BlueCare Provider FAQ

A Message From Todd Ray

 

Dear Valued Provider,

Thank you for your continued dedication to serving the health care needs of our members. We’ve appreciated your flexibility and cooperation as we continue to adapt the way we work with one another.

Now that the state is starting to reopen, we want to assure you we’re being just as thoughtful about the way we serve your needs and the needs of our members. We’re continuing to make changes to help you provide care as we all slowly transition back toward a state of normalcy. Please continue to review this site and our payer space at Availity.com for daily updates.

Thanks again for everything you do to provide care to our friends and neighbors across Tennessee. As always, please reach out to your Network Manager if you have questions or need assistance.


Sincerely,

Todd Ray, Senior Vice President, Corporate Provider Network Management and Medicare Products


We’re Answering Provider Questions About COVID-19
(Revised July 2, 2020; Please note updates are frequent)

Thank you for all you do for our members. We want to be sure our members have access to the care they need, now more than ever. We’ve included information on some common questions many providers have asked us since the spread of coronavirus in the United States.

TennCare Update

On June 4, 2020, the Division of TennCare shared a memo for inclusion here. Please read it carefully, as it covers numerous administrative policies now effective for various dates of service, including EPSDT appointments. The changes in this memo apply only to our BlueCare Tennessee providers, and may extend to a later date. The guidance in this memo supersedes the guidance in the previous memos.

Here are links to the memos:

We’d also like to point you toward additional resources and information related to the COVID-19 emergency:

For more general information about coronavirus resources available to the public, you may also call the

Tennessee Coronavirus Public Information Line at 1-877-857-2945.


COVID-19 Emergency Disclaimer

During the COVID-19 emergency, we’ll continue to follow the COVID-19-related policies and processes listed in this section of the BCBSTupdates website. If a policy or process has a current end date, we’ve indicated that in individual answers. Should we decide to make a voluntary change to a policy or process that’s listed on this website during the COVID-19 emergency, we’ll provide a 30-day advance notice in this section of the BCBSTupdates website. Please refer to this content daily.

 

All answers apply to BlueCare, TennCareSelect and CoverKids plans unless stated otherwise.

 

COVID-19 Testing and Treatment

Q: Will the COVID-19 test be covered for my patients?
Since Feb. 4, 2020, we’ve covered our members’ cost-share for COVID-19 testing. This policy applies to FDA-approved tests and those currently pending FDA approval. It also applies to testing performed by providers outside of our network.

 

Q: Will BlueCare Tennessee waive or suspend prior authorizations for testing and treatment of COVID-19 during this time?
Yes, we are waiving prior authorization requirements for the testing and treatment of coronavirus during the COVID-19 emergency. However, we aren’t suspending other prior authorizations. We have prior authorizations in place for several reasons, but mainly to make sure treatments are covered and our members don’t pay more than they should.

 

Q: How will I be reimbursed for COVID-19 testing?
From Feb. 4, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval.

Please use the following codes for all contracted and non-contracted labs and providers across all BlueCross BlueShield of Tennessee product lines:

  • U0001 – CDC

  • U0002 – Commercial Labs

  • CPT® code 87635 to be priced at the U0002 payment or the lesser of billed charges once physicians can do their own testing

  • U0003 and U0004 – High-Throughput Testing (Effective 4/14/20)

 

Q: How will I be reimbursed for specimen collection testing?
From March 1, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment.

  • G2023 – home/nursing home collection

  • G2024 – home/nursing home collection

  • C9803 – hospital outpatient

 

Q: Will BlueCare Tennessee reimburse for multiple COVID-19 tests for a patient being admitted and/or being evaluated for an outpatient procedure that’s unrelated to COVID-19 treatment?
Yes. Testing guidelines for these circumstances are outlined below:

  • COVID-19 testing done 72 hours before an admission/outpatient procedure will pay “in addition” to the procedural reimbursement.

  • COVID-19 testing done less than 72 hours (i.e., 48 hours), but prior to the day of the admission/outpatient procedure, will pay “in addition” to the procedural reimbursement.

  • COVID-19 testing done at the time of an admission/outpatient procedure and billed on the same claim as the admission/outpatient procedure will be included in the admission or outpatient procedure reimbursement.

Please note: The test will be covered even if the member’s admission/OP procedure is canceled due to a positive COVID-19 test.

 

Q: Will BlueCare Tennessee reimburse for multiple COVID-19 tests for a patient being evaluated in the emergency room for services unrelated to COVID-19 treatment?
Yes. COVID-19 testing performed as part of an emergency room visit will be reimbursed separately from the emergency room visit. Please note: For ER claims, the COVID-19 test should be included on the same claim as the ER services being billed.

 

Q: How are you addressing member cost-share for COVID-19 treatment?
We’re waiving member cost-share for in-network COVID-19 treatment, including hospitalization, until further notice during the COVID-19 emergency. Out-of-network treatment will be subject to out-of-network benefits and our out-of-network allowed amounts.

 

COVID-19 Testing and Treatment – Drive-through testing

Q: Can I offer my patients drive-through testing services for COVID-19?
Yes. We’ll cover our members’ swabs and test results in a drive-through setting as part of the lab payment. Please talk with your Network Manager if you have questions.

 

Q: Does drive-through testing apply to screening services?
No. We’ll only reimburse for our members’ COVID-19 swabs and test results in drive-through testing.

*Codes included on preferred lab exclusion list for BlueCare, TennCareSelect and CoverKids.

 

Q: Do you have a list of testing sites?
The CDC has linked to each state’s department of health contact information for testing. Here’s a link to the CDC site: cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html.

 

COVID-19 Testing and Treatment – Antibody Tests

Q: Will you pay for COVID-19 antibody tests?
We’ll pay for FDA-approved versions of these tests when they’re ordered by an in-network physician during in-person or telehealth appointments.

Many of the antibody tests marketed have proved to be ineffective, so we’ll only cover the ones that the FDA has cleared, approved or given emergency use authorization for. Like you, we’re deeply invested in making sure our members get safe, effective and conclusive tests, while minimizing false or misleading diagnoses.

If the above conditions are met, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment:

  • 86328 and 86769 – Antibody Testing During Appointment
    Effective for dates of service April 10, 2020, until further notice during the COVID-19 emergency.

 

Q: Will you pay for COVID-19 at-home tests that diagnose current disease (not antibody tests)?
We’ll pay for at-home tests that diagnose current disease when they’re ordered by a licensed physician. Many of the at-home tests marketed have been proved ineffective, so we’ll cover just those the FDA has cleared, approved or given emergency use authorization for. Like you, we’re deeply invested in making sure our members get safe, effective and conclusive tests, while minimizing false or misleading diagnoses.

 

Telehealth Coverage

Q: Will BlueCare Tennessee cover telehealth (telephonic or virtual) consultations with my patients?
Yes. Effective for dates of service March 16, 2020, until further notice during the COVID-19 emergency, you may bill for telehealth in the following ways:

  • CPT® codes 99441 – 99443 for telephonic provider-to-member consultations for all lines of business’s PCP or specialist benefits.

  • E/M codes 99201 – 99215 for virtual and telephonic consults with your patients.

  • E/M codes 99421 – 99423 for non-face-to-face digital online consultations.

  • HCPCS codes G2061, G2062 and G2063 for online assessments and management.

  • HCPCS code G2010 for remote evaluation of video and/or images.

  • HCPCS code G2012 for virtual check-ins with your patients.

  • CPT® codes 97153, 97155, 97156, 90791, 90792, 90832, 90834 and 90837 for behavioral health consultations.

  • CPT® codes H0032 and H2019 (with or without a modifier HO) for Applied Behavior Analysis (ABA) therapy.

  • In addition, here are some more recent behavioral health codes.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 or your normal Place of Service code with a 95 modifier appended to the CPT/HCPCS code. This will let us know you’ve treated our member using telehealth.

The Division of TennCare posts regular updates, including recommendations on providing care for Long-Term Services and Supports (LTSS) members in home settings. Visit the site for helpful advice.

 

Q: How should telehealth services be billed on facility claims?
Please bill them with the appropriate Revenue code and the DR (Disaster Recovery) condition code.

 

Q: Do I need different codes to bill for telehealth for PT/OT/ST Skilled Therapies?
Specific outpatient PT/OT/ST CPT® codes are included as part of the temporary expansion of telehealth services as a result of the COVID-19 emergency.

  • Effective for dates of service March 18, 2020, until further notice during COVID-19 emergency.

  • Providers supported by this exception are licensed physical therapists, occupational therapists and speech-language pathologists.

  • All services provided are medically appropriate and necessary.

  • The services must take place in real time, and the patient and provider are connected via an interactive audio and video telecommunications system.

  • All relevant online communications about the member’s medical care and follow-up are included in their medical record.

  • Any existing visit limitations and/or prior authorization requirements continue to apply.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 or your normal Place of Service code with a 95 modifier appended to the CPT/HCPCS code. This will let us know you’ve treated our member using telehealth.

 

 Category CPT® Code Description
Physical Therapy 97161 Physical therapy evaluation – low complexity
Physical Therapy 97162 Physical therapy evaluation – moderate complexity
Physical Therapy 97163 Physical therapy evaluation – high complexity
Physical Therapy 97164 Physical therapy re-evaluation
Physical Therapy 97110 Therapeutic procedure, one or more areas, each 15 minutes
Physical Therapy 97116 Gait training
Physical Therapy 97530 Therapeutic activities, one-to-one patient contact, each 15 minutes
Physical Therapy 97112 Therapeutic procedure, one or more areas, each 15 minutes
Physical Therapy 97535 Self-care/home management training, each 15 minutes
Occupational Therapy 97165 Occupational therapy evaluation – low complexity
Occupational Therapy 97166 Occupational therapy evaluation – moderate complexity
Occupational Therapy 97167 Occupational therapy evaluation – high complexity
Occupational Therapy 97168 Occupational therapy re-evaluation
Occupational Therapy 97110 Therapeutic procedure, one or more areas, each 15 minutes
Occupational Therapy 97530 Therapeutic activities, one-to-one patient contact, each 15 minutes
Occupational Therapy 97112 Therapeutic procedure, one or more areas, each 15 minutes
Occupational Therapy 97535 Self-care/home management training, each 15 minutes
Speech Therapy  92507 Treatment of speech, language, voice, communication and/or auditory processing disorder
Speech Therapy  92521 Evaluation of speech fluency
Speech Therapy  92522 Evaluation of speech sound production
Speech Therapy  92523 Evaluation of speech sound production
Speech Therapy  92526 Treatment of swallowing dysfunction and/or oral function for feeding
Speech Therapy  96105 Assessment of Aphasia and Cognitive Performance Testing
Speech Therapy  97129 Therapeutic interventions that focus on cognitive function
Speech Therapy  97130 Each additional 15 minutes (use in conjunction with 97129)

 

Excluded from this temporary expansion of telehealth services:

  • Any treatment that requires specialized hands-on care or specialized equipment, such as whirlpools, etc. This includes Athletic Trainings (97169 – 97172), Modalities (97010 – 97039) and Group Therapies. Any member currently receiving group therapy should be considered for individual therapy via telehealth.

 

Q: May I use telehealth to treat new and existing patients?
Yes. You can use E/M codes to bill for telehealth with both new and established patients.

 

Q: How should telehealth services be billed on facility claims?
Please bill them with the appropriate Revenue code and the DR (Disaster Recovery) condition code.

 

Q: Can nurses as well as physicians perform and bill for telehealth services?
No. Only contracted and credentialed physicians, specialists, nurse practitioners and physician assistants can bill for telehealth services. Additionally, nurse practitioners and physician assistants who provide telehealth services must be supervised by a contracted physician. Claims should be billed per Provider Administration Manual guidelines.

 

Q: Can providers perform ultrasound testing in a home setting and follow up via telehealth?
No. Our priority is to support our members, which may include exploring ways to temporarily relax or suspend clinical and administrative policies. Right now, our current policies remain in place. During the COVID-19 emergency, however, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

 

Q: Can I use applications like Facebook or Skype for telehealth visits with my patients?
Yes. BlueCare aligns with recent CMS regulations, which allow for telehealth visits via platforms like Apple FaceTime, Facebook Messenger video chat, Skype, Google Hangouts video and Zoom.

 

Q: Will BlueCare Tennessee waive the copay for telehealth?
If there is a COVID-19 diagnosis, we are waiving the cost-share for telehealth services performed by network providers. If telehealth is being provided for other conditions, we will continue to apply cost-share to our members.

 

Q: Can I use telehealth for chiropractic services?
No. We don’t cover chiropractic services for telehealth.

 

Q: Can I refer patients to use telehealth services to protect them and others from transmission of disease during a possible outbreak?
Yes. We encourage our patients to use telehealth benefits when possible. We also encourage patients to avoid using the emergency room, except in a true medical emergency, to prevent the spread of illness.

 

Q: Will BlueCross network providers continue to deliver care through telehealth once the COVID-19 emergency has passed?
Telehealth has made it easier for members to access health care, so we’ve decided to continue to support telehealth services for our Commercial line of business for in-network providers who offer them. Until further notice, BlueCare Tennessee, Medicare Advantage and BlueCare Plus will continue covering telehealth during the COVID-19 emergency, as we have for the past few months.

 

Contracting, Credentialing and Enrollment

Q: What should I do if a recommended process or treatment for COVID-19 conflicts with information in a Provider Administration Manual (PAM)?
We strive to deliver important updates to you quickly through this Provider FAQ, so some details may conflict with what’s already been published in our Provider Administration Manuals (PAMs). If you find information in this Provider FAQ conflicts with a provision in a PAM, the Provider FAQ information will temporarily take precedence over previously published information in the PAM during this pandemic. If you have questions or need clarification, please contact your Network Manager.

 

Q: Will BlueCare Tennessee waive credentialing requirements during the COVID-19 emergency?
You should continue using the same credentialing and enrollment processes; but let us know of any constraints or delays that you have with third-party requirements, such as CMS or accreditation. We can process your application with this additional information, and make it part of your file for our Credentialing Committee to assess. The Committee may decide to approve the application for a shortened period of time and require you to re-credential earlier to ensure that pending requirements have been satisfied.

We’re adhering to the emergency directives set forth in the State of Tennessee Executive Order by the governor, available here.

 

Q: Can BlueCare expedite enrollment for providers during the COVID-19 emergency?
BlueCare is prepared to quickly credential and enroll all initial applicants during the COVID-19 emergency. Providers should submit a PEF and declare the need for an expedited enrollment due to the current COVID-19 emergency. Use the Notes section to provide additional information about the expedited request, including when you anticipate the practitioner to begin providing services. (Providers must have a current CAQH ProView application before starting the enrollment process with us.)

When you submit your form, we recommend emailing your Network Manager with the subject line “COVID-19 Request” so they can work with you and prioritize your expedited request with our enrollment team. Please have the PEF numbers and dates these practitioners need to begin providing services.

 

Q: My practitioner is shifting to cover for a practitioner at one of our other practice locations. What do I need to do?
You don’t need to notify us if the billing Group NPI, Tax ID and Individual NPI on the claim will be the same for the practitioner at either location. Reimbursement won’t change, and claims will process under the practitioner’s existing setup for that network.

 

Q: What if the billing Group NPI or Tax ID will be different for services performed at the new practice location?
Please email your Network Manager using the subject line “COVID-19 Request” so they can help you with any changes needed to your existing contract.

 

Q: One of our practice locations is closing temporarily. What do we need to send you?
If your office or one of your practice locations will be closed for an indefinite period, we suggest you submit that information to us in a Change Form. In the Office Hours section of the Change Form, please indicate all days that each specific location will be closed. We’ll update our member-facing, online provider directory to reflect this closure until we receive an update from you.

Your practitioners, office locations and networks will continue to display in the directory as usual, with the exception of the Location & Hours section. When the office reopens, please submit a new Change Form with the correct office hours for the location.

Thank you for continuing to keep your phone lines and websites up to date with the latest information about your practice’s policies and hours or if you’re redirecting patients to other providers. We’re reminding members to check with you before any office visit.

 

Operations

Q: How will BlueCare communicate with us during the COVID-19 emergency?
We understand this is a confusing and frightening time. We want to keep you updated so we can work together to care for your patients and our members. We’ve received your questions, and we’re regularly posting answers in our provider FAQs on bcbst.com and in Availity. You can also help us communicate with you better by telling us how you prefer to be contacted. Just submit that information in Availity.

 

Q: Will BlueCare call centers be open for claims payment and follow-up during this time?
Yes. We continue to be committed to serving our members and providers during the COVID-19 emergency. We acted quickly to make sure our employees could work effectively from home while practicing social distancing. At the same time, we’ve prioritized our claims, customer service and clinical operations. We’re monitoring the situation and our service metrics, and will revisit as needed.

 

Procedural

Q: Have new codes been added to the medical emergency list for COVID-19?
Yes. The following coronavirus/COVID-19 diagnosis codes have been added to the medical emergency list for all lines of business:

  • B97.29

  • B97.21

  • Z03.818

  • Z20.828

  • U07.1

 

Q: Can my patients get early refills on prescriptions to avoid increased risk of exposure with multiple trips to the pharmacy?
Yes. TennCare is allowing early refills on many medications, and they also encourage 90-day fills for chronic medications. Controlled substances, such as opioids, and some specialty drugs are excluded from this change. Members may have a mail-order benefit if they want to avoid going to the pharmacy.

 

Q: Will BlueCare Tennessee cover home births for my patients during the COVID-19 emergency?
We’ll cover home births with a certified nurse midwife for our members who have that benefit. We recommend home births only for low-risk pregnancies, and the member must have a detailed birthing plan that includes a hospital and doctor, in case of complications. For more information, please refer to your Provider Administration Manual.

 

Q: Will BlueCare and TennCareSelect temporarily waive PCP assignment?
Yes. For dates of service March 1, 2020, through Sept. 30, 2020, we’re waiving PCP lock-in processes during this time. This does not apply to CoverKids.

 

Q: How is BlueCare Tennessee managing recoupments?
To help our providers during this trying time, we announced we would temporarily delay recoupments until further notice. Effective May 15, 2020, we resumed recoupment for funds we’ve overpaid to individual providers. Effective immediately, we’re also resuming recoupments for facilities. If you have questions, please contact your Network Manager.

 

Q: Can I bill BlueCare Tennessee for medical supplies such as masks, gloves and disinfectant given to my patient?
No. We don’t cover these supplies under our health plans.

 

Q: How is BlueCare Tennessee handling prior authorizations for elective procedures during the COVID-19 emergency?
If you want to extend an existing prior authorization that’s already been approved for an elective procedure, please contact us directly and we’ll work with you to change the date of service. Otherwise, please see below for prior authorization validity periods currently in place:

  • We’re working with providers to change the dates of service to the date they call in.

  • There’s currently no limit on how far in the advance we’ll change the date.

 

Q: Will BlueCare Tennessee suspend the need for a signed patient attestation and delivery record during this time and agree that these cases be exempt from future post-payment review audits, given the unique situation?
No. Our priority is to support our members, which may include exploring ways to temporarily relax or suspend clinical and administrative policies. Right now, our current policies remain in place. During the COVID-19 emergency, however, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

 

Q: Will BlueCare Tennessee waive the current requirement for chronic conditions and allow for the provision and reimbursement of these services if a member has a confirmed diagnosis of COVID-19 and has been prescribed home therapy?
No. We aren’t waiving the requirement for chronic conditions, as this is a CMS requirement. During the COVID-19 emergency, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

 

Q: Will BlueCare Tennessee waive timely filing during this time?
No. In light of COVID-19, we are prioritizing the processing of all requests. During the COVID-19 emergency, we want to support our provider partners so they can focus on dealing with this health crisis. Currently our requirements for timely filing is 120 days.

  

Q: How are you handling processes for post-acute admission during the COVID-19 emergency? (BlueCare Tennessee)
BlueCare Tennessee has waived the authorization requirement for initial post-acute care reviews (skilled nursing facility, rehab and LTACH) to support rapid placement and discharge of currently hospitalized patients who can be safely discharged to another setting. Notification is required within one business day of admission. Concurrent reviews for medical necessity will continue after the first week of admission.

 

Q: Will BlueCare Tennessee consider advance payment or other financial support for individual health systems?
No. Our priority right now is to support our members by exploring ways to temporarily relax or suspend clinical and administrative policies, and offering premium extensions.

 

CPT® is a registered trademark of the American Medical Association