Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2021-03-02

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 continues to reevaluate the expiration dates for those measures based on the current state of the pandemic and public health data.

  • Prior Authorization Waiver for COVID-19 Related Services: The waiver of 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 will expire on March 31, 2021. This applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. The prior-authorization waiver will continue for the Federal Employee Program until the end of the Public Health Emergency.
     
  • COVID-19 Treatment Cost-Share Waivers: The member cost-sharing waiver (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 will expire on March 31, 2021, for all fully-insured and self-funded plans, including State Health Plan. The measure will remain in place until the end of the Public Health Emergency for all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health, and the Federal Employee Program. For coding guidance, please click here.

As previously announced, the following temporary measure expired on Feb. 21, 2021:

  • Temporary Prior Authorization Waiver for SNF and RTC: Due to the spike in COVID-19 cases and hospitalizations Blue Cross NC temporarily waived prior authorization requirements for all conditions, including non-COVID-19 conditions, and required notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs).
    • This temporary measure went into effect on Dec. 21, 2020, and expired on Feb. 21, 2021.
    • This waiver only applied 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 applied 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.

Measures Still in Place

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 the next few months.
       

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.