Provider Guide to Telehealth Services

Purpose

This guide is designed to support and guide healthcare providers who deliver telehealth services to Blue Cross Blue Shield of North Dakota and North Dakota Medicaid Expansion members. It aims to assist in managing the billing for these services by providing scenarios that assist providers to choose the correct billing path for filing claims.

BlueCard® is a national program that enables members to get health care services while traveling or living in another Blue plan service area.

Contiguous County are providers located in counties of states that border North Dakota (ND), which include Minnesota (MN), Montana (MT), and South Dakota (SD) that follow specific claims processing guidelines. (Provider Manual (bcbsnd.com) located in the claims submission section).

Home/Local Plan refers to the plan the member has coverage through.

Host Plan refers to the arrangement for the provider with the local plan when providing services to an out-of-state member.

Provider group/facility refers to the provider organization.

Provider refers to a practitioner.

Telehealth and Telemedicine: Telehealth and telemedicine are often used interchangeably, but they have distinct meanings. Telehealth refers to the broad scope of virtual healthcare services provided by healthcare professionals to patients. This includes various electronic communication methods such as audio, video, email, text, and remote monitoring devices for data collection. Refer to our current Telehealth (Medical Policy).

Teleradiology is the practice of a radiologist interpreting radiologic images of internal body parts while not physically present in the location where the images are generated.

Vendor Solutions is a BCBSND participating provider organization that offers national telehealth solutions for virtual only services.

When determining the requirements for contracting and credentialing with Blue Cross Blue Shield of North Dakota (BCBSND), it is important to collaborate with our credentialing and contracting teams.

Initial Contact: Providers interested in contracting should reach out via email to providercontracting@bcbsnd.com.
Additional Questions: Once providers are contracted and have additional questions related to credentialing, they can send an email to prov.net@bcbsnd.com.

Claims Filing

Claims are filed directly to the Home Plan for services rendered by a vendor’s participating telehealth provider. Here are some examples:

In-Area BCBSND Member: If a Blue Cross Blue Shield of North Dakota (BCBSND) member, physically located within BCBSND’s service area (i.e., ND and/or one contiguous county), receives services via telehealth from a participating telehealth vendor, claims are filed to BCBSND.
BCBSND Member Outside Service Area: If a BCBSND member is physically located outside of BCBSND’s service area and receives services via telehealth from a participating telehealth vendor, claims are filed BCBSND.

Exception: In limited situations when a participating vendor uses a nonparticipating telehealth provider to render approved telehealth services, claims must be filed to the local Plan based on the physical location of the nonparticipating provider.

These are providers who reside in one service area (Plan A) and are employed by a brick-and-mortar provider group/facility located in another service area (Plan B) to render virtual services to their members. Claims must be filed by the provider/group facility to its local plan (Plan B). Contracting is limited to the local provider group/facility. Plans may not contract directly with the out-of-area physician residing in service area plan A and employed by their local provider group/facility.

The below example scenarios illustrate how telehealth services can be provided across different service areas using both participating and non-participating providers.

A Nebraska (NE) Provider sees a BCBSND Member: If a provider physically located in NE and employed by a brick-and-mortar provider group/facility in ND (*Note; claim should include address of where the clinician is employed), provides telehealth services to a BCBSND member physically located in BCBSND’s service area, claims are filed to BCBSND.
A NE Provider sees an Out-of-State BCBS Member in ND: If a provider physically located in NE and employed by a brick-and-mortar provider group/facility in ND (*Note; claim should include address of where the clinician is employed), provides telehealth services to an out-of-state BCBS member physically located in BCBSND’s service area, claims are filed to BCBSND.
A ND Provider sees a BCBSND Member, Employed in New York (NY): If a provider physically located in ND and employed by a brick-and-mortar provider group/facility in NY, provides telehealth services to a BCBSND member physically located in BCBSND’s service area, claims are filed to Blue Cross Blue Shield of New York (BCBSNY).
A NE Provider sees a BCBSND Member Outside Service Area: If a provider physically located in NE, and employed by a brick-and-mortar provider group/facility in ND (*Note; claim should include address of where the clinician is employed), provides telehealth services to a BCBSND member physically located outside of BCBSND’s service area, claims are filed to BCBSND.

Providers who collaborate between two or more providers electronically on member care from different locations must adhere to the following:

Claim Filing Based on Provider Location: Claims must be filed to the plan based on where the providers are located.
Claim Filing for Image/Data Collection: Claims must be filed to the local plan based on where the provider is located for the image/data collection.
Claim Filing for Analysis: If the analysis is performed in another Plan’s service area, claims for the analysis must be filed to the local plan based on where the provider is located when performing the analysis.

Exception: If the provider located in one service area (Plan A) is employed by a brick-and-mortar provider group/facility in another service area (Plan B), claims must be filed by the provider group/facility to its local plan (Plan B).

Example of electronic services between providers:

If a provider located in ND takes a radiologic image in a ND clinic, the ND provider files the claim for taking the image to BCBSND. If the ND provider sends the image to a provider outside of BCBSND’s service area, who is not employed by a brick-and-mortar provider group/facility located in ND (*Note; claim should include address of where the clinician is employed), for the analysis of the image, the analyzing provider files the claim for the analysis to their local plan.

Telehealth Claims Filing Scenarios

In this scenario, the telehealth vendor’s provider is physically located outside the home plan’s service area. The member and the provider are in different service areas, and the member’s originating site location is their home. This scenario illustrates how telehealth services can be effectively provided across different geographical locations.

BCBSND has a contract with a telehealth vendor to provide approved telehealth services to its members. Other Blue Cross Blue Shield (BCBS) plans may also be contracted with the same telehealth vendor.
A BCBSND member, who is located in Tennessee (TN), accesses the telehealth vendor as directed by its Home Plan.
The telehealth vendor connects the member to a provider who is physically located in ND and is licensed to render telehealth services to members located in TN.
Claim Filing: The telehealth vendor files the claim directly to BCBSND, which is the member’s home plan.

a. BCBSND processes the claim locally.

In this scenario, the provider is employed by the local provider group/facility but is physically located out-of-area. The member and the provider are in different service areas, and the member’s originating site location is their home. This scenario demonstrates how telehealth services can be provided even when the member and provider are in different geographical locations.

BCBSND has a contract with its local provider group/facility to provide approved telehealth services to members who receive care locally.
A member (local or hosted), who is on vacation in Arizona (AZ), accesses the local BCBSND provider group/facility’s virtual portal as directed by their local BCBSND provider.
The local BCBSND provider group/facility connects the member to its provider who is employed by a brick-and-mortar provider group/facility located in ND, is physically located in ND, and is licensed to render telehealth services to members located in AZ.
Claim filing: The local BCBSND provider group/facility files the claim directly to BCBSND.

a. BCBSND processes the claim locally for its member, or as a BlueCard claim for a hosted member.

In this scenario, a provider, who is temporarily residing out-of-area, continues to render services while the member’s originating site location is their home. This scenario illustrates how a provider can continue to render services to patients even when temporarily residing in a different geographical location.

The provider remains employed by the local provider organization brick and mortar located in ND and temporarily relocates to Florida (FL).
The provider continues to service patients associated with the provider group/facility in ND virtually while residing in FL.
A member associated with the provider group/facility in ND connects with the provider now located in FL and receives services virtually.
Claim filing: The provider group/facility files the claim to BCBSND.

a. This is a local participating provider claim.

In this scenario, a provider permanently relocates out-of-area but remains employed by the local provider group/facility, and the member’s originating site location is their home. This scenario illustrates how a provider can continue to render services to patients even when permanently residing in a different geographical location.

The provider remains employed by the local provider group/facility located in ND and permanently relocates to FL.
The provider continues to service patients associated with the provider group/facility in ND virtually while residing in FL.
A member associated with the provider group/facility in ND connects with the provider now located in FL and receives services virtually.
Claim filing: The provider is employed by a brick-and-mortar provider group/facility located in ND, the provider group/facility files the claim to BCBSND.

a. This is a local participating provider claim.

Scenarios 5 to 8
Electronic Collaboration on Member Care from Different Locations

These scenarios illustrate various situations where healthcare providers, although geographically separated, can work together to provide seamless care to members.

This includes tasks such as image collection, data analysis, and claim filing, all performed in different service areas but coordinated electronically for efficient and effective member care.

In this scenario, the image is taken and/or data is collected and analyzed by the same provider. This scenario illustrates how a provider can manage both the collection and analysis of medical images or data.

BCBSMN contracts with a local MN provider for images taken and/or data collected, and analysis performed in its service area.
A BCBSND member has an image taken at the BCBSMN provider location.
Analysis is performed in MN by the same provider.
Claim filing: The MN provider files a claim for the image and the analysis to BCBSMN, the local plan in whose service area the provider is located.

a. This is a BlueCard participating provider claim.

In this scenario, the image is taken and/or data is collected and analyzed in different service areas using participating providers. This scenario illustrates how image collection and analysis can be performed across different service areas using participating providers.

BCBSND contracts with a local provider for images taken and/or data collected in its service area.
BCBSMN contracts with a local provider for analysis performed in its service area.
An out-of-state Blue Cross Blue Shield member has an image taken in ND. The ND provider sends the image to the provider in MN for analysis.
Claim filing:

a. ND provider files a claim for the image to BCBSND, the local plan in whose service area the provider is located.

i. This is also a BlueCard participating provider claim.

b. The MN provider files a claim for the analysis to BCBSMN, the local plan in whose service area the provider is located.

i. This is also a BlueCard participating provider claim.

In this scenario, the image is taken and/or data is collected and analyzed in different service areas using both participating and non-participating providers. This scenario illustrates how image collection and analysis can be performed across different service areas using both participating and non-participating providers.

BCBSND contracts with a local provider for images taken and/or data collected in its service area.
BCBSMN does not have a contract with the MN provider for analysis performed in its service area.
An out-of-state BCBS member has an image taken in ND.
The ND provider sends the image to a provider in MN for analysis.
Claim filing by Participating Provider: The ND provider files a claim for the image to BCBSND, the local plan in whose service area the provider is located.
a. This is a BlueCard participating provider claim.
Claim filing by Non-Participating Provider: The MN provider files a claim for the analysis to BCBSMN, the local plan in whose service area the provider is located.
a. This is a BlueCard non-participating provider claim.

In this scenario, the image is taken and/or data is collected and analyzed, and these services are included in a single global fee arrangement. This scenario illustrates how a global fee arrangement can include both the collection and analysis of medical images or data.

BCBSND contracts with a local provider for a single global fee that includes images taken and/or data collected in its service area and the analysis of those images.
The ND provider subcontracts with a vendor in MN for the analysis.
An out-of-state BCBS member has an image taken in ND.
The analysis results are returned to the provider in ND.
Claim filing: The ND provider files global fee charges to BCBSND, the local plan in whose service area the provider is located.

a. This is a BlueCard participating provider claim.

Contact Information for Questions

Feel free to reach out to these contacts for any questions or concerns you may have.

Commercial Provider Service Center: 1-800-368-2312.
Medicaid Expansion Provider Service Center: 1-833-777-5779.
BCBSND Contracting: email providercontracting@bcbsnd.com.
BCBSND Credentialing: email prov.net@bcbsnd.com.

Resources and References

These resources can provide valuable information and guidance for healthcare providers.

Disclaimer
Subcontracting Provider Guidelines

The provider in North Dakota is a subcontractor of the provider located in Minnesota and will not file a claim to BCBS of North Dakota. As a result, neither the Minnesota Plan nor the member has any obligation for payment to the provider in North Dakota, who is a subcontractor of the provider in Minnesota. Please note that this guideline is subject to change at any given time.

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Medical Policies Quick Search

Provider Guide to Telehealth Services

Purpose

Definitions

Contracting and Credentialing with BCBSND

Claims Filing

Vendor Solutions

Local Providers and Telehealth Services

Snowbird/Temporarily Out-of-Area Providers

Out-of-Area Virtual Support Providers

Image and/or Data Collection

Telehealth Claims Filing Scenarios

Scenario 1: Telehealth Services Across Different Areas

Scenario 2: Telehealth Service with Out-of-Area Provider

Scenario 3: Snowbird Provider Rendering Service Out-of-Area

Scenario 4: Provider Permanently Relocates Out-of-Area

Scenarios 5 to 8
Electronic Collaboration on Member Care from Different Locations

Scenario 5: Image Collection and Analysis by the Same Provider

Scenario 6: Image Collection and Analysis in Different Service Areas Using Participating Providers

Scenario 7: Image Collection and Analysis in Different Service Areas Using Participating and Non-Participating Providers

Scenario 8: Image Collection and Analysis Included in a Global Fee Arrangement

Contact Information for Questions

Resources and References

Disclaimer
Subcontracting Provider Guidelines

Medical Policies Quick Search

Provider Guide to Telehealth Services

Purpose

Claims Filing

Telehealth Claims Filing Scenarios

Scenarios 5 to 8Electronic Collaboration on Member Care from Different Locations

Contact Information for Questions

Resources and References

DisclaimerSubcontracting Provider Guidelines

Scenarios 5 to 8
Electronic Collaboration on Member Care from Different Locations

Disclaimer
Subcontracting Provider Guidelines