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 Congestive Heart Failure (CHF) and/or Chronic Obstructive Pulmonary Disease (COPD) who meet ALL the following criteria:
a) Requires care coordination and ongoing engagement through BCBSND Case Management
b) History of cardiac conditions including CHF and/or COPD
c) Recent hospitalization in the last six (6) months with a primary diagnosis of CHF or COPD
d) A history of failing to adhere to their treatment plan and are at risk of an acute episode
e) Multiple (greater than 2) emergency department visits in the past six (6) months for treatment of their CHF/COPD conditions
f) The medical exam of the individual must be under the control of the consulting practitioner
g) 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 for CHF/COPD, 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
