Alert: Blue Cross and Blue Shield of Illinois Further Expands Telehealth to All In-Network Providers
Posted March 28, 2020
Blue Cross and Blue Shield of Illinois (BCBSIL) launched an expanded telehealth program on March 11, 2020, in quick response to the COVID-19 crisis in order to provide greater access and remove potential barriers to medical services for our members during this time.
Members and providers have been sharing their stories of how these telehealth visits are making a positive difference during these unprecedented times.
We are committed to working with providers to inform and provide greater clarity around the expanded telehealth program during this crisis transition time through alerts, answers to frequently asked questions (FAQs) and our member benefit and eligibility call centers and systems.
On March 19, Illinois Governor J.B. Pritzker issued an Executive Order expanding telehealth services across the state as part of the continued effort to mitigate the COVID-19 crisis. In collaboration with these state efforts, BCBSIL has expanded in-network telehealth benefits for all state-regulated, fully-insured members for the duration of the Gubernatorial Disaster Proclamation. It is important to note that employer group telehealth benefits may differ by plan.
Effective March 19, 2020, BCBSIL began providing benefits to fully-insured members for health care services provided by in-network and out-of-network providers for all medically necessary covered services and treatments consistent with the terms of the member’s benefit plan. Providers of telehealth may include, but are not necessarily limited to, physicians, physician assistants, APRNs, licensed behavioral health, applied behavioral analysis, physical therapy, occupational therapy, and speech therapy service providers, as well as nutritionists and dieticians. Any telehealth visit, whether in-network or out-of-network, for services related to COVID-19 will not be subject to benefit preauthorization requirements.
This telehealth delivery method for health care services is available to eligible fully-insured and employee plan participants in BCBSIL’s PPO and Blue Choice PPOSM plans. Telehealth benefits for medically necessary services are also available to eligible HMO members from providers in their medical group who offer telehealth (benefit plan requirements still apply, e.g., PCP referral requirements). BCBSIL will reimburse providers for medically necessary services delivered via telehealth billed on claims with appropriate modifiers (95 and GT) in accordance with the member’s benefits for covered services.
Telehealth claims for insured members submitted in accordance with appropriate coding guidelines, including appropriate modifiers, for in-network medically necessary health care services beginning March 19, 2020, will be covered without cost-sharing and will be reimbursed at parity with in-person office visits1 for the duration of the Gubernatorial Disaster Proclamation. As a reminder, employer group telehealth benefits, and therefore cost-sharing may differ by plan.
BCBSIL will continue to follow the applicable guidelines of the Illinois Department of Healthcare and Family Services and Centers for Medicare & Medicaid Services as appropriate for Blue Cross Community Health PlansSM (BCCHPSM) (Medicaid Plans), Blue Cross Community MMAI Plans (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM members.
Furthermore, BCBSIL will continue to evaluate the current telehealth program and make adjustments to best serve our members as the COVID-19 pandemic evolves.
Available telehealth visits with BCBSIL providers currently include 2-way, live interactive telephone communication and digital video consultations, and other methods allowed by state and federal laws, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness. Providers can find the latest guidance on acceptable HIPAA-compliant remote technologies issued by the U.S. Department of Health and Human Services’ Office for Civil Rights in Action.2
Need specific member benefit and eligibility assistance?
As a reminder, it’s critical to check eligibility and benefits for each member at every visit prior to rendering services. Providers may connect with a Customer Advocate to check eligibility and telehealth benefits via phone by calling our Provider Telecommunication Center (PTC) at 800-972-8088 or verify general coverage by submitting an electronic 270 transaction. This step will help providers determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.
Please note that telemedicine is not yet a category offered currently in our automated Interactive Voice Response (IVR) phone system. For telehealth benefits, please call our PTC at 800-972-8088 to request Office Visit benefits and request to speak with an agent for telehealth-specific information.
Continue to watch the News and Updates section of the BCBSIL Provider website for more information.. For the most up-to-date information about COVID-19, visit the Centers for Disease Control and Prevention website.
1 For telehealth providers who do not offer an “in-office” visit option, such as MDLIVE®, reimbursement will continue to be at the same level as it was prior to the Governor’s Executive Order.
2 HIPAA-compliant remote technologies may not be required for telehealth services provided to fully-insured members consistent with the terms of the Governor’s Executive Order.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.
MDLIVE, an independent company, operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.
Virtual visits, powered by MDLIVE, and telehealth may not be available on all plans. Virtual visits and telehealth are subject to the terms and conditions of the member’s benefit plan, including benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product or a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. Other state law limitations and requirements may apply.