Premera Blue Cross Blue Shield of Alaska Response to COVID-19

  • Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak.

    Updates as of May 28, 2020

    • Telehealth services are extended through December 31, 2020. This includes the expanded network and cost share waivers.

    • Premera has a new medical policy for serology antibody testing: SARS-CoV-2 serology (antibody) testing may be considered medically necessary when performed in the inpatient setting and all criteria are met. Refer to the section in our FAQ for guidance and a link to the policy.

    • Premera is waiving cost shares for all COVID-19 related testing and treatment. Learn more.

    Get all the latest COVID-19 updates from the Alaska Department of Health and Social Services and the Centers for Disease Control and Prevention (CDC).

    If you have health plan questions not covered in these resources, call Premera’s customer service team at the number on the back of the member ID card, or your provider network team. Every question will be answered as soon as possible.

    We’ll be updating the following FAQ as additional information is available.

  • Advance payment program

  • We want our community to be healthy. And to be healthy, we need to have a strong provider network. This focus is consistent with Premera’s emphasis on the role of front-line providers in our healthcare system and supportive of our members’ most common needs throughout the months ahead. 

    We’re funding up to $100 million in advance payments for eligible providers in Washington and Alaska.

    Yes. We’ll begin recoupment beginning January 1, 2021 over a 9-month period. There’s no interest charged for this advance.

    If you have unanswered questions, submit them to AdvanceProviderProgram@Premera.com. We’ll respond within 5 business days.

    Legal requirements
    Providers must not be in bankruptcy or have filed a petition for bankruptcy; and not knowingly be under an active medical review or an investigation by Premera.

    Practice requirements
    Contracted professional providers in Washington or Alaska that have billed Evaluation and Management (E&M) codes and behavioral health codes in excess of $4,000 for historical year of experience, resulting in at least a $1,000 advance (for Premera insured members).

    Contracted dental providers in Washington or Alaska that have billed dental services in excess of $4,000 for a historical year of experience, resulting in at least a $1,000 advance (for Premera insured members).

    We had to make a decision on eligibility that was simple to administer. We realize that does leave a lot of providers out of this process. We made a decision to limit to this group of providers.

    We expect payments to begin going out within 20 days of the signed contract being returned. That allows Premera to verify eligibility and for the provider to sign an advance payment agreement.

    Eligible providers could be eligible for a 3-month advance based on an average of historical E&M, behavioral health codes and dental codes incurred between October 1, 2018 and September 30, 2019 and paid through December 31, 2019.

    We’ll be reviewing claims billed between October 1, 2018 and September 30, 2019 and paid by December 31, 2019. Your payment advance will be based your billed charges for fully insured members.

    Premera will begin recoupment January 1, 2021. We’re working through the process for recoupment. There’s no interest charged for this advance.

    Our repayment options are flexible and will include single lump sum payments, weekly voucher deductions, and invoicing. We won’t have the details on each of these options until later this year, but we can log your preference in our system and let you know the process for repayment based on your choice.

    Yes. Premera will require a signed advance payment agreement. If we don’t receive the agreement, the payment will not be sent.

    Yes. Premera is holding on recoupment of overpayments during the healthcare crisis. 

    Until we determine that the immediate crisis is over.

    It will apply to Premera insured and self-funded group business, which is the large majority of our claims.  It will not apply to individual member, Medicare Advantage member, FEP or BlueCard member claims.  We’ll continue normal recoupment for overpayments on these claims.

    BlueCard member claims are for members of other Blue Cross Blue Shield Plans who receive services in our Washington and Alaska service area and for which Premera pays the provider.

  • COVID-19 testing and cost-share waivers

  • Commercial and Medicare Supplement members: We’re waiving in-network cost shares (coinsurance, copays, and deductibles) for members requiring FDA-authorized diagnostic COVID-19 or influenza testing and the related provider visit at in- and out-of-network facilities and laboratories. Effective March 20, 2020 respiratory panel tests are no longer subject to the cost-share requirement, per the Alaska Division of Insurance Bulletin B20-09

    Pre-authorization isn’t required for medically necessary and FDA-authorized COVID-19 testing. If a member requires COVID-19 testing and treatment and there isn’t an in-network provider within a reasonable distance, the claims will be paid as in-network.

    Any additional care related to a COVID-19 diagnosis is covered consistent with the member’s benefits.

    Premera is waiving member cost shares including copays, deductibles, and coinsurance for treatment of COVID-19 or health complications associated with COVID-19, including hospitalizations and medical transportation when needed, FDA-approved medications administered inpatient for both in and out of network providers. This waiver is in effect for dates of service from January 1 through October 1, 2020. For Medicare customers, claims received since February 4, 2020 related to COVID-19 will be reprocessed to waive all cost shares and deductibles.

    This benefit applies to members of insured group, individual, grandfathered, and non-grandfathered plans, associations, and Premera’s Medicare enrollees. Self-funded group plans have the option to participate. This includes qualified high deductible plan participants. For Premera Medicare customers, regulators have not communicated an end date for this flexibility.  Premera will adjust our policy as regulator guidance becomes available.

    This will not apply to Shared Admin, FEP, and Self-funded plans that opt-out. Normal plan benefits apply in this situation for our members. You can check eligibility and benefits on our website.

    Only tests that are FDA approved or FDA authorized for emergency use are covered under your medical plan. Home tests kits are not covered.

    Additionally, antibody testing to provide evidence of prior COVID-19 infection, and not used as a diagnostic, may be covered.

    Premera’s medical policy for serology testing is consistent with CDC’s guidance that serology should not be used to determine immune status in individuals at present. Serology tests are considered medically necessary only when performed in an inpatient setting and will not be associated with a co-pay or deductible specific to the serology test. Our medical policy allows for such testing.

    Yes. Drive-through diagnostic testing for COVID-19 is covered and cost shares will be waived as they are for in-clinic testing.

    S.B. 241 is a comprehensive coronavirus-related bill that assumes firefighters, emergency medical technicians, paramedics, peace officers, or health care providers who contract COVID-19 during the public health emergency declared on March 11 is presumed to have contracted it during employment.

    When a member of this group seeks care, they should notify you they believe they contracted COVID-19 in the course of their job. You then codes the claim and submit as a workers’ compensation claim. Premera pends the claim and asks the member to complete an incident questionnaire to obtain the worker’s compensation information.

    Any member that is presumed COVID-19 with these job titles must file a claim with the appropriate workers' compensation carrier; this could be Office of Worker's Compensation or their Self-Funded Compensation Carrier. The claim will either be processed by workers’ compensation or by Premera, depending on the results of the incident questionnaire.

    • Beginning April 20, 2020, health care facilities and providers defined in the Alaska governor’s statute may resume services that require minimal protective equipment and safety protocols for pre-screening. This includes services such as physicals, routine exams, and minimal procedures.
    • Beginning May 4, 2020, with consideration of COVID-19 cases across the state, health care providers may perform non-urgent, or elective procedures, with defined safety protocols for patients and staff. This includes services such as biopsies and angiograms.

    The Department of Insurance (DOI) recently changed the date for the suspension of prior authorization, concurrent and retrospective review suspension to June 1, 2020.  

    The following summary of coding instruction is provided by the CDC, the World Health Organization (WHO), and CMS related to COVID-19. We urge you to use this COVID-19 diagnosis and procedure coding for patients so cost shares may be waived appropriately.

    There are two new HCPCS codes for lab tests to detect COVID-19: Code U0001 for the CDC test panel and code U0002 for other tests.

    The American Medical Association added a new CPT code for reporting the novel coronavirus tests: 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.

    Per the CDC, a new ICD-10 emergency code, U07.1, 2019-nCoV acute respiratory disease, has been established by the WHO for reporting the virus, effective with the next update, October 1, 2020. Premera is accepting this code and encourages you to use it.

    To identify patients in the interim who’ve tested positive for COVID-19, current CDC guidance instructs to code first for the presenting illness followed by B97.29 - Other coronavirus, as the cause of diseases classified elsewhere. 

    For the new serology tests, the AMA created new CPT lab test codes: 86328 and 86769. Use these codes when submitting a claim for the antibody test.

    The AMA is offering additional guidance for COVID-19 coding scenarios to help healthcare professionals apply best coding practices. The scenarios include telehealth services for all patients.

    COVID-19 testing examples include coding for when a patient:

    • comes to the office for an E/M office visit and is tested for COVID-19
    • receives a telehealth visit regarding COVID-19
    • is directed to come to a physician’s office or physician’s group practice site for testing
    • receives a virtual check-in/online visit regarding COVID-19 (not related to an E/M visit)
    • is directed to come to a physician's office for testing

    There is also a quick-reference flowchart that outlines current procedural terminology (CPT®) reporting for COVID-19 testing. AMA also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center for additional resources.

    Premera is aware of the impact of changes to infection control measures in provider offices. Premera doesn't cover separate fees for PPE and sterilization procedures. We're continuing to monitor the situation.

  • Telehealth

  • Yes. Premera has expanded our telehealth network to address the increased demand related to COVID-19. This expanded coverage will be available until December 31, 2020, with the potential to extend the duration based on business and epidemiological considerations.

    Cost shares waived for telehealth services:

    Telehealth cost shares will be waived for all in-network providers.  If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through December 31, Premera will reimburse when the claim is processed.

    Who is eligible for this in-network expansion?

    • This will not apply to shared admin, FEP, BlueCard, Providence, HCA, and self-funded plans who opt out.

    Can telehealth providers diagnose COVID-19?

    • Telehealth providers can’t diagnose or order any COVID-19 testing. An in-person test is required for a COVID-19 diagnosis.
    • Telehealth providers can diagnose and treat acute and chronic illnesses that do not include COVID-19 symptoms and fulfill necessary prescriptions or order lab tests at local facilities.

    In addition to our existing Premera contracted behavioral health providers (TalkSpace, Teladoc BH*, brick and mortar providers and Employer Assistance Programs), we’re introducing new virtual access for behavioral health and substance use disorder treatment (opioid and alcohol):

    • DoctorOn Demand – Doctor On Demand was added to our telehealth network for our March 25 COVID-19 telehealth expansion. We are now adding their behavioral health services for dates of service April 16 through June 30, 2020. These services are available to member adults and children in all states.
    • Boulder Care - Boulder Care is a digital care provider, offering long-term support and medication-based treatment for opioid use disorder (OUD) and common co-occurring conditions for members 18 years and older. Their digital platform allows patients to connect with providers 24/7 through secure video and messaging with clinicians, care advocates, and peer coaches. Boulder Care is working towards 50 states licensure. If they aren’t licensed in a certain state they will transition the member to an in-network provider for the appropriate services. 
    • Workit Health – Workit Health is a digital care provider offering support for alcohol use disorder (AUD). Via Workit web and phone apps, members age 18 and older have a “recovery in their pocket” harm reduction and sobriety solution that provides 24/7 access to interactive therapeutic courses, online support groups supervised by licensed care teams. Workit is working towards 50 states licensure. If they aren’t licensed in a certain state, they will transition the member to an in-network provider for the appropriate services.  

    Additional covered telehealth services include:

    • Applied behavioral analysis (ABA)
    • Partial hospitalization programs (PHP) for mental health and substance use disorders
    • Intensive outpatient programs (IOP) for mental health and substance use disorders

    * Teladoc behavioral health is currently available only for self-funded groups who previously opted-in to Teladoc behavioral health in addition to their general Teladoc election.  

    Effective May 1, 2020, as self-funded groups renew, Teladoc behavioral health will automatically be added for groups that already have general Teladoc services elected. Cost shares would then apply for Teladoc behavioral health through December 31, 2020, depending on whether the group elected to temporarily waive cost shares for telehealth. Teladoc behavioral health will not be added for self-funded groups who do not already have Teladoc services.

     

    Yes. For Premera-contracted providers, your current contract covers telehealth services if the care provided is appropriate within the scope of the provider’s licensure. This change applies to Premera’s individual and commercial members. However, some self-funded employer groups don't cover virtual care, so be sure to check your patient's benefits before providing care.

    Note: Telehealth services aren’t coded like in-office visits due to different modifiers and place of service codes needed to identify a telehealth service. There are additional codes that can be used for online video encounters as well as telephone visits in conjunction with the office visit codes.

    Refer to your Premera contract for allowable information for virtual care codes. For specific coding information for Premera patients, see our telehealth payment policy for Alaska.

    For Medicare Advantage patients: CMS has loosened guidelines around telehealth services during the COVID-19 Public Health Emergency. Starting March 6, Premera will cover telehealth visits for Medicare Advantage members billed by any healthcare facility in the same way as a regular, in person visits with the same cost shares. The previous requirement for services to be provided in certain types of originating sites and locations has been waived for the duration of the COVID-19 public health emergency.

    For dental providers: You may bill the following visit types via tele-dentistry adding tele-dentistry modifier code of D9995/6:

    • D0140 - Limited Oral Evaluation – Problem Focused
    • D0170 - Re-evaluation, limited problem focused (established patient, not post-operative visit): This code is appropriate when assessing a previously existing condition related to trauma, or a follow-up evaluation for continuing issues
    • D0190 – Screening of a patient. A screening, including state or federally mandated screenings, to determine an individual’s need to be seen by a dentist for a diagnosis.

    Premera wants to emphasize that this is a temporary relaxation of the rules during this nationwide public health emergency. Correct coding and notification to the patient that the provider is using non-HIPAA compliant communication tools is required. 

    Refer to your Premera contract for allowable information for virtual care codes. For specific coding information for Premera patients, see our telehealth payment policy for Alaska.

    Yes. Premera is following CMS guidance on telehealth payments during the COVID-19 health crisis. Providers who normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (GT can't be used for a Medicare claim). If the provider normally bills POS 19 and 22 for their in-person visits, then they should continue to bill using 19 and 22 but append modifier 95 or GT to their procedure code.

    This allows claims to process for reimbursement consistent with an in-office visit during the public health emergency. This change is in effect through June 30, per CMS guidance. We'll be reviewing claims back to March 6 and will remit any additional funds due.

    This guidance is in effect during this public health emergency for fully insured group and individual plans. FEP, shared admin, and self-funded plans who've opted out of this process are excluded from this guidance.

    Refer to your Premera contract for allowable information for virtual care codes. For specific coding information for Premera patients, see our telehealth payment policy for Alaska

    For Medicare Advantage patients, view the policy page and then go to the Enhanced Benefits tab at the top and search for “Remote Technologies” for correct telehealth codes.

    Premera wants to emphasize that this is a temporary relaxation of the rules during this nationwide public health emergency. Correct coding and notification to the patient that the provider is using non-HIPAA compliant communication tools is required.

    Per Health & Human Services and the Office of Civil Rights, a covered physician or healthcare provider who wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19. Additionally the criteria that telehealth may only be used with established patients is being relaxed and new patient encounters can be billed with these codes. 

    Providers can care for new patients via a telehealth virtual encounter and bill those services using the appropriate CPT that reflects the services rendered, in addition to the telehealth modifier and place of service.  Virtual care for an established patient should also be billed with an appropriate CPT, many of which are found in Premera’s payment policy.  Note that these services must also be billed using the appropriate telehealth modifier and place of service.

    Yes. Premera offers Talkspace for all our members. This is an online, virtual behavioral health provider resource. Many local mental health providers are also offering virtual services. Your patient should check with their provider first, or they can go directly to Talkspace

    Yes, ABA services can be provided virtually for dates of service on or after 3/20/20. This is temporary and will be in effect until government agencies indicate that we no longer need to practice social distancing.

    Claims for services provided virtually must be submitted with appropriate telehealth modifiers using the codes that are currently on the ABA fee schedule. See our telehealth payment policy for Alaska.

    Reimbursement for virtual care will be at the same amount as if the service were provided in-person.

    This change applies to Premera’s individual and commercial members. However, some self-funded employer groups do not cover virtual care, so you’ll need to check benefits for your patient before providing care.

    With the increasing use of telemedicine to interact and treat patients, it can be difficult to capture information and do a physical exam. Fortunately, synchronous audio and video platforms make it possible for providers to capture almost all areas of a physical exam. We’ve developed a tip sheet using best practices and information from  Telemedicine: Conducting an Effective Physical Exam to help you conduct an effective physical exam during a telehealth visit.

  • Prior authorizations

  • In order to better serve our members and providers, Premera has made some process changes in response to the COVID-19 outbreak. The below list of services and changes will be effective for services requested after February 1, 2020 and will be effective through June 1, 2020:

    • Suspend prior authorization for services with location of hospital inpatient (IP) or hospital outpatient (OP) (outpatient hospital location codes 19 and 22). This doesn’t apply to contract exclusions and experimental and investigational services on the Clinical Review Coding (CRC) list – standard review process will apply.
    • Suspend inpatient admission review for acute care facilities
    • Suspend inpatient concurrent review for acute care facilities
    • Suspend retrospective review for all inpatient hospital, outpatient hospital, and emergency services
    • Suspend post-acute placement prior authorization for skilled nursing facility, home health, acute rehab, and long-term acute care
    • Extend prior authorization duration from 90 to 180 days
    • Contract exclusion and experimental and investigational services are excluded from the above actions

    This change applies to Premera’s individual and commercial members. However, some self-funded employer groups did not opt into this process, so you’ll need to check benefits for your patient before providing care.

    Note: Prior authorization rules do not apply to Medicare Supplement plans.

    Our normal processes still apply: Continue to use our online prior authorization tool as required and fax any supporting documents. We’re not currently experiencing any delays in processing, other than requests for additional information. We ask that you wait 5 days before checking online for your authorization.

    This is a temporary measure only effective for services requested after February 1, 2020 through June 1, 2020. We want to ensure our members are receiving the services they need. We’ll continue to evaluate and determine if we need to extend these temporary measures.

    We’re hopeful this will eliminate the burden on providers to resubmit a PA for elective surgeries that are postponed and to ensure that we’re authorizing necessary services and supplies as quickly as possible.  

    Yes. from February 1, 2020 through June 1, 2020:

     

    • For advanced imaging and sleep studies, AIM has extended the authorization time frame for 6 months from date of approval. 
    • For radiation therapy, there is no extension of authorization. AIM’s view is that for these services, timeliness is critical for the patient’s care. They’re always able to extend an authorization if a patient is unable to get into treatment.
    • For services approved through eviCore, prior authorizations have been extended from 90 days to 6 months.

     

  • Pharmacy and prescriptions

  • Yes. We’ve adjusted our refill too soon policy for medications. This allows pharmacies to override refill too soon edits during a declared emergency at the pharmacy counter. Members have access to Express Scripts mail order prescriptions

    Yes. For drugs with an initial length authorization of 3 months, we’ll extend the authorization for 180 days for reviews performed between March 30, 2020 through June 30, 2020.

    We’ll also pull a list of expiring authorizations and anything that expires in the next 3 months will have the authorization extended for 180 days from March 30, 2020.

    We frequently see drug shortages in the U.S. based on manufacturer issues, raw product issues, etc. We may see new reported shortages based on the COVID-19 impact to Chinese manufacturers. Premera will respond to these shortages the same way we do today, by ensuring the following:

    • The pharmacy team will check public and industry resources to identify new shortages that may impact our members.
    • We’ll review medical policies to determine if adjustments are needed to ensure access to alternative medications (should we change our preferred drugs or update prior authorization criteria to account for shortages both short and long term).
    • Our review processes already account for drug shortages. If a drug we require as first-line therapy is in short supply, we’ll waive this requirement based on market realities and approve coverage when preferred formulary alternatives are in short supply.

    We’re also reviewing rejected claims to see if members are getting the medications they need. If we see any drug shortages, we’ll seek other options to meet member needs. We’ll continue to monitor the situation with our pharmacy partners, so members won’t run out of needed medications.

    Both medications are available to members for the treatment of COVID-19. We are continually reviewing our medical policies to determine if adjustments are needed to ensure access to needed alternative medications. Our review processes today already account for drug shortage situations. If a drug we require as first line therapy is in short supply, we will waive this requirement based on market realities and approve coverage where appropriate where preferred drug alternatives are in short supply.