Coronavirus (COVID-19) Provider Information for ERS Participants



Updated: 6/30/20

The Employees Retirement System of Texas (ERS) is the administrator of the HealthSelect of Texas® and Consumer Directed HealthSelectSM self-funded plans. ERS has provided the following policy for administration of benefits during the COVID-19 crisis.

Because this is a rapidly changing situation, BCBSTX will continue to monitor the situation and provide updates as they become available. Please check back often for updates.


Prior Authorizations

Prior authorizations for all initial/concurrent requests received without clinical documentation will be approved for a short period of time according to medical necessity and benefits covered under the health plan. This benefit policy expires May 31, 2020.

This includes:

  • inpatient acute,
  • inpatient post-acute,
  • physical therapy, occupational therapy, speech therapy,
  • home health and
  • elective ambulatory transport.

Prior authorization is not required for an inter-facility transfer to a medically appropriate lower level of care. This will accelerate and simplify the transfer and discharge of patients from acute level facilities to the safest, clinically appropriate lower level setting of care (e.g., Long Term Acute Care Hospitals, Skilled Nursing Facilities, and others). This benefit policy expires May 31, 2020.

BCBSTX will honor all prior authorizations on non-emergency/elective surgeries, procedures, therapies and home visits that were approved or scheduled between Jan. 1 and June 30, 2020.

  • These prior authorizations are approved through Dec. 31, 2020, so approved procedures can be rescheduled before Dec. 31, 2020.
  • Therapy sessions and home visits authorized for a specific number of visits between Jan. 1 and June 30, 2020 will have the same number of visits available through the end of the year.

Health care providers should call the BCBSTX prior authorization number at 1-800-344-2354 for questions regarding a prior authorization request.


Referrals

HealthSelect participants do not need a referral from their primary care provider (PCP) to see an in-network specialist (this does not apply to services received from out-of-network providers). This allows providers to focus on providing care and saves time and effort for both participants and providers. This benefit policy expires May 31, 2020 for non-COVID-19 related requests.

If you expect to see a participant beyond May 31, 2020, you must have a referral on file to get in-network benefits. BCBSTX is still accepting referral requests if you would like to submit one to prevent the need to get one beyond May 31, 2020. Reference the Master Benefits Plan Document (MBPD) for services that require a referral or authorization outside of this designation time period.


Telehealth

A participant’s PCP or specialist may be able to provide services via telemedicine/telehealth platforms. In-network telemedicine services are covered at no cost to HealthSelect participants for covered services. Participants are encouraged to contact their providers’ office(s) to ask if this service is available. This benefit policy expires Aug. 31, 2020 for non-COVID-19 related, in-network telemedicine and virtual visits.


COVID-19 Lab Testing

Lab testing for COVID-19 is available to HealthSelect participants for both in-network and non-network labs at no member cost share. If you test a member when it’s medically necessary, medically appropriate and in accordance with generally consistent medical standards, submit the claim to us using the appropriate code. Member cost-share will be waived. In accordance with FFCRA this policy will extend through the end of the public health emergency.


COVID-19 Coding and Guidance

For more details on COVID-19 coding and guidance, refer to the:


Have Questions?

If you have any questions or need additional information, please contact your BCBSTX Network Management Representative.