Medicare Advantage Provider Information on COVID-19 Coverage
Blue Cross and Blue Shield of Texas (BCBSTX) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We are providing information here, on our TX Medicare Provider COVID-19 FAQs and on our COVID-19 Related News section.
Testing and Treatment Coverage
We are covering testing to diagnose COVID-19 for members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.
For treatment of COVID-19, we cover medically necessary health benefits in accordance with the terms of each member's benefit plan. Effective Jan. 1, 2021, copays, deductibles and coinsurance apply for COVID-19 treatment. Members should call the number on their ID card for answers to their specific benefit questions.
Note: Blue Cross Group Medicare SupplementSM and Blue Cross Medicare SupplementSM members don’t have network restrictions unless otherwise noted on their plans.
Check Members Eligibility and Benefits
Use the Availity® Provider Portal or your preferred vendor to check eligibility and benefits.
For 2021, Medicare payment for the COVID-19 vaccine and its administration will be through the original fee-for-service Medicare program. Members will have no cost-sharing on vaccines through Dec. 31, 2021.
Providers should submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved. See our News & Updates article for more details.
Claims for COVID-19 Testing
Submit testing claims using the appropriate collection or lab code. Testing must be for individualized diagnosis or treatment of COVID-19, medically appropriate and in accordance with generally accepted standards of care, including the Centers for Disease Control (CDC) guidance as appropriate.
Claims for COVID-19 Antibodies Testing
Submit claims for COVID-19 antibody testing using the appropriate code. Member cost-share will be waived during the public health emergency for antibody tests that are FDA-authorized, including tests with Emergency Use Authorization (EUA), regardless of the diagnosis. Antibody testing should be medically appropriate for the member and ordered by a health care provider.
If you are not in our networks, we will reimburse according to CMS reimbursement rates. Call the customer service number on the member’s ID card for benefit information.
We are temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing and processes will apply. For more details, refer to the Credentialing Process Simplified for COVID-19 article.
Telemedicine and Telehealth
For members who have BCBSTX pharmacy benefits administered through Prime Therapeutics, BCBSTX will allow members to receive an early fill of their medication. We also encourage members to use their 90-day mail order benefit, if applicable.
AllianceRX Walgreens Prime is the preferred mail order pharmacy for our Medicare Advantage members. Members can also use the 90-day supply benefits for covered non-specialty medications at select retail pharmacies or home delivery (mail order). All pharmacy practice safety measures, prior authorization reviews, as well as prescribing and dispensing laws, still apply. It’s easy to get started with home delivery, just visit www.myprime.com to sign up.
Note on Medicare members: Members of these plans can get 90-day fills through mail order:
- Blue Cross Group Medicare Advantage (HMO)SM
- Blue Cross Group Medicare Advantage (PPO)SM
- Blue Cross Group Medicare Advantage Open Access (PPO)SM
- Blue Cross Group MedicareRxSM
- Blue Cross Medicare Advantage (HMO)SM
- Blue Cross Medicare Advantage (PPO)SM
- Blue Cross Medicare Advantage Dual Care (HMO SNP)SM
We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.
What is the risk of COVID-19?
According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.
Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on our COVID-19 Related News.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSTX contracts with Prime to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.