Virtual Rounds BLUE CROSS NC VIRTUAL ROUNDS
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Virtual Rounds
BLUE CROSS NC VIRTUAL ROUNDS
May 17, 2021
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PROPRIETARY & CONFIDENTIAL
® Marks of the Blue Cross and Blue Shield Association. U10404, 2/16
Slides updated as of 11.16.2020. Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date information
BLUE CROSS NC VIRTUAL ROUNDS
Agenda
+ Overview of all measures and deadlines Please note:
+ Latest news There is a slight delay
▪ Updates on coding guidance for COVID-19 testing in the webinar feed.
and revenue coding for COVID-19 vaccine admin Please keep this in
▪ COVID-19 treatment waiver extension mind as we proceed.
▪ In-network lab updates
There have been
+ Q&A technical issues
▪ Please hold your questions until we open Q&A. across all platforms
due to increased
+ Next steps
usage. Close your
▪ We will post these slides at window and rejoin the
BlueCrossNC.com/Coronavirus-Providers. webinar if you’re
having issues.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationOVERVIEW OF ALL MEASURES AND DEADLINES
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationSlides updated as of 05.29.2020. Content is subject to change. Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date information.
BRIEF OVERVIEW OF ALL BLUE CROSS NC
MEASURES FOR COVID-19
COVID-19
(Coronavirus) Expanded telehealth
Expanded Telehealth
Blue Cross NC is waiving
Refill medications early
member cost-sharing for
measures
Measures COVID-19 clinical visits, testing
and related treatments.
Measures We’re
Taking to Support
Members and
Clinicians No cost-sharing for No prior authorization for and
Members with suspected
COVID-19 testing members diagnosed
confirmed with
COVID-19 diagnosis:
No Prior Authorization for
COVID-19: Inclusive of for
No prior authorization
COVID-19 Testing and
covered services
diagnostic teststhat
thatare
are
For the latest updates, please visit Related Services
BlueCrossNC.com/Coronavirus
medically
medically necessary
necessary based on
based onCDCCDC guidelines.
guidelines. 4
Slides updated as of 12.14.2020. Content is subject to change. U35722, 4/20
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationBLUE CROSS NC COVID-19 MEASURES
How our measures apply to patients
+ At a high level, all measures available to: BlueCrossNC.com/Coronavirus-Providers
▪ Fully insured (group and individual)
▪ High-deductible health plan, Medicare
Advantage (includes Experience Health)
▪ State Health Plan, except the drug benefit
(administered through CVS)
▪ PLEASE NOTE: We are working with self-
funded groups to revise their benefits for
each measure. We can’t guarantee benefits
or payments for self-funded, FEP or IPP.
Use the contacts on the back of a patient’s
card to verify benefits for these plans.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationOVERVIEW OF DEADLINES
The following measure is in place through December 31, 2021:
+ Virtual Care: Blue Cross NC will continue its expanded virtual care
policy. Under this expanded policy:
▪ Visits to providers that previously required an in-person encounter
can be performed virtually and will be paid at parity with office visits
as long as they are medically necessary, meet criteria in the updated
Blue Cross NC Telehealth Corporate Reimbursement Policy,
(effective on or after March 6, 2020 – present).
- This includes virtual care encounters for patients that can
replace in-person interactions across appropriate care settings,
including outpatient clinics, hospitals, and the emergency
departments.
▪ This measure applies to all Blue Cross
NC commercial plans and Medicare Advantage plans offered and
administered by Blue Cross NC, including Experience Health.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationOVERVIEW OF DEADLINES
The following measure will be extended through June 30, 2021:
+ COVID-19 Treatment Cost-Share Waivers: Blue Cross NC will waive
through June 30, 2021*, member cost-sharing (copays, deductibles and
coinsurance) for COVID-19 related treatment that is medically necessary
and consistent with CDC guidance if a member is diagnosed with
COVID-19.
▪ The expiration date for this measure applies to all fully-insured and
self-funded plans, including State Health Plan.
▪ *For all Medicare Advantage plans offered or administered by Blue
Cross NC, including Experience Health, and the Federal Employee
Program, this measure will remain in place until the end of the
Public Health Emergency or 12/31/21 (whichever comes first) .
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationOVERVIEW OF DEADLINES
The following measure is required by current laws and guidance. We
will continue to monitor for any changes to the benefits and length of
coverage.
+ COVID-19 Testing and Clinical Visit Cost-Share Waivers: Blue Cross NC
will waive member cost-sharing (including deductibles, copayments, and
coinsurance) for allowed charges for COVID-19 testing or for a clinical visit or
call to determine if testing is necessary. Specifically, there will be no member
cost-share for COVID-19 testing or clinical visits to determine if testing is
needed through virtual care visits, outpatient office visits, urgent care visits or
ER visits. This measure applies to all Blue Cross NC commercial plans and
Medicare Advantage plans offered and administered by Blue Cross NC,
including Experience Health.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationLATEST NEWS
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationLATEST NEWS
Updates on coding guidance for COVID-19 vaccine administration -
Commercial members
+ Professional claims:
▪ Use administration code specific to vaccine given
▪ Vaccine code may be included on the claim with 0.01 or 0 charge
▪ Use Z23 on claim line to indicate encounter for immunization
+ Facility claims
▪ Use revenue code 0771 (Vaccine administration) along with CPT
administration code specific to vaccine given
▪ Vaccine code may be included on the claim with $0.01 or 0 charge
▪ Use Z23 on claim line to indicate encounter for immunization
+ Claims submitted with ADA (dental) COVID-19 vaccine administration
codes will be denied if billed by providers other than licensed dental
provider
+ We have identified an issue with COVID vaccine administration claims pulling member liability in
error. The impacted claims will be adjusted. Please allow at least 30 days for adjustments to be
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made.
Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationLATEST NEWS
Updates on coding guidance for waving cost-share for clinical visits
to determine if COVID-19 testing is necessary – Overview
COMMERCIAL MEDICARE
DOS 8/1/20 to DOS on or after
All DOS
1/31/21 2/1/21
Coding of related services Append CS modifier Append CS modifier Use HCPCS codes
on each CPT/HCPCS on each CPT/HCPCS for billing the -CS
code code modifier in MLN-
SE20011
Use Z20.822 or
Z11.52 as primary dx
on each claim line
Coding of COVID-19 No modifier required No modifier required DO NOT use CS
tests/vaccine modifier or claim will
be denied**
**Vaccine claims for MA (Including Experience Health) should be filed to Original Medicare
Please note: Providers should use the phone number on the back of a patient’s ID card
to verify benefits for Blues plans from other states as not all are waiving cost share in
the same way that Blue Cross NC is. 11
Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationLATEST NEWS
Coding guidance for COVID-19 treatment
+ Diagnosis code U07.1 should be in the principal or primary position on
the claim.
▪ Exceptions include:
- Sepsis present upon admission: A41.89 in the primary
position/U07.1 secondary position
- Pregnancy: O98.51x in primary position/ U07.1 in secondary
position
- HIV: B20 in primary position/U07.1 in secondary position
+ New codes effective Jan 1, 2021; Should be in secondary position with
U07.1 in the principal or primary position:
▪ J12.82 Pneumonia due to coronavirus disease 2019
▪ M35.81 Multisystem inflammatory syndrome
+ U07.1 should not be used when billing for the test itself.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationLATEST NEWS
General coding/claims reminders
+ We cannot control or guarantee any benefits or payments for other Blues
plans or FEP. You should check the back of the patient’s insurance card
and use the contact information listed for benefit verification.
+ You can view detailed coding guidance on our website. If you have
questions about a specific claim, complete this form.
+ You also can visit the Blue Cross and Blue Shield Association’s
Coronavirus Updates page to find out how local Blues plans are
responding to the pandemic.
+ For information on FEP, visit https://www.fepblue.org/en/coronavirus-
updates.
+ For the latest CPT coding updates from the American Medical
Association (AMA), visit the AMA website.
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Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationAVALON NETWORK CAPACITY AND TURNAROUND TIME
Lab RT-PCR Multiple Capacity (per TAT • For the State, total daily testing capacity is
Y/N Platforms day)
Quest Y Y 300,000 1-2 days
over 1M tests per day. Average turnaround
LabCorp Y Y 275,000 1-2 days time for COVID-19 testing has increased to
Aegis Y Y 110,000 1-2 days 1.7 days over the past month.
BioReference Y Y 100,000 1 day
Premier Medical Lab Y Y 100,000 1-2 days
Eurofins-Diatherix Y N 60,000 1-3 days • North Carolina has provided over 12.8M
Mako Medical Lab Y Y 50,000 1-2 days total tests throughout the Pandemic. The
GenetWorks Y Y 40,000 2 days
state has seen a 14-day downward trajectory
AIT (American Institute Y Y 20,000 1-2 days
of Tox) in terms of positive tests as a percentage of
PathGroup Y Y 20,000 1-2 days total tests.
Sonic-CPL Y Y 20,000 1-3 days
Genesis DX Y Y 16,000 1-2 days • Over 40% of North Carolinians have been
MDL (Medical Y N 12,000 1-3 days
Diagnostic Lab) vaccinated with at least one dose, while 36%
AccuReference Y N 10,000 2 days of the population are reported as fully
LabTech Y Y 10,000 2 days
vaccinated2
Inform Diagnostics Y N 5,000 1-2 days
Luxor Y Y 5,000 1 day
Neogenomics Y Y 5,000 1-4 days
• For a list of in-network labs, please visit the
Transplant Genomics Y N 5,000 1-2 days Provider News page at:
Precision Genetics Y N 4,000 1-2 days https://www.bluecrossnc.com/provider-
BAKO Y N 2,500 1-2 days
news/updated-participating-laboratory-list-
Radeas Y Y 2,400 1-2 days
NephronPharm Y Y 2,000 2-3 days and-reminder-about-use-avalon-network-0
Wake Medical Lab Y Y 1,500 1 day
Consultants
Andor Labs Y N 500 1-2 days
SMA Y Y 500 1-2 days
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Source: 1Avalon Healthcare Solutions – current as of 04.21.2021
2Covid19.ncdhhs.gov – current as of 05.14.2021Q&A
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Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationNEXT STEPS
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Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationNEXT STEPS
Latest information
+ Visit BlueCrossNC.com/Coronavirus-
Providers.
+ We will post the slides on this page.
+ Remember to sign up for E-briefs.
+ Register for "Virtual Rounds."
▪ Sign up in our registration form.
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Slides updated as of 12.14.2020. Content is subject to change.
Please visit BlueCrossNC.com/coronavirus-providers for the most up-to-date informationTHANK YOU
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Content is subject to change.
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