Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-07-10

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 measure is in place through December 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 commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. For coding guidance, please click here.
     

The following measure has been extended through September 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 commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. For additional guidance, please click here.
     

The following measure has been extended through October 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. For coding guidance, please click here.
     

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.
     

The following are reminders on Blue Cross NC coverage policies for the use of hydroxychloroquine and chloroquine for COVID-19:

  • On April 24, 2020, the U.S. Food and Drug Administration (FDA) updated its drug safety information regarding use of hydroxychloroquine and chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems. This announcement does not affect FDA-approved uses for malaria, extraintestinal amebiasis, chronic discoid erythematosus, systemic lupus erythematosus and rheumatoid arthritis.
  • Because of this, Blue Cross NC previously updated its own COVID-19 coverage policies accordingly for both the Commercial and Medicare lines of business:
    • Commercial: Effective May 15, 2020, Blue Cross NC modified prior authorization 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. Members who were previously approved for coverage and/or cost waiver through this policy will not be impacted by this change.
    • Medicare: Blue Cross NC currently offers a cost-share waiver for hydroxychloroquine and chloroquine for Medicare members with a COVID-19 diagnosis. Effective May 1, 2020, Blue Cross NC modified the cost-share waiver to only apply to these drugs when they are started in the hospital, and it is medically necessary to continue treatment after discharge.
    • This 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 (ASO) group customers. These changes do 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.
       

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