Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-05-27

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) implemented a number of measures to support members and providers during the COVID-19 pandemic. Blue Cross NC has reevaluated the expiration dates for those measures based on the current state of the pandemic and public health data. Updates are below. We will continue to reevaluate all measures as we approach expiration dates.

The following measures will be extended through July 31, 2020.

  • Virtual Care: Blue Cross NC will continue its expanded virtual care policy. Under this expanded 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 members and Experience Health members.
  • 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, Blue Cross NC Medicare Advantage members, and Experience Health members. Self-funded employer groups will be given the option to apply these changes to their employees' plans.

The following measure will be extended through June 30, 2020.

  • 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 members and Experience Health members.

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 members and Experience Health members.

Blue Cross NC has made the decision not to renew three measures related to non-COVID-19 services based on public health data (See expiration dates listed below). We are closely monitoring the COVID-19 pandemic and will consider reinstating these measures if needed.

  • The prior authorization waiver for non-COVID-19 related services expires on May 31, 2020. This means that providers should follow their usual process for prior authorization for emergent non-elective inpatient admissions, skilled nursing facility, acute inpatient rehabilitation, and home health services with a date of service on or after June 1, 2020. As hospitals return to doing elective procedures, and the state takes steps to return to business, we are doing the same by reinstating some of our normal policies such as prior authorizations.
  • For non-COVID-19 vendor-based telehealth services (MDLIVE or Teladoc), the member cost-share waiver expires on June 4, 2020. This means that cost-sharing (copays, deductibles, coinsurance) will apply for members who have access to these services through their Blue Cross NC plans, starting on June 5, 2020.
  • Blue Cross NC's early medication refills policy is set to expire when the North Carolina state of disaster expires on May 31, 2020. Members can still ask their doctor to order a 90-day prescription of maintenance medication(s) for ongoing conditions or needs and can even ask for these to be mail-ordered for delivery to their homes.

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