4 steps we’re taking to make it easier for you to provide care to your patients.
When referenced, the following information applies to all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health
1. VIRTUAL CARE
Switch to Virtual ASAP: We will pay for virtual visits at parity including visits through secure video or by phone through June 30, 2021. On March 6th, we announced we were making telehealth easier for our members and clinicians to use. And, we meant it.
You can even use telehealth options with hospital and ED physicians. Behavioral health too. Click for a detailed guide on clinical scenarios and how to file claims here.
This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health.
2. COSTS (Testing, Treatment and Vaccine)
Clinical Visits and Testing
Blue Cross NC will waive member cost-sharing (including deductibles, copayments, and coinsurance) for allowed charges for COVID-19 testing or for a doctor visit or call to determine if testing is necessary as long as COVID-19 testing meets all three criteria:
- Ordered by a licensed health care provider,
- Determined as medically necessary by a licensed health care provider for the diagnosis and management of a member’s medical condition
- Have been cleared, approved or given emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA)
Specifically, there will be no member cost-share for COVID-19 testing or clinical visits to determine if a testing is needed through virtual care visits, outpatient office visits, urgent care visits or ER visits. These changes are required by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. (As of today, the federal government has not set an end date for this measure.)
We continue to encourage the use of virtual visits as the first step to seeking testing. For details and coding guidance, please click here.
This measure applies to Blue Cross NC's fully-insured, State Health Plan, Medicare Advantage, and Federal Employee Program members and self-funded employer groups that did not opt out.
COVID-19 Screening Prior to End-of-the-Year Holiday Gatherings
From Nov. 13 through Dec. 31, 2020, no doctor’s order is needed for member cost sharing to be waived for COVID-19 testing. Tests performed in the emergency room or urgent care center for holiday gathering reasons will not be covered. This is a temporary measure ending on Dec. 31, 2020. It applies to all members on an individual, group or Medicare Advantage plan offered or administered by Blue Cross NC, including Experience Health, and State Health Plan members. It doesn’t apply to members of the Federal Employee Program or members of other Blue Cross Blue Shield plans receiving care in North Carolina. Providers do not need to code differently and should continue following the coding guidance provided for COVID-19 testing.
COVID-19 Related Treatment
The following changes are in effect through March 31, 2021.
Blue Cross NC will waive member cost-sharing for COVID-19 related treatments for both in-network and out-of-network providers. The company will reimburse providers in full at its in-network or Medicare rates in an effort to support them financially and administratively during this emergency.
Blue Cross NC will also work to shield members from balance billing and will work with providers to ensure access to affordable care during this crisis. Blue Cross NC encourages out-of-network providers to accept our payment in full and to work together to shield North Carolinians from financial harm.
Please note that when submitting treatment claims, providers must use designated COVID-19 codes.
This measure applies to all fully insured, State Health Plan, Federal Employee Program, and all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. Self-funded employer groups will be given the option to apply these changes to their employees' plans.
We are committed to carrying out actions to assist our members and community in the face of COVID-19. We will continue to re-evaluate this and other measures. For details and coding guidance, please click here.
Blue Cross NC will cover COVID-19 vaccines that are FDA approved for emergency use authorization (EUA) at no cost for all members - both during the public health emergency and after.
During the public health emergency, the federal government will pay for the cost of the COVID-19 vaccine for all individuals. Additional costs associated with administering the vaccine (such as vaccine supplies, storage and provider costs) will be covered by either the federal government or the member’s health plan, depending on the member.
- For members over 65 (Medicare and Medicare Advantage), the federal government will pay all vaccine-related costs, with no cost to members.
- For commercial members, the cost to administer the vaccine will be covered by the member’s health plan, with no cost to members.
- For customers on a grandfathered group plan, vaccines will be available at no member cost-share. Because of differences in the federal rule related to grandfathered plans, we're working on additional details around how we will handle provider reimbursement for vaccine administrative fees. We will provide more details as soon as possible.
After the public health emergency, Blue Cross NC will cover the cost of the COVID-19 vaccine with no cost-sharing to members, as part of our routine preventative care and immunization benefits in accordance with federal laws and regulations.
Members who live outside of North Carolina will need to follow their local and state guidelines to determine how they should receive the vaccine. States will determine the appropriate staging on who gets the vaccine first and how it will need to be administered based on supply.
We believe the distribution of a safe, effective and clinically approved COVID-19 vaccine is of utmost importance. We will work with providers in our network to support capacity to meet member demand.
For full details on provider reimbursement for vaccine administrative fees according to Blue Cross NC segment, see our Provider News article.
3. WAIVING PRIOR AUTHORIZATION
Blue Cross NC will not require prior authorization for diagnostic tests and covered services that are medically necessary and consistent with CDC guidance for members with a confirmed or suspected COVID-19 diagnosis. For details and coding guidance, please click here.
Additionally, Blue Cross NC will waive prior authorization requirements for emergent non-elective inpatient admissions, durable medical equipment and post-acute care services that are medically necessary for COVID-19 related services through March 31, 2021.
4. WAIVING MEDICARE ADVANTAGE COPAYS
Blue Cross NC is waiving all copays for in-network primary care and outpatient behavioral health visits for Medicare Advantage members from June 1 through the end of 2020. Visits do not have to be related to COVID-19 and can be done in person or virtually through telehealth.
The copay waiver is specific to the primary care medical visit or behavioral health therapy visit. Members may have costs for other services unless they are related to COVID-19 treatment or testing.
Behavioral Health Providers
You can provide any services covered under your existing Blue Cross NC contract using telehealth (video and/or audio) in accordance with the Temporary Expansion of Reimbursement for Telehealth Services. Services can be provided for conditions not related to COVID-19. Member cost sharing continues to apply.
If you would like to be added to this directory of behavioral health providers using telehealth in response to COVID-19: Complete this survey.
CLARIFICATION ON CLAIMS AND REIMBURSEMENT FOR TELEHEALTH
We have received numerous questions related to claims and reimbursement for our expanded telehealth measures. Please see below for additional guidance.
- Any claims for telehealth submitted on or after March 6, 2020, will be reprocessed and paid at parity to in-person visits. You do not need to take additional actions.
- You can use any face-to-face CPT codes for telehealth. However, you must also list place of service (POS) 02. Additionally, if you used telephone only (no video), you must use the modifier CR. Please note that any prior authorization requirements still apply when services are performed via telehealth.
We thank you for your patience and continued service to our members. Our priority is to address these issues as quickly as possible to ensure that both providers and members are able to utilize our expanded telehealth benefit.
Additional Behavioral Health Resources
- American Psychiatric Association Telepsychiatry and COVID-19
- National Center for PTSD COVID-19: Resources for Managing Stress
- American Society of Addiction Medicine COVID-19 Resources
- Resources for Addiction Treatment Providers
- SAMHSA COVID-19 Information
- NCDHHS Hope4NC helpline and Hope4Healers helpline
Provider COVID-19 Triage Listing – How to Get COVID-19 Care
We want to help members find the right care, at the right place, at the right time.
This is especially important in the case of COVID-19. We can prevent the spread of infection. We can protect our members and you on the front lines.
Our recommendation to members is to always first call your primary care provider (PCP).
We will continue to update this list. If you are a health system or practice that would like to be on this list, complete this form.
North Carolina Department of Health and Human Services (NC DHHS)
- General Questions on COVID-19: Call North Carolina Coronavirus Helpline 866-462-3821
- Get answers to COVID-19 testing questions here, or find a COVID-19 testing location
Below, we’ve made a list of resources from health care systems and practices throughout NC. We’ve included the right first steps for our members to engage appropriately in triage protocols.
PROVIDER COVID-19 TRIAGE LISTING
If you want your health system or practice’s listing to be included below, please provide the right first step for members to engage with your triage protocol. This is not for a provider directory. This is a specific listing to support your COVID-19 triage efforts. To provide these right first steps, complete this form.
North Carolina’s Regional Sites
For community physicians only: 704-512-7878
- COVID-19 Risk Assessment bot at https://atriumhealth.org/coronavirus
- Virtual and eVisits offered at: http://atriumhealth.org/GetCareNow
If your patient does not have a PCP at Novant Health, call helpline 877-9NOVANT
- Self-assessment chat bot: www.novanthealth.org/coronavirus
Iredell Health System
Wake Forest Baptist Health
For community physicians only: 336-716-7654 or 800-277-7654.
Make a free MyChart COVID-19 e-Visit at http://conehealth.com/appointments
If your patient does not have a PCP at Novant, call helpline 877-9NOVANT
Self-assessment chat bot: www.novanthealth.org/coronavirus
Triangle: Durham, Chapel Hill, Raleigh
If your patient does not have a PCP at UNC Health, call helpline 1-888-850-2684
Virtual Care: http://www.uncurgentcare247.com/
Testing: You may refer your patient to a UNC Health Respiratory Diagnostic Center or to a UNC Virtual Care center; patients must be scheduled by a clinician.
WakeMed & WakeMed Key Community Care (WKCC)
WakeMed Health Help Line at 919-350-5200
Virtual Care: Set up a virtual urgent care visit: https://www.wakemed.org/virtual-urgent-care
Testing: Respiratory Diagnostic Centers (RDC) open, but patients must first call the WakeMed Health Help Line to receive screening and an order from a physician to make an appointment
Phone Hotline: If your patient does not have a PCP at Duke Health, call COVID-19 Hotline 919-385-0429
Virtual Care: www.dukehealth.org/treatments/virtual-urgent-care
Testing: At this time widespread testing including drive-up testing is not available. Duke Health is currently building capabilities to offer drive-up testing and will continue to follow CDC and State guidance on who to test.
- If your patient is established with Wilmington Health, have them text “APPT” 839894
- If you are a Blue Cross NC member and a NEW patient to Wilmington Health, have them text “BCBS” to 839894.
- Or have them call 910.341.3400 — always call before leaving home.
Phone Hotline: Public Information Recorded Hotline 252-726-7177 by the Carteret County Health Department. Includes # of confirmed cases, what to do if feeling sick, and information on sheltering in place. Public Inquiry Phone 252-726-7060 – Staffed by the Carteret County Health Department.
Phone Hotline: Brunswick County Public Health Department at 910-253-2339 or NC DHHS at (866) 462-3821
Phone Hotline: Call nurse line at 1-833-945-2395 to direct to appropriate resources
Advent Hendersonville (formerly Park Ridge)
Phone Hotline: 24-hour AdventHealth Triage Nurse Hotline: 828-681-2300
Virtual Care: Download the AdventHealth app for a virtual urgent care visit (details at )
Hugh Chatham Memorial
Phone Hotline: If you have nonurgent questions, call the Care Line at 336-527-CARE
Catawba Valley Medical Center
Appalachian Regional Health System
Virtual Care: If you have symptoms, connect with a RelyMD doctor at .
Testing: Two alternative COVID-19 testing sites in Avery or Watauga County; the RelyMD physician will help you make an appointment if you have symptoms
Northern Regional Hospital (Surry County)
Erlanger Murphy Medical Center
Phone Hotline: If you don’t have a PCP, call the closest urgent care center
Phone Hotline: General community resource hotline: 252-847-8000 or NC DHHS hotline at 866-462-3821
Phone Hotline: Call 252-744-1111 for instructions
Cape Fear Valley
Phone Hotline: If your patient has COVID-19 symptoms, call the Carelink line at 910-615-LINK
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