COVID-19

As we continue to face the coronavirus pandemic, we want to make sure you have pertinent information available that impacts you and our members. Please know we extend our wishes for health and safety during these trying times; don't hesitate to reach out with questions or issues.

Furthermore, due to the ever-changing status of COVID-19, BCBSNE will research and make retroactive changes to claims on your behalf as we adjust our policies.

COVID-19 Updates to Support our Providers

BCBSNE has sent notification to UR and CM teams ensuring everyone is aware we will begin reinstatement of our precertification requirements.

Currently we are all working towards the goal of a new normal and part of that is to re-establish our precertification process. We will reinstate our precertification requirements for inpatient admissions beginning July 1, 2020.

Thank you for all you do for our members each day. We appreciate your dedication and service. Please continue to watch our COVID-19 page for updates.

BCBSNE will further extend expiring pharmacy preauthorization’s for members that have BCBSNE prescription drug coverage. We will also be extending our “Refill Too Soon” overrides for pharmacies through June 30, 2020. We understand the impact of the coronavirus on our members and providers and have committed to assisting them through this pandemic.

  • Pharmacy preauthorization’s set to expire prior to May 31, 2020, will be extended 90 days from the original expiration date, for all members that have BCBSNE drug coverage
  • BCBSNE will continue to require preauthorization review for members who are new to therapy and prescribed a medication that requires preauthorization

Effective immediately, BCBSNE has updated their cost-share waiver process for medications when used for the treatment of COVID-19. BCBSNE is following the FDA recommendation to caution the use of hydroxychloroquine and chloroquine outside of a hospital setting or clinical trial. We have made the decision to remove the cost share waiver for these drugs. For more information on the FDA information,  please visit the FDA website.

At this time, the evaluation of Actemra for the treatment of COVID-19 will also be considered. BCBSNE will follow already-established processes for its use given it is also included in Medical Policy X.42. A cost-share waiver may be granted if Actemra is used for COVID-19 treatment. This applies to BCBSNE fully insured, individual plan members, and some self-funded employers.

In addition to BCBSNE, other Blue Cross and Blue Shield Plans, as well as the BCBS Federal Employee Program (FEP), are waiving member cost shares related to COVID-19 treatment. For more information, go to   bcbs.com.

Effective April 15:
  • BCBSNE will continue to cover brand ProAir HFA, ProAir Respiclick and Ventolin HFA as preferred albuterol inhalers.
  • BCBSNE will expand temporary coverage of generic ProAir HFA (labeled as albuterol HFA), generic Proventil HFA (upon release), Proventil HFA and the authorized generics of Proventil HFA and Ventolin HFA (labeled as albuterol HFA).

BCBSNE has implemented this change due to shortages of albuterol at some pharmacies. BCBSNE is supporting our network pharmacies by allowing them to use available stock to meet the needs of our members.

Please note: This change is temporary. These coverage updates will be in place through June 30, 2020. This shortage will be evaluated prior to June 30, 2020 to determine if continuation is warranted.

BCBS Federal Employee Program (FEP) understands there are times when it is necessary and appropriate for our non-teladoc network providers to also treat patients remotely. With this in mind, we will allow for appropriate covered services (i.e., office visits with primary care, specialty and mental health providers, ABA, speech and other therapies) when billed with the correct place of service (02) and modifier (95 GT and GQ).

In these cases, non-telehealth benefits will apply, meaning regular office visit copays will be charged to the member for the remote virtual visit depending on which option they are enrolled in, whether the provider is a PCP and SCP and what the provider’s contracted status is.  

However, if the claim is related to testing or treatment for COVID-19, member cost-share is waived regardless of the provider’s contracted status. 

Note: Cost-share is waived regardless of whether the COVID-19 test comes back positive or negative. 

For services provided under the telehealth benefit by a teladoc provider, member cost-share is being waived. For services from non-teladoc providers, member cost-share is only being waived if those services are for testing or treatment of COVID-19. Telehealth charges are accepted from any credentialed provider with no video component required during this pandemic urgency period.

A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95, GT and GQ and POS 02 for reimbursement. Normal cost-shares will apply; however, if the claim is related to testing or treatment for COVID-19, member cost-share is waived regardless of the provider's contracted status.

Notice of termination for this policy will be given in writing at least 60 days prior to termination.  However, we will review and consider an extension for this policy as needed.    

Telehealth Codes

Please use in place of service 02 and modifier 95, GT and GQ with the appropriate CPT codes. We have updated the fee schedule to reflect these changes. To download the fee schedule,  log in to NaviNet.

Our members may seek telehealth services through their current provider, or they can receive services through teledoc. This information has been communicated separately to our members.

Thank you for the care you provide our members, especially in times of crisis.  

Effective April 9, 2020, BCBSNE is extending the timely filing deadline for providers to Dec. 31, 2020 or to providers’ current contract filing deadline, whichever is later.

BCBSNE will cover the following teledentistry billing codes for in-network care through June 30:
  • D0140 – Limited oral examination – problem focused
  • D0170 – Re-evaluation – limited, problem focused
  • D0171 – Re-evaluation – post-operative office visit  
  • D0190 – Screening of a patient
  • D9992 – Dental case management – care coordination
  • D9995 – Teledentistry – synchronous; real-time encounter (identifier only)
  • D9996 – Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review (identifier only)

BCBSNE continues to support our customers and has made the decision to waive member cost-sharing for in-network treatment of COVID-19 from March 1, 2020, through June 30, 2020. This applies to office, urgent care, emergency room and inpatient hospital stays for the following BCBSNE plan members:

  • Fully insured
  • Individual
  • Medicare Supplement
  • Medicare Advantage

Further supporting our providers, 100% of allowable amounts for in-network covered benefits will be paid.

In addition to BCBSNE, other Blue Cross and Blue Shield Plans, as well as the BCBS Federal Employee Program (FEP), are waiving member cost shares related to COVID-19 treatment. For more information, go to  bcbs.com.

After much consideration, BCBSNE has made the decision to adjust our telehealth policy to cover - without copayment  – all telehealth services from qualified health care providers, including dentists, within the BCBSNE network at 100% of the assigned fee schedule from March 13, 2020, through June 30, 2020.  

BCBSNE will accept telehealth charges from any credentialed provider with no video component required during this pandemic urgency period.

A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95 and POS 02 for reimbursement. All codes will be covered at 100% of the provider’s existing fee schedule.

Notice of termination for this policy will be given in writing at least 60 days prior to termination. However, we will review and consider an extension for this policy as needed.

Please see the updated telehealth policy in the  General Policies and Procedures Manual.

Telehealth Codes

Please use in place of service 02 and modifier 95 with the appropriate CPT codes. We have updated the fee schedule to reflect these changes. To download the fee schedule,   please log in to NaviNet.

These changes are specific to BCBSNE members; please check benefits for FEP or out-of-state Blue Cross and Blue Shield members. For coverage information on other Blue Cross and Blue Shield Plans, as well as the BCBS Federal Employee Program (FEP), related to COVID-19 treatment go to  bcbs.com.

BCBSNE will allow facility claims submitted on a UB for Telehealth. Please use modifier 95 to identify such claims. 

Providers performing and billing teleservices must be eligible to independently perform and bill the equivalent face-to-face service.

Our members may seek telehealth services through their current physician/provider, or they can receive services through Amwell®. This information has been communicated separately to our members.

As we continue to partner with you, we want to thank you for the care you provide our members, especially in times of crisis.




Amwell® is an independent company that provides telehealth services for Blue Cross and Blue Shield of Nebraska.

Effective immediately, BCBSNE will implement a quantity-limit program for hydroxychloroquine and chloroquine products to preserve supplies and enable currently established patients to continue treatment while allowing flexibility for members that may be prescribed this treatment for an active COVID-19 infection.

Details:
  • The quantity-limit program will limit use to one course of therapy every three months.
  • Prescriber can demonstrate the need for higher doses or another course of therapy for COVID-19 to go beyond the quantity limit by using our online  Medical Policy Tool or by using our  General Medication Preauthorization Physician Fax Form
  • For those newly starting therapy for a non-COVID-19 indication, quantity-limit review will be required to go beyond the established quantity limits.
  • Members with paid claims prior to the COVID-19 outbreak are assumed to be using for a non-COVID-19 indication and will be grandfathered in to eliminate the need to submit a clinical review.

This will help support efforts to maintain adequate supply in the market while effectively treating our members that need it.

To obtain auto-approval please use our  MedPolicy Blue tool

In addition to BCBSNE, other Blue Cross and Blue Shield Plans, as well as the BCBS Federal Employee Program (FEP), are waiving member cost shares related to COVID-19 treatment. For more information, go to  bcbs.com.

BCBSNE continues to partner with you during the COVID-19 pandemic. Effective March 30, 2020, we will not require prior authorization for acute inpatient hospital admissions. This does not include residential treatment center admissions.

We do ask our hospital partners to notify us of all admissions, so we can assist with discharge planning and refer members to our care management programs. Clinical review will not be required for the duration of these stays.

If you are unable to provide admission notifications or if notifications are untimely, BCBSNE will not deny claims during this timeframe. This process will remain in place until further notice.

BCBSNE has made the following adjustments in response to Gov. Ricketts’ announcement allowing retired and out-of-state providers to practice in Nebraska during the pandemic:

BCBSNE will review credentialing criteria on a case-by-case basis and evaluate whether providers meet the criteria to be allowed in network and recredentialed later.

BCBSNE will loosen the following criteria:
  • License requirements 
  • FBI background checks
  • Test dates and results due to boards being postponed

We recommend retired and out-of-state providers submit using the Locum Tenens billing guidelines found in the  General Policies and Procedures. This will eliminate the need to have these providers in the directory and uploaded into the system. Additionally, it will ensure providers are paid according to their specialty and networks.