COVID-19

As we continue to evaluate the information around 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 

July 1, 2020, BCBSNE updated its telehealth services policy to a limited number of providers, including:

  • Medical doctors
  • Doctors of osteopathy
  • Physician assistants
  • Nurse practitioners
  • Behavioral health providers
  • Occupational, physical and speech therapists** 

BCBSNE will continue to pay eligible providers at the assigned office fee schedule rates and prefers providers use a HIPPA-secure platform. The video component is not required.

Telehealth Codes
Member cost shares will apply beginning January 1, 2021.  The below codes are the only applicable telehealth codes that should be billed:

Telehealth Codes

Continue to use place of service 02 and modifier 95 with the appropriate CPT codes. 

**As of November 1, 2020, institutional telehealth services are no longer a covered service with the exception of OT, PT and ST.

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.

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.  Currently we do not have an “end date” for the telehealth services, once one is established, we will provide you with 30 days’ notice.

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

BCBSNE will commit to extending the approval dates for an already approved preauthorization due to the continued precautions with coronavirus. When this is requested by the ordering provider, BCBSNE will allow an additional six months. 

Please contact our team at 800-247-1103, option 2 to begin this process.  

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

BCBSNE has updated its medical policy to address COVID-19 testing when done for the purpose of surveillance using Z11.59 diagnosis code.  

  • Surveillance testing is not covered effective Nov. 1, 2020
  • Surveillance testing, including but not limited to routine workplace testing, is not covered for asymptomatic persons with no known exposure to COVID-19

Claims for these purposes will be denied. Please reference MedPolicy Blue for more information. Other services billed with this diagnosis code may be considered. 

In response to the COVID-19, BCBSNE extended the timely filing deadline for providers to December 31, 2020 or your current contract’s filing deadline, whichever is later. 

Enforcement of timely filing deadlines will resume for all claims received on and after 1/1/2021.  Please refer to your current agreement timely filing deadlines.  

Example:
  • Patient is discharged Dec. 30, 2020
  • Claim is received May 1, 2021
  • Provider has XXX days to file a timely claim (based on contractual language)

Even though the date of service was 2020, as the claim was received after 1/1/2021, this claim is subject to timely filing limits.

As a reminder, participating (PAR) providers with BCBSNE hold a contractual obligation to advise our members/your patients to use in-network providers for COVID-19 testing or treatment.  

These providers will never ask for an upfront payment from BCBSNE members.

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 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

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.