Skip to main content
An important notice to our 800,000 BCBS of WNY members

Information Regarding COVID-19 (Coronavirus)

BlueCross BlueShield of Western New York is closely monitoring the COVID-19 (Coronavirus) situation. The health and well-being of our members is our top priority, and we remain committed to ensuring our members and customers have access to the care and information they need.

An Important Message from our Chief Medical Officer, Thomas Schenk, M.D.

Frequently Asked Questions (FAQs)

Updated March 24, 2020

Who can get tested for COVID-19? What’s medical necessity?

What should I do if I have a patient who meets the criteria for testing?

  • If you suspect a patient has the coronavirus, we advise you to contact your patient’s local health department for guidance

What labs are performing COVID-19 testing?

  • The capacity for testing in FDA-authorized public and private labs continues to increase each day
  • Please contact your patient’s local health department for consultation on the best lab to direct their specimens.
  • We’re waiving all copays and deductibles (including deductibles on HSA plans) for FDA-authorized COVID-19 tests conducted at any public or private lab (this temporarily includes out-of-network labs)
  • Quest Diagnostics continues to be our preferred outpatient laboratory

Are COVID-19 lab tests and office visits covered?

  • We’re waiving all copays, coinsurance and deductibles (including deductibles on HSA plans) for FDA-authorized COVID-19 lab tests
  • This applies to both the test and the related in-network provider visit to order the test for any of your Commercial or Medicare Advantage BlueCross BlueShield patients who meet the CDC guidelines
  • The New York Department of Financial Services is mandating that providers do not collect any deductible, copayment, or coinsurance for these patients (for dates of service on or after March 1)
  • Note: COVID-19 testing claims will be processed for services dating back to either February 4, 2020 (U0001) and (U0002) or March 13, 2020 (87635); office, urgent care and ER visit claims will be processed for services dating back to March 1, 2020
  • Any relevant claims submitted after this date and before the change is implemented will be reprocessed

What codes should I bill for the office visit related to the COVID-19 lab test order?

  • We are working closely with the federal and state officials to support the most appropriate and uniform coding guidance for COVID-19 testing
  • To ensure claims are processed appropriately, with $0 cost-share for members, please use the following diagnosis coding for these visits:
    • For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out
    • For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases
  • We are working to implement the cost-sharing waiver for claims with dates of service on or after March 1, 2020
    • Any relevant claims submitted after this date and before the change is implemented will be reprocessed

What codes should I bill for treatment of the coronavirus?

  • We are working closely with the federal and state officials to support the most appropriate and uniform coding guidance for COVID-19 testing
  • At this time, we are recommending that providers use the following diagnosis code for treatment related to the coronavirus as of April 1st
    • U07.1 - 2019-nCoV acute respiratory disease

Are preauthorizations required for testing of COVID-19?

  • There are no prior authorizations related to lab testing for COVID-19

Are you reducing or removing preauthorizations in this state of emergency?

  • Yes, to help reduce administrative burden on all providers, we will be removing preauthorization, concurrent, and retrospective review for all provider types, facilities, and specialties for 90 days
  • This includes all inpatient and outpatient medical services reviewed by our plan and our delegated partners
    • Note: we are still reviewing preauthorization requirements for medical and pharmacy prescription drugs; please continue to submit these authorizations to our plan and Express Scripts until there is further guidance provided
    • Note: hospitals should use their best efforts to provide 48 hours’ notice to us after an admission, and include information necessary for us to assist in coordinating care and discharge planning
    • We may retrospectively review these services after 90 days
  • Although we are removing preauthorization, concurrent, and retrospective review, providers should continue to follow appropriate medical necessity
  • We are working to implement this change for claims with dates of service on or after March 20, 2020 through June 20, 2020
  • We will continue to work with providers, local and state officials, to monitor the necessity of this temporary change and may choose to extend if necessary

Do COVID-19 test specimens need to be sent to Quest for coverage?

  • Please contact your patient’s local health department for consultation on the best lab to direct their specimens
  • Quest Diagnostics continues to be our preferred outpatient laboratory
  • If specimens are sent to an authorized lab other than Quest, we will still waive your patients’ copays, coinsurance and deductibles (including deductibles on HSA plans)
  • For the latest updates on Quest Diagnostics' COVID-19 testing capabilities, please visit their website

Can I offer telehealth services to my patients?

  • We are strongly encouraging our members to utilize their telehealth benefit to avoid leaving their homes and promoting the spread of the coronavirus

  • In support of this, we are expanding access to telehealth for our members

  • We are temporarily waiving cost-shares and reimbursing for any clinically appropriate claims (not just limited to Evaluation and Management service codes) billed with an 02 place of service for your BlueCross BlueShield Commercial and Medicare Advantage patients

  • Please Note:
    • Providers can bill any code with an 02 place of service as long as it’s clinically appropriate and medically necessary
    • BestPractice Providers - Four telemedicine codes were temporarily removed from capitation to pay Fee for Service (see below); all other capitated codes will continue to be capitated, even if billed with 02 place of service
    • We will reimburse for both video and telephonic services but a SOAP note must be documented in your EMR
    • There are no restrictions on specialty types that can bill for telehealth services
    • The New York Department of Financial Services is mandating that providers do not bill these patients any deductible, copayment, or coinsurance (for dates of service on or after March 17, 2020)
    • Many codes were previously included in payment for other services (No Separate Fee); but will be temporarily paid as Fee for Service
    • For Medicare patients: telehealth visits still require a GT modifier and preventive visits require both audio and video components
    • Telehealth claims as noted above will be processed for services dating back to March 17, 2020.
      • Any relevant claims submitted after this date and before the change is implemented will be reprocessed
         
  • We are paying certain telehealth CPT codes that are capitated under BestPractice as Fee for Service
    • For primary care offices that participate in BestPractice, certain telephonic CPT codes are capitated in your monthly base payment
    • This includes CPT codes 98966 and 99441-99443
    • We are temporarily removing these codes from capitation and will pay these as Fee for Service ; all other capitated codes will continue to be capitated, even if billed with 02 place of service
    • Please note: Telehealth claims as noted above will be processed for services dating back to March 17, 2020
    • Click here to view the full list of codes, descriptions, requirements and rates
      • To further promote the use of telehealth, we increased rates for Evaluation and Management telehealth services for 90 days
      • We notified providers on March 24, in accordance with our 90 day contract notice requirements that the rate increases and the expansion of certain covered services will be in effect for 90 days in response to the COVID-19 emergency and may be extended based on further regulatory guidance
         
  • We are reimbursing digital and telephonic CPT codes provided by qualified non-physicians for clinically appropriate services 
    • We recognize COVID-19 testing and treatment may require the support of your full health care team (for example nursing team), speech language or physical therapists, dieticians, etc.)
    • We are temporarily reimbursing telehealth services provided by qualified non-physicians
    • This includes CPT codes 98967, 98968, 98970-98972, 99421-99423, G2010, G2012, G2061-G2063 when billed with place of service of 02
    • These were previously included in payment for other services (No Separate Fee)
    • Please note: claims for services rendered by RNs need to be electronically billed under the NPI of the supervising physician
    • Please note: Telehealth claims as noted above will be processed for services dating back to March 17, 2020. 
      • Any relevant claims submitted after this date and before the change is implemented will be reprocessed
         
    • Click here to view the full list of codes, descriptions, requirements and rates
      • To further promote the use of telehealth, we increased rates for Evaluation and Management telehealth services for 90 days
      • We notified providers on March 24, in accordance with our 90 day contract notice requirements that the rate increases and the expansion of certain covered services will be in effect for 90 days in response to the COVID-19 emergency and may be extended based on further regulatory guidance
         
  • In addition to telehealth services your office may offer, many of your BlueCross BlueShield patients can access telemedicine through Doctor on Demand® with no member out-of-pocket costs.

  • You can direct them to visit DoctorOnDemand.com to get started

If my patient tests positive for COVID-19, will the treatment be covered?

  • Yes the patient’s continued treatment will be covered according to their benefits
  • Please confirm benefits and eligibility using HEALTHeNET

Are there any benefit limits for testing or treatment of COVID-19?

  • No. We are not reducing benefit limits due to this situation
  • Please check eligibility and benefits on HEALTHeNET

How can my patients get a longer supply of prescription medication?

  • We encourage them to use their mail order benefit to obtain a 90-day supply of their prescription medication
  • They can also refill or renew their prescription medication at retail pharmacies when 25% of their current prescription is remaining – consistent with the Centers for Disease Control (CDC) recommendation to have a one-month supply of medication on hand
  • If they have an emergent need to refill your prescription earlier, the dispensing pharmacist may be able to request an emergency waiver
  • Our clinical pharmacists will review each case to ensure appropriate access for your patients
  • Our goal is to ensure that your patients can access medications when they need them by avoiding medication stockpiling
  • If your patients have additional questions about a prescription, they can contact our pharmacy service team by calling the number on the back of their member ID card

How do my patients use their mail order benefit to obtain a 90-day supply of prescription medication?

You can order 90-day prescriptions from Express Scripts the following ways:

  • ePrescribe: For the fastest service, submit prescriptions electronically. For more information, go to the Express Scripts PharmacySM

  • Online/Mobile App: Log in to express-scripts.com or the Express Scripts Mobile App, choose the medicine you want to be delivered, add it to your cart, then check out.

  • Fax: Providers can call 1-888-327-9791 for faxing instructions

  • Your patients can visit bcbswny.com/pharmacy and log in to their member account to manage prescriptions, or contact our pharmacy service team by calling the number on the back of their member ID card

How can you ensure their prescriptions will continue to be available?

  • BlueCross BlueShield monitors guidance from the Federal Drug Administration (FDA), as well as guidance from local, state and federal government and health officials
  • ·Currently, we have not received confirmation of any medication shortages related to COVID-19, but will respond swiftly to any updates we may receive from the FDA and our pharmacy partners
  • Should BlueCross BlueShield be alerted to a potential shortage of critical medications, we are prepared to:
    • Work with our Pharmacy Benefits Manager, Express Scripts, to strengthen community pharmacists’ ability to provide early medications if needed; and
    • Make benefit or formulary changes to make alternative medications available to your patients

Is there a prescription for the treatment of COVID-19?

  • Currently, there is not an FDA-approved treatment available for COVID-19, however, great efforts are being made toward vaccine development and drug clinical trials are underway
  • While specific medications have been reported as possible treatments, the science supporting these is still in its early stages – starting as early as Tuesday, March 24, clinical trials will study both the safety and the effectiveness of these drugs 
  • At this time all possible COVID-19 treatments are considered investigational – right now, widespread prescribing could deplete current medication supplies and impact patients who rely on these drugs to treat their chronic conditions or acute infections
  • Our clinical pharmacists have longstanding processes in place to quickly review the safety and effectiveness of any new drugs approved by the FDA that may emerge as treatment for COVID-19
  • Be assured that as new treatments for COVID-19 are developed, we will ensure that your patients have access to medically necessary medications through their existing benefits

What support can you provide for patients that are feeling stressed or concerned?

  • Visit the New York State Office of Mental Health for their guidance for individuals who are feeling stressed about the CCoronavirus
  • Many behavioral health providers offer telemental health services, so you can direct them to their current behavioral health provider if they offer telemental health
  • In addition to telehealth services your office may offer, many of your BlueCross BlueShield patients can connect with a psychologist or psychiatrist confidentially through telemedicine powered by Doctor on Demand® with no member out-of-pocket costs

In the News

March 12, 2020

What Steps BlueCross BlueShield Is Taking

Julie R. Snyder, from BlueCross BlueShield, came to Wake Up! on Thursday morning to tell us about how the company is taking extra steps during the virus outbreak.

Source: WIVB

March 12, 2020

Coronavirus Virtual Town Hall

Mike Baggerman and Tom Puckett talk with two people in quarantine about their experience with COVID-19. They also have Dr. Thomas Schenk, Senior Vice President of Healthcare Services and Chief Medical Officer of BlueCross BlueShield of Western New York in studio.   

Source: WBEN AM Radio