-network providers. Yes, with a provider order. When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. COVID-19 Testing Coverage Website: Licensing - Consumer Finance and Mortgage. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Will it be covered? Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. about potential out-of-pocket costs from out-of-network providers. 800-942-0954 (main). We have plans to help keep you covered. However, they will not be able to order a COVID-19 test for you. Have more questions about testing coverage? In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. 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. Does BCBSIL cover at-home test kits? Health screenings, immunizations, and annual checkups can all be safely resumed. FEP will waive copays for telehealth services related to COVID-19. See details on theState Medi-Cal websitefor how to submit a claim. Your health is our priority. 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. All rights reserved. Type OTC or Home in the search bar to narrow the results for at-home tests. Testing and Treatment Coverage Everyone qualifies. No, COVID-19 Testing Coverage Website: If a test reader is required, reimbursement is limited to $12. Member Discounts Take advantage of member-only discounts on health-related products and services. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: For more information, visit https://www.phpmichigan.com/?id=175&sid=1. 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. This is in place for the duration of the Massachusetts state of emergency. 11Medicare members can get up to eight OTC COVID-19 home tests each calendar monththrough the Centers for Medicare and Medicaid Services. 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. 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: Standard out-of-pocket costs will apply for treatments received. Neuropsychological testing services COVID-19 Testing Coverage Website: Members will have the option of online submission through the secure member website or sending a paper submission. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. You can bill all services for which you are contracted using the telehealth codes with the telehealth modifier. Blue Cross members with a COVID-19 diagnosis will be protected against balance billing. You will be reimbursed via check, mailed to the address we have on file within 30 days of Blue Cross Blue Shield of Arizona (BCBSAZ) receiving your reimbursement information. Get an in-person test at a Washington or Alaska testing location . 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. This policy update applies to all medical providers. California Physicians' Service DBA Blue Shield of California 1999-2023. 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). How to get at-home test costs covered: Submit a reimbursement claim form by mail. Viral testing Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. If you plan to provide a previously approved service to a patient in 2021, please call our Clinical Intake Department at the appropriate number and we will create a new authorization or update the existing one. Patient symptoms are expected to improve with cognitive rehabilitation. Access+ HMO is a registered trademark of Blue Shield of California. If you are not an FEP member and have questions about your health plan, please contact your local BCBS Company: bcbs.com/memberservices. I have a Medi-Cal plan. *UB-04 billers do not need to submit place of service code. California Physicians' Service DBA Blue Shield of California 1999-2023. Reimbursement for tests purchased before January 15, 2022: https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, Phone Number: Where can I go for more details about COVID-19? This coverage applies to all BCBSRI health plans except Medicare. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. 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. Blue Shield and Blue Shield Promise will cover most COVID-19 tests at no out-of-pocket cost to you for specified plans noted below. Members can call our dedicated coronavirus help line at 1-888-372-1970. Are at-home COVID-19 tests eligible items for reimbursement under an FSA, HSA, or HRA? If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. Members should call the number on the back of their ID card. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Vaccine and vaccine administration codes for COVID-19. To avoid paying any extra fees, please usenetwork locationsfor testing. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. 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. 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. Reimbursement for tests purchased before January 15, 2022: Log in and to go Office Resources>Billing & Reimbursement>Fee schedules. How many at-home test kits can I purchase each month? Some may choose to cover screening tests for employment purposes, return to school, or sports. 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 Kaiser's California Member Services hotline is (800) 464-4000. 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. Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage. 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. You may also submit a digital claim online with a copy of your receipt. With a BCBSTX health plan, you have access to care for COVID-19 related health issues.