We’re improving your shopping experience and some features may be unavailable from Saturday at 12 p.m. until Sunday at 4 a.m.  Thank you for your patience!

Physicians/Specialists
Facilities/Hospitals
Publication Date: 
2020-03-27

May 8 Update

The telehealth measure has been extended through July 31, 2020.


April 9 Update

We updated this sentence: Our COVID-19 measures are in effect as of March 6, 2020. They were extended for an additional 30-day period starting on April 5, 2020, and will be re-evaluated for further extension.


We at Blue Cross and Blue Shield of North Carolina (Blue Cross NC) continue to be committed to the safety of the patients and communities that we serve together. We want to support your heroic efforts to address the COVID-19 outbreak.

Since COVID-19 developments are occurring quickly, we’re providing this update on telehealth policies and procedures in six parts:

  1. Overview of our telehealth measures
  2. Updated clinical scenarios table to inform your telehealth implementation approach
  3. Additional details on telehealth coverage for Federal Employee Program (FEP) members
  4. Additional details on telehealth coverage for opioids and controlled substances prescriptions
  5. Reference table of telehealth coverage by segment (Commercial, Medicare Advantage including Experience Health, and FEP)
  6. Ways to learn more and have your telehealth questions answered

 

  1. Updated Overview of our Telehealth Measures

Visits to providers that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits as long as they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.

  • These temporary measures include virtual care encounters for patients that can replace in-person interactions across care settings. They include virtual encounters through video OR telephone (audio-only).
    • For video telehealth visits be sure to include Place of Service (02).    
    • For telephone (audio-only) telehealth visits be sure to include both Telehealth as Place of Service (02) and CR (catastrophe/disaster-related) modifier.
  • Some commercial members can access MDLive or Teladoc as a virtual care benefit, as noted on their member ID card. 
  • Details on coverage for FEP members can be found below.
  • The policy is in effect for dates of service beginning March 6, 2020 and can be accessed here: https://www.bluecrossnc.com/document/telehealth.  
  • Our COVID-19 measures are in effect as of March 6, 2020. They were extended for an additional 30-day period starting on April 5, 2020, and will be re-evaluated for further extension.
  1. Updated Clinical Scenarios Table to Inform Telehealth Implementation

The switch to virtual can be challenging. To provide guidance on how to apply our telehealth measures, we’ve developed and updated a table of clinical scenarios. The document is available here: https://www.bluecrossnc.com/provider-news/covid-19-additional-details-about-relief-efforts

The table covers most of the questions we’re receiving about seeing established and new patients, routine visits, visits for suspected COVID-19 symptoms, in-hospital visits, behavioral health encounters, and more. We will continue to update the table as necessary.

  1. Additional details on telehealth coverage for FEP members

The Blue Cross and Blue Shield FEP has waived member cost-sharing for all telehealth services through the Teladoc network. This change in telehealth benefits took effect March 10, 2020, because of COVID-19 and will remain in place until further notice.

On March 9, FEP announced it was waiving copays, deductibles and prior authorization for COVID-19 testing and medically necessary treatment of a COVID-19 diagnosis.

When FEP members seek telehealth services, they are encouraged to use the Teledoc app, register at www.fepblue.org/telehealth or call 1-855-636-1579 to connect to a Teladoc provider. Through Teladoc, members currently have no copay for all services, including minor acute conditions, behavioral health and nutritional counseling.

Members who seek telehealth services outside Teladoc will have cost-sharing waived only if the claim is related to COVID-19 testing or treatment. Non-Teladoc providers should include place of service (02) and acceptable modifiers (95 GT, and GQ) in the claim.

For more information, providers may call FEP provider service at 1-800-222-4739.

  1. Reference table of Telehealth coverage by segment (Commercial, Medicare Advantage including Experience Health, and Federal Employee Program)

Please see this PowerPoint for an updated view of the measures we are taking to respond to COVID-19 and coverage by segment.

  1. Additional details on telehealth coverage of opioids and controlled substances prescriptions

On March 16, 2020, the Secretary of Health and Human Services, concurring with the acting administrator of the Drug Enforcement Administration, applied a telehealth allowance for all Schedule II-V controlled substances, as long as certain conditions were met.

We have updated our processes to enable prescriptions through telehealth visits that meet these criteria. More information can be found in the FAQ document referenced below.

  1. Ways to learn more and have your telehealth questions answered

We know the switch to telehealth can be confusing. Blue Cross NC is committed to supporting providers through this transition. Please visit our dedicated site for providers: www.bluecrossnc.com/coronovirus-providers. Through this site you will find:

  • Telehealth FAQ: We have compiled the common threads of questions from our Virtual Rounds event held on March 20, 2020 and summarized this in this FAQ document.
  • Virtual Rounds on COVID-19 and telehealth slides: we have updated our slides from the March 20, 2020 Virtual Rounds event. They can be viewed here.
  • Save the date: We will host a follow-up “Virtual Rounds” on telehealth with Dr. Janet McCauley, Head of Medical Effectiveness, Dr. Larry Wu, Medical Director, and Glenna Mcmenamin, Director of Medical and Reimbursement Policy/Medical Review, on Monday, March 30, 2020 from 1:00-2:00 PM. Sign up on our registration form.