Information from Empire for Care Providers About COVID-19 - (Updated March 23, 2020)
Please continue to check our Provider News page for any updated information on COVID-19.
During these challenging times, Empire BlueCross BlueShield (“Empire”) is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. We have taken actions to assist you and our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.
To help address care providers’ questions, we have developed the following frequently asked questions:
What is Empire doing to prepare?
Empire is committed to providing increased access to care, while eliminating certain costs and to help alleviate the added stress on individuals, families and the nation’s healthcare system.
These actions are to support the protective measures taken across the country to help prevent the spread of COVID-19 and are central to the commitment of Empire to remove barriers for its members and support communities through this unprecedented time.
Empire is committed to helping our members gain timely access to care and services in a way that places the least burden on the healthcare system. We want to reduce barriers to seeing a doctor, getting tested and adhering to medications for long-term health issues.
COVID-19 testing and visits associated with COVID-19 testing
Empire health plans will waive cost sharing for our fully insured employer, Individual, Medicare and Medicaid plan Members —inclusive of copays, coinsurance and deductibles—for the COVID-19 test and visits to determine if testing is needed. Self-insured plan sponsors are required under federal law to also waive cost sharing for COVID-19 tests and visits to get the test.
IMPORTANT: Starting March 16, 2020 in-network providers are advised that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test.
Telemedicine (video + audio):
For 90 days effective March 17, 2020, Empire began waiving member cost sharing for telemedicine visits, including covered visits for mental health and substance use disorders, for our fully insured employer plans, Individual plans, Medicare plans and Medicaid plans, where permissible. This applies to use of our LiveHealth Online platform, as well as for care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.
Telehealth (Telephonic/FaceTime care)
Effective March 19, 2020, Empire began waiving member cost sharing for telehealth visits (by phone or FaceTime/Skype) with in-network providers, including covered visits for mental health and substance use disorders and medical services. Cost sharing is waived for in-network providers only and applies where medically appropriate if all other requirements for a covered health service are met. Out-of-network telehealth visits are also covered if the member’s benefit plan has out of network benefits but may be subject to cost sharing. This applies to our fully insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Self-insured plan sponsors may opt out of this program.
Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telehealth. This waiver will remain in place for 90 days.
Deductible will apply to telehealth and telemedicine visits unrelated to COVID-19 as required for high deductible health plans to preserve tax deductibility of associated HSAs.
We are also providing coverage for members to have an extra 30-day supply of medication on hand. In addition, we are encouraging that when member plans allow, members switch from 30-day home delivery to 90-day home delivery. This applies to members who have prescription drug coverage.
Frequently Asked Questions:
Will Empire waive member cost shares for COVID-19 testing and visits to get COVID-19 testing?
Yes. Cost shares for fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test are waived. Self-insured plan sponsors are required under federal law to also waive cost sharing for COVID-19 tests and visits to get the test.
How are telemedicine services covered?
- Empire covers telemedicine e.g., Live Health Online (live video audio) services for providers who have access to those platforms/capabilities and participate in the program.
- Effective March 17, Empire began waiving member cost sharing for telemedicine (video + audio) visits, including covered visits for mental health or substance abuse disorders, for our fully insured employer plans, Individual plans, Medicare plans and Medicaid plans where permissible. Self-insured plan sponsors may opt out of this program. This will remain in place for 90 days.
How will Empire cover telephone-only/FaceTime provider services (telehealth)?
Effective March 19, Empire began waiving cost sharing for in-network provider telehealth visits (by phone or FaceTime/Skype) where medically appropriate if all other requirements for a covered health service are met. Out-of-network telehealth visits are also covered if the member’s benefit plan has out-of-network benefits but may be subject to cost sharing.
Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Self-insured plan sponsors may opt out of this program. This will remain in place for 90 days.
What codes would be appropriate to consider for a telehealth or a telephonic visit?
Based on standard coding guidelines from the AMA and HCPCS, office visit (99201-99215) telehealth claims will require Place of Service (POS) code “02” and either modifier 95 or GT.
For Medicare Advantage telehealth claims, please follow original Medicare coding guidance.
Audio-only telephonic codes 99441, 99442, 99443, 98966, 98967, 98968 do not require a telehealth modifier to be appended. Place of service would be the location where the provider initiates such a call.
For Medicare Advantage audio-only telephonic claims please use codes 99441, 99442, 99443, 98966, 98967, and 98968. Note, however, Medicare Advantage coding for either telehealth or audio-only telephonic claims could change in the future based on guidance from CMS.
How is Empire monitoring COVID-19?
Empire is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders.
Empire has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics.
Empire’s parent’s enterprise-wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and Virtual Command Center for Emergency Management command, control and communication.
In addition, Empire has a team of experts to monitor, assess and help facilitate timely mitigation and response where it has influence as appropriate for the evolving novel coronavirus threat.
Does Empire have recommendations for reporting, testing and specimen collection?
The CDC updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information from the CDC: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19?
The CDC has provided coding guidelines related to COVID-19: https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf
Is Empire waiving member cost-shares when a member needs treatment from a doctor or a hospital related to COVID-19?
No, the waiver of member cost shares applies to the COVID 19 test and visits to get the test. This waiver does not apply to treatment.
However, keep in mind that telemedicine and in network telehealth visits for any covered treatment do not require cost share for 90 days. See above FAQs for details.
Does Empire require a prior authorization on the focused test used to diagnose COVID-19?
No, prior authorization is not required for diagnostic services related to COVID-19 testing.
In case of mass epidemic, how can you ensure that your contracted providers can still provide services?
Empire is committed to working with and supporting its contracted providers. Our benefits already state that if members do not have appropriate access to network doctors that we will authorize coverage for out-of-network doctors as medically necessary.
In addition, Empire’s telemedicine provider, LiveHealth Online, is another safe and effective way for members to see a doctor to receive health guidance related to COVID-19 from their home via mobile device or a computer with a webcam.
How can I support access to telemedicine?
Providers can apply to join the LiveHealth Online panel of providers here: https://providers.amwell.com/
Are you aware of any limitations in coverage for treatment of an illness/virus/disease that is part of an epidemic?
Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from an epidemic.
Is Empire’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telemedicine?
As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability and stands ready to have doctors available to see the increase in patients, while maintaining reasonable wait times.
Does Empire expect any slowdown with claim adjudication because of COVID-19?
We are not seeing any impacts to claims payment processing at this time.
What is the best way that providers can get information to Empire’s members on Empire’s alternative virtual care offerings?
Empire.com and Empire’s member facing blog (https://www.empireblue.com/coronavirus/) are great resources for members with questions and are being updated regularly.
Empire members have access to telemedicine 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or by downloading the LiveHealth Online app from the App Store or Google Play.
Empire members also can call the Empire 24/7 NurseLine at the number listed on their Empire ID card to speak with a registered nurse about health questions.