The Record - Here’s an update on temporary changes due to COVID-19 pandemic

Here’s an update on temporary changes due to COVID-19 pandemic

Blue Cross Blue Shield of Michigan and Blue Care Network have made many temporary changes to support providers and protect members during the COVID-19 pandemic. Some of those changes have ended and one has been extended.

These updates apply to Blue Cross commercial, BCN commercial, Medicare Plus Blue^SM and BCN Advantage^SM members, unless otherwise noted.

Temporary changes that have ended

For dates of service on or after June 13, 2020

Clinical review is again required by Blue Cross/BCN Utilization Management for acute care admissions with non-COVID-19-related diagnoses. You’ll need to submit clinical documentation along with your authorization requests.

For dates of service on or after July 1, 2020

Member cost share once again applies for Blue Cross commercial and BCN commercial members for common medical and behavioral health visits that are performed using telemedicine.
Notes:

As indicated in the second section of this chart, we’ll continue to waive cost share for COVID-19-related treatment through Dec. 31, 2020. This includes COVID-19-related treatment delivered through telemedicine.
For Medicare Plus Blue and BCN Advantage members, cost share will be waived for common medical and behavioral health services through Dec. 31, 2020, for both in-office and telehealth visits. See Blue Cross and BCN waiving cost share for Medicare Advantage members for more information.

For acute care admissions with COVID-19-related diagnoses, clinical review is once again required.

For CT scans of the chest to rule out pneumonia diagnosis associated with COVID-19, AIM Specialty Health^® again requires clinical review for procedure codes *71250, *71260 and *71270.

For the first three days of admission to a skilled nursing facility for members transferred from acute care, Blue Cross/BCN Utilization Management and naviHealth once again require clinical review.

For Blue Cross and BCN-primary original claims with submission deadlines of Oct. 1, 2020, and after

The 90-day extension to claim submission time limits, which was in effect for original claims with submission deadlines of Jan. 1, 2020, and after, will end Sept. 30.

For primary original claims with submission deadlines of Oct. 1, 2020, and after, existing participation/affiliation agreement submission deadlines apply for all lines of business, including Blue Cross commercial, BCN commercial, Medicare Plus Blue and BCN Advantage.

Temporary change that has been extended

End date extended from June 30, 2020, to until further notice

For Blue Cross’ commercial and BCN commercial members, we’ll waive member cost share for COVID-19 treatment through Dec. 31, 2020. Previously, this was scheduled to end on June 30, 2020.

As previously communicated, we’ll continue to waive cost share for COVID-19 treatment through Dec. 31, 2020, for Medicare Plus Blue and BCN Advantage members. See Blue Cross and BCN waiving cost share for Medicare Advantage members for more information.

To determine end dates for other temporary actions Blue Cross and BCN have taken, see the Temporary changes due to the COVID-19 pandemic document. You can find this document on our public website at bcbsm.com/coronavirus and through Provider Secured Services.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.