Criteria
BCBSND requires members to be enrolled in Case Management services prior to receiving benefits for this program.
Benefits are available for telehome telemonitoring for individuals with Chronic Disease(s) who meet
ALL
the following criteria:
a) Requires care coordination and ongoing engagement through provider care team.
b) Recent hospitalization in the last six (6) months.
c) A history of failing to adhere to their treatment plan and are at risk of an acute episode.
d) Multiple (greater than two (2)) emergency department visits in the past six (6) months.
e) The medical exam of the individual must be under the control of the consulting practitioner.
f) A permanent record of online communications relevant to the ongoing medical care of the individual should be maintained as part of the individual medical record.
Ongoing benefits are dependent upon measurable clinical improvements in acute symptoms and stabilization of the individual's acute symptoms. For members receiving Home Health skilled nursing visits, it is anticipated that face-to-face skilled nursing visits will decrease due to telehome telemonitoring.
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.
Procedure Codes
Telemonitor equipment rental
Data collection and interpretation
