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.
Who Does This Affect?
Commercial (Individual and Employer Group Plans)
- Coverage is included.
CHAND
- Coverage is included.
Federal Employee Program (FEP)
- FEP will cover the COVID-19 home test kits and home collection test kits. Visit fepblue.org for detailed information.
Medicaid Expansion
- Medicaid Expansion members have access to at-home COVID-19 tests at no cost from BCBSND-participating Medicaid Expansion providers. Members cannot be reimbursed for purchases they make on their own. Providers should file claims to BCBSND for coverage to apply. For additional questions, contact the ND Medicaid Expansion Provider Service Center at 1-833-777-5779.
Medicare & CHAND Supplements
- Coverage is not included.
NextBlue of North Dakota (Medicare Advantage)
- Coverage is not included.
For additional questions, contact BCBSND Provider Service Center at 1-800-368-2312, unless noted otherwise.
