Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-06-18

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced today that it is extending its policy to pay providers at parity for telehealth services through Dec. 31, 2020.

Under the expanded telehealth policy, 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. This includes virtual care encounters for patients that can replace in-person interactions across appropriate care settings, including outpatient clinics, hospitals, and the emergency departments. This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. 

Blue Cross NC will use data and insights gained from this time period of increased virtual visits to develop a long-term telehealth policy thoughtfully designed to best serve providers and members. It will ensure that telehealth remains a tool that improves health, increases access to health care and lowers costs. The new policy will be announced later in the year and be effective Jan. 1, 2021.

In addition to the telehealth reimbursement policy, Blue Cross NC has implemented the following measures to support providers and members during the COVID-19 pandemic. We will continue to reevaluate all measures as we approach expiration dates.

Measures extended through July 31, 2020:

  • COVID-19 Treatment Cost-Share Waivers: Blue Cross NC will continue waiving member cost-sharing (copays, deductibles and coinsurance) for COVID-19 related treatment that is medically necessary and consistent with CDC guidance if a member is diagnosed with COVID-19. 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. 
  • Prior Authorization Waiver for COVID-19 Related Services:  Blue Cross NC will continue waiving 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. This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. 
  • Prior Authorization Required for Hydroxychloroquine and Chloroquine: Blue Cross NC is requiring prior authorization for hydroxychloroquine and chloroquine. Additionally, Blue Cross NC has modified criteria to only cover these drugs for COVID-19 if a member has been started on hydroxychloroquine and chloroquine in the hospital and requires outpatient continuation.  There has been an increase in the prescriptions of these medicines recently, despite them not being recommended for treatment of COVID-19 by the Centers for Disease Control nor the Infectious Diseases Society of America. Additionally, on April 24, the U.S. Food and Drug Administration updated its drug safety information regarding use of hydroxychloroquine and chloroquine for COVID-19 outside the hospital setting or a clinical trial. This measure applies to pharmacy benefit coverage for all Commercial and Medicare Advantage members who have their pharmacy benefits through Blue Cross NC, including individual (under-65) customers, fully insured group customers and self-funded (administrative services only) group customers. These changes will not apply to State Health Plan customers, Federal Employee Program customers or any self-funded employer groups that carve out their pharmacy benefits to another pharmacy benefits manager.  

The following measure is required by current laws and guidance. We will continue to monitor for any changes to the benefits and length of coverage. 

  • COVID-19 Testing and Doctor Visit Cost-Share Waivers: Blue Cross NC is waiving member cost-sharing (copays, deductibles and coinsurance) for COVID-19 related clinical visits and testing that is ordered by a provider, medically necessary and FDA cleared, approved or authorized for members with a suspected or confirmed COVID-19 diagnosis. Specifically, there will be no member cost-share for COVID-19 testing or clinical visits to determine if testing is needed through virtual care visits, outpatient office visits, urgent care visits or ER visits. This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. 

For additional details, visit our dedicated provider coronavirus webpage at www.bluecrossnc.com/coronavirus-providers