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Our customer contact center is currently experiencing high call volumes. We thank you for your patience.
BCBSND issued a health care news article to the provider community on January 18, 2022, and would like to provide additional information regarding coverage for at-home COVID-19 tests. Starting January 15, 2022, members will need to go to an in-network pharmacy to receive their best benefit for purchase of an at-home COVID-19 test.
Pharmacies can find the necessary information to file a claim on the member’s ID card. These tests do not require a prescription. Information has also been provided to pharmacists who use Prime Therapeutics Inc. (PTI). For claims processing questions, contact PTI by calling 1-888-877-6323.
If the member’s specific plan does not have prescription drug coverage or does not utilize the PTI system, a medical claim can be submitted. To file a medical claim, follow the by report, Not Otherwise Classifiable (NOC) billing guidelines. Below is a provider reference:
Provider Submitted | |
DX Code | Provider to decide |
Procedure Code | NOC code with description of test |
Place of Service (POS) | POS 17 for retail pharmacy |
Modifier | CS |
Claims should not be filed to secondary insurance. Members who utilize a non-participating pharmacy or retailer will have the ability to file their own claim, excluding Medicaid Expansion members.
These tests cannot be used for employer-required testing, travel or resale purposes.
Commercial (Individual and Employer Group Plans)
CHAND
Federal Employee Program (FEP)
Medicaid Expansion
Medicare & CHAND Supplements
NextBlue of North Dakota (Medicare Advantage)
For additional questions, contact BCBSND Provider Service Center at 1-800-368-2312, unless noted otherwise.