Blue Cross and Blue Shield of Oklahoma Further Expands Telemedicine to All In-Network Providers
Telemedicine visits are an option under most of our member benefit plans. With COVID-19, we temporarily lifted cost-sharing for medically necessary medical services provided via telemedicine with local providers and MDLIVE. The cost-share waiver is scheduled to end Aug. 31, 2020 (Dec. 31, 2020 for Medicare members). We will continue to monitor and reassess that end date as needed.
After the end date, cost share will again be applied to telemedicine visits and members may be responsible for copays, deductibles and coinsurance consistent with the terms of the member's benefit plan.
Updated to reflect new end date of Aug. 31, 2020 and Dec. 31, 2020 for Medicare members
Blue Cross and Blue Shield of Oklahoma (BCBSOK) has temporarily expanded our telemedicine program in response to the COVID-19 crisis to provide greater access to medical and behavioral health services for our members.
BCBSOK has expanded access to in-network telemedicine services at no cost-share for all state-regulated, fully-insured members and for Medicare (excluding Part D), and Medicare Supplement members, consistent with the terms of the member’s benefit plan. Employer group telemedicine benefits may differ by plan.
We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.
What is covered?
Effective March 15, 2020, BCBSOK began providing access to telemedicine services at no cost-share with in-network providers for fully-insured members for health care services for all medically necessary, covered services and treatments consistent with the terms of the member’s benefit plan.
This telemedicine delivery method for health care services is available to all fully insured, individual and family plan and Medicare members and applies to claims incurred from March 15, 2020 through Aug. 31, 2020 (previously June 30) (Medicare members through Dec. 31, 2020).
Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles, based on their employer’s election to participate in this benefit.
Providers of telemedicine may include, but are not necessarily limited to:
- Physician assistants
- Licensed behavioral health, applied behavioral analysis, physical therapy, occupational therapy, and speech therapy service providers
Available telemedicine visits with BCBSOK providers currently include:
- 2-way, live interactive telephone communication and digital video consultations
- Phone calls (COVID-19 related benefit)
- Online services
- Other methods allowed by state and federal laws, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness.
Oklahoma Statute: "Telemedicine" and "store and forward technologies" shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference or facsimile machine.
Providers can find the latest guidance on acceptable HIPAA-compliant remote technologies issued by the U.S. Department of Health and Human Services’ Office for Civil Rights in Action.
Members covered by some self-funded employer group plans and Federal Employee Plan (FEP) members have a limited benefit requiring the use of a single-source telehealth provider. Verify coverage, by calling Provider Services at 800-496-5774 and speak with a Customer Advocate.
Note: PPO members may see out-of-network providers through telemedicine. If they do, the member will be responsible for copays, coinsurance, and deductibles.
Professional claims may be submitted for services where the provider is acting within the scope of their state license, the service being rendered can be performed via telemedicine and meets the definition of the procedure code billed. Claim should include POS 2 (professional) and appropriate modifier (95, GT, GQ).
Note: If a claim is submitted using a telemedicine code, the modifier 95 is not necessary. Only codes that are not traditional telemedicine codes require the modifier.
Telemedicine claims for insured members submitted in accordance with appropriate coding guidelines, including appropriate modifiers, for in-network medically necessary health care services beginning March 15, 2020, will be covered without cost-sharing and will be reimbursed at the contracted allowances as in-person office visits during the COVID-19 public health emergency. As a reminder, employer group telemedicine benefits, and therefore cost-sharing may differ by plan.
State and Federal Regulations
BCBSOK will continue to follow the Executive Orders by Governor Stitt and applicable guidelines of Centers for Medicare & Medicaid Services.
Member benefit and eligibility assistance
Check eligibility and benefits for each member at every visit prior to rendering services. Providers may:
- Verify general coverage by submitting an electronic 270 transaction. This step will help providers determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.
- Telemedicine is not yet a category offered currently in our automated Interactive Voice Response (IVR) phone system. For telemedicine benefits, please call our Provider Customer Service Center at 800-496-5774 to request Office Visit benefits and request to speak with an agent for telemedicine-specific information.
Continue to watch the News and Updates section of the BCBSOK website for more information and review the COVID-19 – Oklahoma Provider Frequently Asked Questions .
For the most up-to-date information about COVID-19, visit the Centers for Disease Control and Prevention website.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, call the number on the member’s ID card.
Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association