Blue Cross Blue Shield Telehealth – Overview
Blue Cross Blue Shield (BCBS) Telehealth companies work to expand coverage and improve access to virtual healthcare solutions. Since 1929, BCBS has been the healthcare industry’s leader and has risen to challenges with revolutionary outcomes yet evolving.
The Blue Cross Blue Shield is a national association of 34 distinguished independent, community-based BCBS companies. The Association owns and manages these locally-operated BCBS companies.
About Blue Cross Blue Shield (BCBS) Telehealth and Telemedicine Services
After the onset of the recent global pandemic, BCBS improved access to its extensive telehealth and telemedicine services. This has greatly helped to give members better access to virtual healthcare. BCBS members can easily access any medically-necessary coverage benefits with healthcare providers who deliver their services through telehealth technology. Numerous BCBS members also have easy access to various BCBS-licensed telehealth vendors, such as MDLIVE.
What is Covered Under BCBS Telehealth?
The terms and conditions of every member’s benefit plan will determine the telehealth and telemedicine services provided under BCBS Telehealth and Telemedicine initiative. Additional coverage is also provided to self-funded employer group members, PPO members, and fully-insured HMO members. These members can go to providers who belong to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS).
Besides this, BCBS members also receive the following coverage under telehealth benefits:
- PHO (Partial Hospitalization Programs)
- IOP (Intensive Outpatient Program) Services
- PT (Physical Therapy)
- OT (Occupational Therapy)
- ST (Speech Therapy)
To get the full list of BCBS telehealth benefits, you can check it here https://www.bcbstx.com/docs/provider/tx/clinical/telemedicine-code-list.pdf.
Remember, the self-funded employer group customers can make decisions for their employee benefit plans. So, make sure to check your eligibility for any differences in member plan benefits.
BCBS telehealth and telemedicine services are recommended for the following:
- Choose telehealth as a mode of healthcare delivery that can provide reasonably equivalent results as compared to in-person visits to the doctor’s office.
- Select telehealth services when to can enhance healthcare and care integration, and continuity once a strong patient-provider relationship is established.
- You can integrate telehealth/telemedicine records into electronic medical record systems and enhance the efficiency of healthcare services. This helps to maintain strong clinical documentation and also improves patient outcomes.
Who is Eligible for Blue Cross Blue Shield Telehealth Services?
Any telehealth-centered care provided to eligible members is consistent with the terms and conditions of the member’s plan benefits. The following types of benefit plans are allowed access to BCBS-licensed telehealth services:
- Blue Cross Medicare Advantage (except Part D)
- Medicare Supplement
- State-regulated fully-insured PPO and HMO plans
Every BCBS telehealth provider will follow the state and federal requirements.
How to Submit Claims for BCBS Telehealth Services?
The telehealth provider is mainly responsible for the accurate coding of documents after the service is performed. These claims are submitted for medically necessary healthcare services through telehealth technology by putting the appropriate codes and/or Place of Service (POS) 02 and modifiers (95, GT, GQ, G0).
If the telehealth service claim is billed with modifier POS 02, then it may be denied or returned. The healthcare provider will then need to re-submit the claim with the correct POS.
Remember, even when telehealth services are provided to members at their homes, the healthcare provider must use POS 02 when filing telehealth claims. If a claim is filed with the code POS 10, it may be rejected.
How Much Does it Cost to Use BCBS Telehealth Services?
CMS dictates the specifics of coverage for BCBS telehealth services. What this means is that BCBS will cover all the telehealth/telemedicine costs, including those available during the PHE for Medicare Advantage and Medicare Supplement members.
As long as the PHE lasts, BCBS will waive the cost share for Medicare Advantage members. With this, the members do not owe any deductibles, coinsurance or copays for their telehealth or telemedicine visits.
For Medicaid members, BCBS follows the state-specified guidelines for Medicaid and CHIP policies. Additionally, some telemedicine/telehealth providers will require the patient’s referrals or prior authorizations, which should be in accordance with the member’s individual plan benefits. So, make sure to check the eligibility and benefits for each member.
How is Blue Cross Blue Shield Telehealth Service Provided?
The BCBS Telehealth service providers offer telehealth/telemedicine visits through:
- Asynchronous telecommunications (involving captured images and recorded videos)
- Live interactive 2-way telephone communication with audio and video capabilities for digital video consultations
- Any other telemedicine/telehealth method allowed by state and federal laws
BCBS Telehealth providers use interactive audio and video telecommunication technology that allows real-time interactive communication. This ensures optimal and efficient telehealth services. CMS also allows audio communication as part of telehealth/telemedicine services in limited instances.