Provider Information on COVID-19 Coverage

Blue Cross and Blue Shield of Illinois (BCBSIL) is covering testing to diagnose the 2019 Novel Coronavirus (COVID-19) for most members with no prior authorization needed and no member copays or deductibles. For treatment of COVID-19, we cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of each member’s benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.

Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles, based on their employer’s election to participate in this benefit.  

Check Member Eligibility and Benefits
Use the Availity® Provider Portal  or your preferred vendor for eligibility and benefit verifications. 

Claims for COVID-19 Testing
If you test a member when it’s medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance, submit the claim to us using Healthcare Common Procedure Coding System (HCPCS) code U0002. The Centers for Medicare & Medicaid Services (CMS) has set the price for the COVID-19 diagnostic tests. We will follow CMS pricing and apply the terms of our contracts.

Out-of-Network Providers
If you are not in our networks, our allowed amount for U0002 is consistent with Medicare pricing.

BCBSIL has further expanded its telehealth program in response to COVID-19. Refer to our March 28 announcement for details. We are also temporarily lifting cost-sharing for medically necessary health services delivered by an in-network provider via telehealth for eligible fully insured members. Benefits may be different for our members covered under certain employer-funded health plans. BCBSIL will continue to evaluate the telehealth program and make adjustments to best serve our members. All new developments for providers will be posted to our News and Updates.

For members who have BCBSIL pharmacy benefits administered through Prime Therapeutics, BCBSIL will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues. 

What is the risk of COVID-19?
According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19. 

We’ve developed a flier about COVID-19 that you may share with your patients.

More Information
Because this is a rapidly evolving situation, you should continue to use CDC guidance on COVID-19, as the CDC has the most up-to-date information and recommendations. Also watch BCBSIL’s News and Updates for announcements, such as updates to our COVID-19 Provider FAQs and other information and related resources.

Checking eligibility and/or benefit information 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.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.

the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website.