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.

COVID-19 Updates to Support our Providers

Retroactive Changes

Added April 9, 2020

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.

Timely Filing Deadline Extension

Added April 8, 2020

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.

Cost Share Waiver for Hydroxychloroquine/Chloroquine

Updated April 8, 2020

Effective immediately, BCBSNE is waiving member cost-share for hydroxychloroquine or chloroquine when used for the treatment of COVID-19. Additionally, when hydroxychloroquine or chloroquine are requested for the treatment of COVID-19, cost-share will also be waived for azithromycin in the event the products are used together.

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 and individual plan members. BCBSNE is working with self-funded employers who would like to implement a similar approach.

To determine eligibility for a cost-share waiver BCBSNE has implemented a review process to accurately evaluate the use of hydroxychloroquine or chloroquine for the treatment of COVID-19 infection. If being used for other uses a cost-share will still apply and the review process will need to be conducted. All members previously using hydroxychloroquine or chloroquine for uses other than COVID-19 treatment will not need to be evaluated for use and the cost-share waiver.

3 EASY OPTIONS
We have provided 3 easy options for our providers to request the use of hydroxychloroquine or chloroquine and evaluate for waiver of member cost-shares.

  1. Use our online  Medical Policy Tool. We have enabled functionality for auto-approval when this tool is used. Other online programs and tools, not operated by BCBSNE, are not options for us as we cannot adjust those programs to accommodate this waiver.
  2. Call 800-247-1103 between the hours of 7:30 a.m. - 5 p.m. CST to provide the necessary information over the phone.
  3. Use the General Medication Preauthorization Physician Fax Form and fax it to the number provided at the bottom of the form.

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.

Teledentistry

Added April 6, 2020

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)

Waiving Member Cost Share for COVID-19 treatment

Added April 6, 2020

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.

COVID-19 and Telehealth – UPDATED

Updated April 6, 2020

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.




Telehealth services are offered through American Well®, also known as AmWell. American Well is an independent company that provides telehealth services for Blue Cross and Blue Shield of Nebraska.

Hydroxychloroquine/Chloroquine

Updated March 31, 2020

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.

Extension of Expiring Rx Prior Authorizations Affected by COVID-19

Updated March 31, 2020

BCBSNE will extend expiring pharmacy pre-authorizations for members that have BCBSNE prescription drug coverage. We understand the impact of COVID-19 on our members and providers and have committed to assisting them through this pandemic.

  • Pharmacy pre-authorizations set to expire prior to May 31, 2020, will be extended to May 31, 2020, for all members that have BCBSNE drug coverage.
  • BCBSNE will continue to require pre-authorization review for members who are new to therapy and prescribed a medication that requires pre-authorization.

Acute Inpatient Admissions

Updated March 31, 2020

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.

Additional Providers During COVID-19 Pandemic

Updated March 30, 2020

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. 

Pre-Authorizations Affected by COVID-19

Updated March 23, 2020

BCBSNE will extend the approval dates for an already-approved pre-authorization (PA) due to coronavirus precautions. When this is requested by the ordering provider, BCBSNE will allow an additional three months.

Please contact Customer Service at 800-635-0579 to begin this process.

The BCBSNE PA nurse will then update the approval and send an updated letter to the member, provider and rendering provider (if applicable).