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Alert: COVID-19 Updates for BCCHP Providers

Posted April 2, 2020

Blue Cross and Blue Shield of Illinois (BCBSIL) recently announced expanded services to help provide greater access and remove potential barriers to medical services for participants in BCBSIL’s PPO, Blue Choice PPOSM and HMO plans during the COVID-19 crisis.

We also wanted to provide an update on expanded services for our Blue Cross Community Health PlansSM (BCCHPSM) members, following guidance from the Illinois Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) during this COVID-19 crisis.

Telehealth for BCCHP Members:

Effective March 9, 2020, BCBSIL is covering telehealth, virtual check-ins and portal visits by qualifying Medicaid providers for BCCHP members. These services do not require benefit preauthorization, co-pays or deductibles.

  • Providers are encouraged to review the billing guidelines and provider qualification requirements posted on the HFS website.
  • Telehealth visits are appointments with a qualifying medical professional that are conducted virtually through telephone or video conferencing, or other methods allowed by state and federal law, that typically last for 30 minutes to 1 hour.
  • Virtual check-ins are brief 5 to 10 minute discussions with a qualifying medical professional who has an established relationship with the patient.
  • Portal visits may be conducted through a provider’s patient portal or secure chat messaging with a qualifying medical professional who has an established relationship with the patient.

COVID-19 Testing for BCCHP Members:

  • BCBSIL is covering COVID-19 testing for all BCCHP members. We are reimbursing for codes U0001 and U0002 and 87635 retroactive to Feb. 4, 2020, at the rates published by HFS.

Pharmacy for BCCHP Members:

BCBSIL has put the following measures in place to ensure access to medications for BCCHP members:

  • Allowing early refill overrides. Pharmacists should use clinical judgement to determine when it is appropriate to override the claim.
  • Non-preferred products may become preferred if shortages of preferred agents occur.
  • The edit requiring prescribing practitioners to be enrolled Medicaid providers has been temporarily turned off and will be reinstituted after the COVID-19 pandemic has ended.
  • All authorizations for maintenance medications will be appropriately extended.

Benefit Preauthorizations for BCCHP Members:

We have implemented benefit preauthorization flexibilities during the COVID-19 public health emergency and we are committed to working with our providers to facilitate removal of barriers to care for our members:

  • Benefit preauthorizations are not required for medically necessary services and treatment related to COVID-19.
  • Benefit preauthorizations for BCCHP members are being relaxed for certain non-elective care, but we will not cover any services that are not medically necessary and may be determining medical necessity post-service.
  • We are requesting notification of all inpatient admissions so that we can monitor the status of our members and coordinate post-discharge care.
  • Benefit preauthorizations are still in place for elective treatments and procedures.
  • Benefit preauthorizations that were obtained with an expiration date will be extended beyond the expiration date for any services that have been rescheduled so that providers do not need to get new authorizations.
  • Benefit preauthorization is not a guarantee of payment.

Please note that this information does not apply to Blue Cross Community MMAI Plans (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM members. BCBSIL will continue to publish updated information in the News and Updates section of the BCBSIL Provider website.

Furthermore, BCBSIL will continue to evaluate the current telehealth program and make adjustments to best serve our members as the COVID-19 pandemic evolves.

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 benefits via phone by calling our Customer Service Center at 877-860-2837 or verify general coverage by submitting an electronic 270 transaction. This step will help providers determine eligibility and other important details.

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.

This material is for informational and educational purposes only. It is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. This material is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Prior authorization for health care services is not a guarantee of payment.

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.