Appropriate Telehealth Services

In response to the COVID-19 pandemic that began in 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) allowed certain services to be billed as telehealth.  We have discovered through our claims review process that some services have been billed as telehealth that would not have been possible to be performed via telehealth such as surgery, anesthesia, laboratory testing and radiology.  

We will deny or request refunds for any services that were billed and paid as telehealth incorrectly.  In most cases, these services are reimbursable when claims are submitted accurately.  

Blue Cross NC will continue to review and process claims where telehealth services are billed to ensure appropriateness.   

Please note, Blue Cross NC is continuing to evaluate our telehealth policies and will keep providers updated on any changes. 

This communication applies to fully insured commercial lines of business, State Health Plan, ASO and Medicare Advantage.