Blue Cross Blue Shield Urgent Care Copay 2020

® Marks of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. U21751, PREVENTIVE SERVICES SUMMARY (70/30, 80/20 and HDHP) Service1 In-Network2 In Office Urgent Care Outpatient Facility Mammograms Covered at 100%. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Outside the United States. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. Urgent care centers and emergency departments, and acute inpatient care in. 2020, Blue Cross Dental Blue members can also take advantage of. Plus the convenience of delivery to their homes. Financial Stimulus Bill – CARES Act How will waiving cost share (copay. The Blue Cross and Blue Shield Association is the Carrier of the Plan. The address for the Blue Cross and Blue Shield Service Benefit Plan administrative office is: Blue Cross and Blue Shield Service Benefit Plan. 1310 G Street NW, Suite 900 Washington, DC 20005 This brochure is the official statement of benefits.

The purpose of this Data Protection Statement is to notify you of the practices that will govern the processing of your personal data and to obtain your explicit consent for the processing of your personal data consistent with it, in particular in accordance with the legal requirements of the European Union’s (“EU”) General Data Protection Regulation (“GDPR”):

The personal data collected may include your address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide (“Personal Data”). This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. We will retain the information in our system in accordance with applicable law and our Data Protection Policy:https://www.highmark.com/hmk2/gdpr.shtml

Your email address and phone number may be used to contact you. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website.

Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:

Blue cross blue shield drug formulary
  • (i) when required or permitted by law or government agencies,
  • (ii) when required valid requests by law enforcement,
  • (iii) for purposes relevant to corporate policies or litigation to the extent permitted under applicable law or when it is prescribed in GDPR or other applicable law.

We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. These services providers are located in the United States. These service providers will be bound by sufficient guarantees to implement appropriate technical and organizational measures in such a matter that their processing will meet the requirements of applicable law.

Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose(s) provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. After that, all Personal Data will be deleted or the documents with such data will be anonymized. If you have questions regarding how we process your Personal Data and what we store about you, please contact [email protected] or write us:

Data Protection OfficerHighmark Health120 Fifth Avenue, Suite 2114Pittsburgh, PA 15222, USA

Consent

By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement.

You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently.

Notes: This consent is given voluntarily and can be revoked at any time in writing by sending an email to [email protected] If you want to exert your withdrawal right or your rights to access, rectify, block, transfer or delete your personal data pursuant to the GDPR, please contact us and provide us at least with your full name, address and the data processing you are inquiring about. If you are not satisfied with our data processing you have the right to lodge a complaint to the data protection authority in your country of residence.

Information from Anthem for care providers about COVID-19 (updated April 6, 2021)

Please note that the following information applies to Anthem’s Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.

Commercial: Provider News Home

Medicare: Medicare Advantage Provider News Archives

Information from Anthem for Care Providers about COVID-19

Anthem is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.

To help address care providers’ questions, Anthem has developed the following updates and frequently asked questions.

Contents:

Update Summary

Frequently Asked Questions:

  • Anthem’s actions
  • COVID-19 testing
  • COVID-19 vaccines
  • Virtual, telehealth and telephonic care
  • Coding, billing, and claims
  • Other

Update Summary

COVID-19 testing and visits associated with COVID-19 testing

Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits and services during the visit associated with the COVID-19 test, including telehealth visits. Anthem looks for the CS modifier to identify visits and services leading to COVID-19 testing. This modifier should be used for evaluation and testing services in any place of service including a physician’s office, urgent care, ER or even drive-thru testing once available. While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help members get to a provider who can do so. The waivers apply to members who have individual, employer-sponsored, Medicare and Medicaid plans.

Telehealth (video + audio)

For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021.

For telehealth services not related to the treatment of COVID-19 from Anthem’s telehealth provider, LiveHealth Online, cost sharing will be waived from March 17, 2020 through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.

From March 17, 2020, through September 30, 2020, Anthem’s affiliated health plans waived member cost shares for telehealth visits for services not related to the treatment of COVID-19 from in-network providers, including visits for mental health or substance use disorders, for our fully-insured employer plans, and individual plans.

For out-of-network providers, Anthem waived cost shares from March 17, 2020, through June 14, 2020. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

Telephonic-only care

Effective from March 19, 2020, through May 31, 2021, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required by law. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

Prescription coverage

Anthem’s affiliated health plans are also providing coverage for members to have an extra 30-day supply of medication on hand, and we are encouraging that when member plans allow, that members switch from 30-day home delivery to 90-day home delivery.

Frequently Asked Questions

Anthem’s actions

What is Anthem doing to prepare?

Anthem’s affiliated health plans are committed to help provide increased access to care, while eliminating costs and help alleviate the added stress on individuals, families and the nation’s healthcare system.

These actions are intended to support the protective measures taken across the country to help prevent the spread of COVID-19 and are central to the commitment of Anthem’s affiliated health plans to remove barriers for our members and support communities through this unprecedented time.

Anthem’s affiliated health plans are committed to help our members gain timely access to care and services in a way that places the least burden on the healthcare system. Our actions should reduce barriers to seeing a physician, getting tested and maintaining adherence to medications for long-term health issues.

Anthem is waiving:

  • cost sharing for the treatment of COVID-19 from April 1, 2020, through January 31, 2021, for members of our fully-insured employer, individual, Medicare Advantage and Medicaid plans. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
  • cost sharing for COVID-19 diagnostic tests as deemed medically necessary by a healthcare clinician who has made an assessment of a patient, including serology or antibody tests, for members of our employer-sponsored, individual, Medicare and Medicaid plans. Cost share waiver extends to the end of the public health emergency.
  • cost sharing for visits and services during the visit to get the COVID-19 diagnostic test, beginning March 18, 2020, for members of our employer-sponsored, individual, Medicare and Medicaid plans. Cost share waiver extends to the end of the public health emergency.
  • cost sharing for telehealth in-network visits for COVID-19 treatment from March 17, 2020, through January 31, 2021, including visits for behavioral health, for our fully-insured employer, individual plans, and where permissible, Medicaid. Medicare Advantage and Medicare GRS plans are waived through February 28, 2021.
  • cost sharing for telehealth services not related to the treatment of COVID-19 from Anthem's telehealth provider, LiveHealth Online, from March 17, 2020, through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.
  • cost sharing for telephonic-only in-network visits from March 19, 2020, through May 31, 2021, for fully-insured employer-sponsored, individual, Medicare and Medicaid plans. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
  • cost sharing for U. S. Preventive Services Task Force (USPSTF) or CDC approved vaccines as they become available.

The cost sharing waiver includes copays, coinsurance, and deductibles.

Blue Cross Blue Shield Urgent Care Copay 2020

For additional services, members will pay any cost shares their plan requires, unless otherwise determined by state law or regulation. Members can call the number on the back of their identification card to confirm coverage. Providers should continue to verify eligibility and benefits for all members prior to rendering services.

How is Anthem monitoring COVID-19?

Anthem is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders.

How Much Is Urgent Care Visit Blue Cross Blue Shield

Anthem has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics, and will be ready to deploy the plan if necessary.

Anthem’s enterprise wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and Anthem’s Virtual Command Center for Emergency Management command, control and communication.

In addition, Anthem has established a team of experts to monitor, assess and help facilitate timely mitigation and response where we have influence as appropriate for the evolving novel coronavirus threat.

In case of mass pandemic, how can you ensure that your contracted providers can still provide services?

Anthem is committed to working with and supporting our contracted providers. Our benefits already state that if members do not have appropriate access to network physician that we will authorize coverage for out-of-network physicians as medically necessary.

In addition, Anthem’s telehealth provider, LiveHealth Online, is another safe and effective way for members to see a physician to receive health guidance related to COVID-19 from home via a mobile device or computer with a webcam.

COVID-19 testing

When member cost sharing has been waived (where permissible) by Anthem as outlined in this FAQ for COVID-19 testing and visits associated with COVID-19 testing, telehealth (video + audio) services, and in-network telephonic-only services, how does that impact provider reimbursement?

Anthem will process the claim as if there is no member cost sharing, as it does, for example, with preventative health services.

How is Anthem reimbursing participating hospitals that perform COVID-19 diagnostic testing in an emergency room or inpatient setting?

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of member cost share amounts waived by Anthem. As we announced on March 6, 2020, Anthem will waive cost shares for members of our fully insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test.

How is Anthem reimbursing participating hospitals that are performing COVID-19 diagnostic testing in a drive- thru testing setting?

Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, Anthem will recognize the codes 87635 and U0002, and will reimburse drive-thru COVID-19 tests according to the lab fee schedule inclusive of member cost-share amounts waived by Anthem. Participating hospitals without lab fee schedules will follow the same lab testing reimbursement as defined in their facility agreement with Anthem inclusive of member cost share amounts waived by Anthem. As we announced on March 6, 2020, Anthem will waive cost shares for members of our fully-insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test.

Does Anthem require a prior authorization on the focused test used to diagnose COVID-19?

No, prior authorization is not required for diagnostic services related to COVID-19 testing.

Does Anthem require use of a contracted provider for the COVID-19 lab test in order for waiver of the member’s cost share to apply?

Anthem will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers. This is applicable for our employer-sponsored, individual, Medicare and Medicaid plan members.

What codes would be appropriate for COVID-19 lab testing?

Anthem is encouraging providers to bill with codes U0001, U0002, U0003, U0004, 86328, 86769, or 87635 based on the test provided.

Is urgent care covered by blue cross blue shield

COVID-19 vaccines

How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines?
The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government.

For members of our fully-insured employer and individual plans, as well as self-funded plans, Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines at a reasonable prevailing rate. Anthem will cover the administration of COVID-19 vaccines with no cost share for in- and out-of-network providers, during the national public health emergency, and providers are not permitted under the federal mandate to balance-bill members.

For members of Medicare Advantage plans, CMS issued guidance (https://www.cms.gov/files/document/COVID-19-toolkit-issuers-MA-plans.pdf) that the COVID-19 vaccine administration should be billed by providers to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved. This will ensure that Medicare Advantage members will not have cost sharing for the administration of the vaccine.

For members of Medicaid plans, Medicaid state-specific rate and other state regulations may apply.

Corel painter 2020 download. What CPT/HCPCS codes would be appropriate to consider for the administration of a COVID-19 vaccines?

CMS has provided coding guidelines related to COVID-19 vaccines: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

Virtual, telehealth and telephonic care

Will Anthem cover telephonic-only services in addition to telehealth via video + audio?

Anthem does not cover telephonic-only services today (with limited state exceptions) but we are providing this coverage effective from March 19, 2020, through May 31, 2021, to reflect the concerns we have heard from providers about the need to support continuity of care for plan members during extended periods of social distancing. Anthem will cover telephonic-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

What member cost-shares will be waived by Anthem’s affiliated health plans for virtual care through internet video + audio or telephonic-only care?

For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021.

For telehealth services not related to the treatment of COVID-19 from Anthem’s telehealth provider, LiveHealth Online, cost sharing will be waived from March 17, 2020, through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.

From March 17, 2020 to September 30, 2020, Anthem’s affiliated health plans waived member cost share for telehealth (video + audio) in-network provider visits for services not related to the treatment of COVID-19, including visits for behavioral health, for our fully-insured employer plans and individual plans. For out-of-network providers, Anthem waived cost shares from March 17, 2020, through June 14, 2020. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

Effective from March 19, 2020, through May 31, 2021, Anthem will cover telephonic-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

Is Anthem’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telehealth?

As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability and stands ready to have physicians available to see the increase in patients, while maintaining reasonable wait times.

What codes would be appropriate to consider for a telehealth visit?

For telehealth services rendered by a professional provider, report the CPT/HCPCS code with Place of Service “02” and also append either modifier 95 or GT.

For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT.

What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies?

Telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT would be appropriate for our fully-insured employer, individual, Medicare Advantage plans and Medicaid plans, where permissible:

  • Physical therapy (PT) evaluation codes 97161, 97162, 97163 and 97164
  • Occupational (OT) therapy evaluation codes 97165, 97166, 97167 and 97168
  • PT/OT treatment codes 97110, 97112, 97530 and 97535
  • Speech therapy (ST) evaluation codes 92521, 92522, 92523 and 92524
  • ST treatment codes 92507, 92526, 92606 and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139-97150, 97533 and 97537-97546.

What codes would be appropriate to consider for a telephonic-only visit with a patient who wants to receive health guidance during the COVID-19 crisis?

Submit with the correct time-based CPT code (99441, 99442, 99443, 98966, 98967, 98968) and the place of service code that depicts where the provider’s telephonic-only services occurred.

What is the best way that providers can get information to Anthem’s members on Anthem’s alternative virtual care offerings?

Anthem.com and Anthem’s COVID-19 site (https://www.anthem.com/blog/member-news/how-to-protect/) are great resources for members with questions and are being updated regularly.

Anthem members have access to telehealth 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or download the LiveHealth Online app from the App Store or Google Play.

Anthem members also can call the Anthem 24/7 NurseLine at the number listed on their Anthem ID card to speak with a registered nurse about health questions.

Coding, billing, and claims

Does Anthem have recommendations for reporting, testing and specimen collection?

The Centers for Disease Control and Prevention (CDC) updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information from the CDC: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19 for services where a member’s cost shares are waived?

Blue Cross Blue Shield Medication Formulary

The CDC has provided coding guidelines related to COVID-19: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

What modifier is appropriate to waive member cost sharing for COVID-19 testing and visits related to testing?

CMS has provided the Medicare guideline to use the CS modifier: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-10-mlnc-se. Anthem also looks for the CS modifier to identify claims related to evaluation for COVID-19 testing. This modifier should be used for COVID-19 evaluation and testing services in any place of service.

Does Anthem expect any slowdown with claim adjudication because of COVID-19?

We are not seeing any impacts to claims payment processing at this time.

Should providers who are establishing temporary locations to provide healthcare services during the COVID-19 emergency notify Anthem of the new temporary address(es)?

Providers do not need to notify Anthem of temporary addresses for providing healthcare services during the COVID-19 emergency. Providers should continue to submit claims specifying the services provided using the provider’s primary service address along with current tax ID number.

Will Anthem allow Roster Billing for the COVID-19 vaccine?

Providers who currently submit electronic claims are encouraged to do so. The electronic process is the quickest way to get the claims to Anthem.

Yes, Anthem will accept Roster Billing from providers and state agencies that are offering mass vaccinations for their local communities. Providers may submit the COVID-19 Vaccination Roster Billing Form to Availity at https://www.availity.com/ by signing in and submitting the form electronically to the Anthem health plan.

How can a provider submit Anthem’s Roster Billing claim form?

In addition to Availity.com, providers and state agencies who wish to submit Roster Billing claims can submit paper forms:

  • Paper submission form (editable pdf)
    • Obtain form from Anthem.com https://www.anthem.com/docs/public/inline/COV19_BillRoster_ABCBS.pdf and upload to Availity at the entry point to web form

Or

  • Obtain form from Anthem.com https://www.anthem.com/docs/public/inline/COV19_BillRoster_ABCBS.pdf and mail to:

Anthem Blue Cross and Blue Shield

PO Box 27401

Richmond VA 23261

Is there a specific diagnosis code Anthem would look for on the COVID-19 Vaccination Roster Billing Form?

No. However, to assist providers our COVID-19 Vaccination Roster Billing Form provides a default Z23 diagnosis code.

Other

Do the guidelines contained in this FAQ apply to members enrolled in the Anthem affiliated health plans in states living in another BCBS Plan’s service area?

Anthem’s guidelines apply to Anthem’s affiliated health plan’s membership (members with Anthem ID cards) wherever they reside, except where prohibited by law or local emergency guidelines. Each BCBS Plan may have different guidelines that apply to members of other Blue plans. Providers should continue to verify an individual’s eligibility and benefits prior to rendering services.

Do these guidelines apply to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan commonly referred to as the Federal Employee Program (FEP®)?

Where permissible, these guidelines apply to FEP members. For the most up-to-date information about the changes FEP is making, go to https://www.fepblue.org/coronavirus.

Are you aware of any limitations in coverage for treatment of an illness/virus/disease that is part of a pandemic?

Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from a pandemic.

If you have questions, please contact your local Anthem representative.

Please note that the above information applies to Anthem’s Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.

Commercial: Provider News Home

Medicare: Medicare Advantage Provider News Archives
288-0421-WP-GA


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