The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. 800-942-0954 (main). 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. These may include fees for other tests or other services unrelated to the COVID-19 test. Find a COVID-19 diagnostic testing location near you throughmyturn.ca.gov, These locations may include out-of-network pharmacies and community centers. Extended authorizations for deferred services, Expiration of extended authorizations for deferred services on 12/31/20. Network of Preferred Providers: When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Blue Cross Blue Shield said it is also working on a system that would allow members to avoid the reimbursement process. Network of Preferred Providers: Yes. Please follow the billing instructions outlined in our COVID-19 Temporary payment policy. Blue Shield of California. The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. Effective January 1, 2021 Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgent care, and outpatient mental health services. You can bill all services for which you are contracted using the telehealth codes with the telehealth modifier. You are now leaving the blueshieldca.com website, Your coverage for COVID-19 | Blue Shield of CA. Proper documentation will need to be submitted. Some out-of-network providers may charge added fees. Questions about medical or prescription coverage? For providers not in the Teladoc network, the applicable cost share applies (unless COVID-19 related). These tests can be ordered by visiting covidtests.gov. Please consult your local Blue plan you are contracted with. COVID-19 booster recommendations A list of reports produced by our Department. Find out about COVID-19 vaccination, including side effectsand more. Or, you can call Dental Provider Services at 1-800-882-1178. New authorizations will be required for services deferred into 2021, and all other administrative requirements related to these services continue to apply. Please choosein-network locationsfor testing to avoid paying any extra fees. Members are responsible for any fees or tests that are not covered by their plan. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. 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. 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. As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. You may be aware that on March 30, 2020, the Food and Drug Administration (FDA) issued an emergency authorization to use chloroquine and hydroxychloroquine as experimental coronavirus treatment. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. Reimbursement Process Link or Description: If you did not receive a refund from your provider, please contact their office. For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186. We extended existing authorizations through December 31, 2020. Subsequent tests will require the order of an authorized health care professional. . A direct link to the Ambetter provider search tool is given for members to find a pharmacy from the COVID-19 home test kit page: https://guide.ambetterhealth.com. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. You will be able to get an at-home test at no cost through these network pharmacies. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. They have their own payment policy for telehealth services. In that case, you may be responsible for paying the difference. Will it be covered? 2019. Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. 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. Network of Preferred Providers: This is in place for the duration of the Massachusetts state of emergency. Learn more about the different types of tests. 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. Schedule your COVID-19 vaccine booster today. Commercially insured members: 1-888-624-3096. At in-network pharmacies. But I called @BCBSTX as a consumer, and asked . We are making every effort to credential providers within seventy-two (72) hours of the date we receive your application. 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. 24/7 access is provided at no cost. As of Jan. 15, the federal government is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests. Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. These tests are available without out-of-pocket cost at locations specified by your insurance company. Contact your primary healthcare provider to find out if they have virtual visits available. To bill for services by phone 3. Who can order a test? COVID-19 Testing Coverage Website: With a BCBSTX health plan, you have access to care for COVID-19 related health issues. Find out which COVID-19 tests are available to members and where to get tested. 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. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. 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. 1-800-316-BLUE (2583), Dental Network Management Health plans are offered by Blue Shield of California. For Federal Employee Program (FEP) members, member cost is removed for inpatient acute care hospitals, inpatient rehab facilities, long-term acute care hospitals, and skilled nursing facilities for services related to COVID-19. 8 At-Home Rapid tests per 30 days. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. What options do I have for at-home test kits at no cost? FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. All rights reserved. What if I seek care from an out-of-networkprovider for COVID-19? Learn more about potential out-of-pocket costs from out-of-network providers. Reimbursement Process Link or Description: COVID-19 test Note: Cost share waive for to COVID-19 treatment expires on 08/31/2021. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. Health screenings, immunizations, and annual checkups can all be safely resumed. Blue Shield Coverage for COVID-19 Testing. Need to talk with DIFS? Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. Claims must include proof of purchase (e.g. Authorization requirements will resume for Commercial, Federal Employee Program (FEP) and Medicare Advantage plans. Blue Cross members with a COVID-19 diagnosis will be protected against balance billing. For eligible plans, you can fill out and mail a paper claim form. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. 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. Providing Support During the COVID-19 Pandemic Communities Leading through a public health crisis All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. 04:20. For information about your insurer's network of preferred providers and reimbursement process, see the information below. As of February 1, 2022, pleasecontact Medi-Cal Rx to locate an in-network pharmacy. For Medicare Advantage plans, you must submit claims for COVID-19 vaccine and the administration of the vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. Legal | Privacy Policy, OptumRx Over-the-Counter Test Reimbursement Form. All rights reserved. In 2020, we extended time-limited authorizations through the end of the year for specific outpatient procedures that our members may not have been able to receive due to the COVID-19 emergency. (Medical and Mental Health) Network Management and Credentialing Services To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. You do not need health insurance to receive your free tests. Not all plans have access to these services. The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost.