Our Member Services Representatives are unavailable Thursday, November 26, and Friday, November 27, due to the holiday. (Medium)

Expanded Coverage for Members

Telehealth Services

Effective March 1, 2020, through the end of the emergency declaration, BCBSND has expanded telehealth services to all products. A significant majority of products have already instituted this expanded set of telehealth services, but to reduce confusion and create consistency, all products will have the expanded telehealth benefit during the COVID-19 pandemic.

The expanded telehealth benefit includes telehealth visits from local participating providers and AmWell. In addition, BCBSND fully insured products will waive cost-sharing for all telehealth services. BCBSND will work with self-funded clients for potential expanded coverage for their employees.

The Federal Employee Program (FEP) has expanded telehealth services to allow non-Teladoc telehealth services. Services performed by non-Teladoc providers and not related to COVID-19 will apply cost shares.

COVID-19 Testing

Effective March 1, 2020, through the end of the emergency declaration, BCBSND will waive any cost-sharing, including co-pays, deductibles and co-insurance for testing of COVID-19 so that the cost-sharing does not serve as a barrier to access these important tests. BCBSND will also waive cost-sharing for an in-network provider office visit, urgent care center and emergency room visit when testing for COVID-19. This is regardless of confirmed diagnosis and applies to all symptomatic BCBSND members including FEP and self-funded members. BCBSND will cover services and testing performed during a visit related and resulting in COVID-19 testing at no cost-share to the member. Services must be in accordance with accepted standards of current medical practice and medically appropriate for the individual. Waiving cost-shares may be done on a retrospective case-by-case basis.

With the expansion of COVID-19 testing technology, currently, there is no coverage for asymptomatic individuals for public health surveillance screening purposes. COVID-19 antibody or serological testing will be covered at 100% when medically indicated. COVID-19 antibody or serological testing is not covered for those who have previously tested positive for COVID-19.

COVID-19 Treatment

Effective March 1, 2020, through December 31, 2020, BCBSND will waive out-of-pocket costs for the treatment of COVID-19, including hospital stays and outpatient treatment. This applies to BCBSND fully insured members. Out-of-pocket costs include incremental medical co-pays, deductibles and co-insurance charges related to the treatment for COVID-19 and will be paid at in-network rates. 

Prescriptions

Effective March 1, 2020, through December 31, 2020, BCBSND is increasing access to prescriptions by allowing pharmacies to refill prescriptions earlier than typically allowed. In addition, most plans allow members to fill maintenance medications for up to a 90-day supply through local or mail-order pharmacies.

To ensure members have the medications they need on hand, BCBSND now allows pharmacies to waive “refill too soon” limits on prescriptions. 

DME Supplies

Effective March 1, 2020, through December 31, 2020, BCBSND will allow requests for additional supplies outside the normal quantity and frequency limits during the COVID-19 emergency. Members may receive up to an additional 90-day supply through local or mail-order suppliers.

Waiver of Precertification of Authorization for Post-Acute/Alternative Care

Blue Cross Blue Shield of North Dakota (BCBSND) will temporarily waive the precertification process for all in-state post-acute/alternate care service requests when transferring from acute care hospitals beginning November 12, 2020 through December 31, 2020.

Admission notification for the transfer of patients to these services must be made to BCBSND, preferably via Availity, our provider portal. Notification can also be made via fax at 701-277-2971.

Concurrent review of these cases must be completed by day seven of the patient transfer. At that time, clinical documentation will be required for continued approval.

Post-acute/alternate care services covered under this temporary change include:

  • Skilled Nursing Facilities
  • Long Term Acute Care Facilities
  • Home Health Care
  • Hospice Care
  • In-patient Rehab Facilities
  • Transitional Care Units

Precertification will continue to be required for alternate care services requested for FEP and out-of-state services.

Additional questions?

Please refer to COVID-19 Billing and coding guidelines for additional information.

As a reminder, all services are reviewed based on medical necessity and appropriateness and are not guaranteed for payment.For additional information in regards to changes and updates to COVID-19 related items, please visit our website for the latest updates.