Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-12-21

Due to the spike in COVID-19 cases and hospitalizations, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will waive prior authorization requirements for all conditions, including non-COVID-19 conditions, and require notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs). Please see below for details:

  • This temporary change goes into effect on Dec. 21, 2020, and will be reevaluated every 30 calendar days.
  • This waiver only applies to services incurred at in-network SNFs or RTCs for members discharging from inpatient level of care. Medical necessity review is required for length-of-stay extensions beyond the days allowed on the initial approval. 
  • This measure applies to fully insured, self-funded employer groups (including State Health Plan) and all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. This does not apply to Federal Employee Program members.

Our Blue Cross NC teams are working to review all prior authorizations for post-acute care and inpatient hospital admissions as quickly as we can.

Additional COVID-19 Member and Provider Support Measures
Blue Cross NC implemented a number of measures to support members and providers during the COVID-19 pandemic. We continue to reevaluate the expiration dates for these measures based on the current state of the pandemic and public health data.

Blue Cross NC announced its coverage for COVID-19 vaccines on Dec. 9:

  • COVID-19 Vaccine Coverage: 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. While additional guidance may be released by the North Carolina Department of Health and Human Services later, we’re providing you with critical information that is known at this time. Click here to view more details, including coding and reimbursement details and a provider FAQ.

The following measure is in place through June 30, 2021:

  • Virtual Care: Blue Cross NC will continue its expanded virtual care policy. Under this 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. For coding guidance, please click here.
    • Blue Cross NC has been covering telehealth for more than 20 years and will continue to do so after the pandemic. We’re continuing to look at data to determine a permanent telehealth policy to best serve our members and health care providers. We plan to announce the permanent policy in early 2021.

The following measure is in place through March 31, 2021:

  • 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.

The following measure is in place through March 31, 2021:

  • 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. For coding guidance, please click here.

The following measure is in place from Nov. 13 through Dec. 31, 2020:

  • 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 for eligible members. 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. Providers do not need to code differently and should continue following the coding guidance provided for COVID-19 testing. It applies to members on a fully insured 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. Self-funded employer groups have the option to apply this change to their employees' plans.

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 coding guidance, please click here.

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