A.Effective immediately and through June 30, 2020, all fully insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) will not pay any cost share amounts (copay, coinsurance, deductibles) for covered services related to the testing, diagnosis and treatment of COVID-19 for:

• All charges associated with a visit to an in-network or out-of-network primary care physician or urgent care center or Emergency Room (ER) for evaluation of symptoms identified as possible indicators of COVID-19 infection.
• All in-network and out-of-network labs for charges associated with the delivery of services connected to CDC-approved lab studies or tests for COVID-19 for members who know they have been exposed to an individual diagnosed with COVID-19 or with symptoms identified by the CDC as possible indicators of COVID-19 infection.
• All covered benefits associated with inpatient and outpatient care when delivered by in-network professionals and facilities, and when the claim indicates treatment was related to COVID-19.

The Company will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

We will waive early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan) and/or encourage members to use their 90-day mail order benefit, if available. Horizon BCBSNJ will also ensure formulary flexibility if there are shortages or access issues, and not hold patients liable for additional charges stemming from obtaining a non-Preferred medication resulting from shortages or access issues.

Hydroxychloroquine and chloroquine are FDA-approved drugs and are therefore eligible for coverage. However, due to inappropriate prescribing and concerns related to hoarding of hydroxychloroquine and chloroquine, there are certain restrictions for prescribing and dispensing hydroxychloroquine and chloroquine to reduce the risk of a shortage.

Horizon BCBSNJ will consider claims for hydroxychloroquine or chloroquine when prescribed as off-label treatment of COVID-19 eligible for coverage. Note that a positive test for SARS-CoV-2 is required and the test result must be documented on the prescription. Coverage will be limited to a 14-day supply, with no refills permitted.

Prescriptions for members who are taking the medication for an FDA-approved condition will not be limited to a 14-day supply. Refills for such members will not be impacted.

These changes apply to Horizon BCBSNJ fully insured members, including those covered through Medicaid, Medicare, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

Other self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and we will continue to work with them to administer their plan designs as directed.

Physicians and facilities are prohibited from billing any fully insured Horizon BCBSNJ member, State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) member for any services connected to COVID-19 evaluation or testing, performed in keeping with the Centers for Disease Control and Prevention (CDC) guidelines.

A. Please submit claims as you regularly do.

In order for cost-sharing obligations to be waived, claims must include one of the following diagnosis codes in addition to any other diagnosis appropriate to report on the claim:

• Z20.828 - Contact with and suspected exposure to other viral communicable diseases

• Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out

• B97.29 – Other Coronavirus as the cause of diseases classified elsewhere

• U07.1 - 2019-nCoV acute respiratory disease

Based on CDC recommendations, we believe that one of these would be most appropriate to report when a patient is evaluated and COVID-19 was considered in the differential diagnosis. Other diagnoses, in addition to these codes, should also be reported as appropriate.

Claims that do not include one of the above diagnoses will be processed normally and the reimbursement will be reduced by any applicable member cost sharing based on the benefit plan.

Please visit the CDC websiteCDC website opens a dialog window for additional information regarding diagnosis coding related to COVID-19.

A. Horizon BCBSNJ is prepared to accept the following codes:

A. Claims for COVID-19-related services should include one of the following diagnosis codes:

• Z20.828 - Contact with and suspected exposure to other viral communicable diseases

• Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out

• B97.29 - Other Coronavirus as the cause of diseases classified elsewhere

• U07.1 - 2019-nCoV acute respiratory disease

Based on CDC recommendations, we believe that one of these would be most appropriate to report when a patient is evaluated and COVID-19 was considered in the differential diagnosis. Other diagnoses, in addition to these codes, should also be reported as appropriate.

Claims that do not include one of the above diagnoses will be processed normally and the reimbursement will be reduced by any applicable member cost sharing based on the benefit plan.

Please visit the CDC websiteCDC website opens a dialog window for additional information regarding diagnosis coding related to COVID-19.

A. You will be reimbursed per the terms and conditions of your participating provider agreement.

Claims that do not include Z20.828, Z03.818, B97.29 or U07.1 will be processed normally, and reimbursement will be reduced by any applicable member cost sharing based on the benefit plan.

A. Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Medicare, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), will not have any out-of-pocket costs for services related to COVID-19 testing or treatment.

Other self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and we will continue to work with them to administer their plan designs as directed.

Horizon BCBSNJ will cover, with no cost share to the member, the appropriate medically necessary diagnostic testing for COVID-19.

Yes. Horizon BCBSNJ will cover the cost of a COVID-19 vaccine recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Services Task Force (USPSTF).

Horizon BCBSNJ has waived prior authorization requirements for:

• Diagnostic testing and evaluation for individuals presenting with concerns of COVID-19
• Lab studies or diagnostic testing for COVID-19 required during an ER evaluation or inpatient hospital stay
• All inpatient admissions with date of admission on or prior to May 31, 2020, unless extended
• Post-acute facility inpatient admissions to Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for dates of admission prior to or on May 31, 2020, unless extended*
• Supplemental oxygen for all patients who are discharged from the ER prior to or on May 31, 2020, unless extended

These changes take effect immediately for Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies.

* This does not apply to Federal Employee Program® (FEP®) members.

All of our mission critical vendors have the capability to recover business operations within 24 to 72 hours. As part of our vendor delegation process, we review and approve all of our vendor business continuity plans and redundant capabilities annually. Horizon BCBSNJ is working closely with these vendors to mitigate any potential disruption related to COVID-19.

Please get the latest COVID-19 news from credible information sources, such as:

• World Health OrganizationWorld Health Organization opens a dialog window

• Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC) opens a dialog window

• National Institutes of HealthNational Institutes of Health opens a dialog window

• The New Jersey Department of HealthThe New Jersey Department of Health opens a dialog window

Physicians and health care professionals can collect the appropriate specimen at the health care facility where the patient is seen and the test is ordered, and send the specimen to laboratories using standard procedures. If you have any questions, please contact the labs directly.

Patients cannot be sent to a Quest Diagnostics (Quest) or LabCorp location or their draw sites to have a specimen collected.

Additional testing facilities are also available to the public.

Horizon BCBSNJ will cover FDA-authorized antibody testing performed by a lab that has a Clinical Laboratory Improvement Amendments (CLIA) certification to bill for the service. During the current national public health emergency, antibody testing is covered with no member cost sharing. Antibody tests should not be used as a sole basis for diagnosis.

Network and non-network providers may perform services through telemedicine platforms. As such, Horizon BCBSNJ will cover the cost of office visits performed through telemedicine at the benefit level under your plans.

In addition, Horizon BCBSNJ recently announced some changes to help its members when care is received through in-network doctors.

• For all fully insured, SHBP/SEHBP, Medicaid and Medicare members Horizon BCBSNJ will relax its telemedicine rules to allow members to get covered services by phone, chat or video, including common video platforms such as FaceTime and Skype, from in-network and out-of-network health care professionals. Horizon BCBSNJ will also waive the member out-of-pocket costs for covered services, including diagnosis and treatment of COVID-19, routine care, therapy or mental health care when provided by an in-network health care professional through telemedicine.

• Self-insured health plans are responsible for the specific plan designs and may not cover telephone visits.

These changes will remain in effect through June 30, 2020.

Members with out-of-network benefits may get covered services from their preferred health care professional using these platforms or phone, but they remain responsible for their out-of-network, out-of-pocket costs according to the terms of their individual policies.

Please consult Horizon BCBSNJ’s telemedicine services guidelines:

• Horizon BCBSNJ Policy

• Horizon NJ Health Policy

No. As with all routine, primary care, mental health or follow-up office visits, no prior authorization is required.

Horizon NJ Health will continue to accept claims for telemedicine and telehealth services billed including, but not limited to:

• Professional services related to diagnosis or treatment of COVID-19
• Routine care
• Therapy
• Mental health care and substance use treatment

In accordance with the Division of Medical Assistance and Health Services (DMAHS) guidelines, please submit all claims for telemedicine and telehealth services as if the service was provided in the office setting. Please do not submit the telehealth codes for audio–only telemedicine services.

• For professional claims billed on the CMS-1500, please submit with the appropriate HCPCS or CPT codes, modifiers 95 or GT and place of service (POS) 02 or 11.
• For facility claims billed on the UB04, please submit with the appropriate revenue code, HCPCS or CPT codes and modifiers 95 or GT.

View a full list of existing and extended codes for COVID-19.

Regardless of the coding paradigm, Horizon BCBSNJ will reimburse up to the allowed amount, and providers may not collect member cost share that would otherwise be collectible.

Health care professionals, facilities and ancillary providers should continue to ensure a high-level of accuracy and compliance with the most current and appropriate coding practices, rules and guidelines.

All services that can be performed through telemedicine platforms are eligible regardless of whether the service is for medical care or behavioral care. Please consult Horizon BCBSNJ’s telemedicine services guidelines:

• Horizon BCBSNJ Policy

• Horizon NJ Health Policy

Furthermore, Horizon BCBSNJ is relaxing telemedicine rules to allow phone-only visits with providers. Members will incur no out-of-pocket costs for telemedicine visits, including via phone, when delivered by an in-network health professional. This change applies to covered services including diagnosis or treatment of COVID-19, routine care, therapy or mental health care. This is effective immediately and through June 30, 2020, unless extended.

Yes, the providers’ reimbursement rates for telemedicine and telehealth visits are the same as if they performed the service in the office setting. Horizon BCBSNJ will reimburse up to the allowed amount, and providers may not collect member cost share that would otherwise be collectible.

No, only one Evaluation and Management Services code will be paid to the provider. The services from both visits can be combined to determine the appropriate level of care.

There is no global period for telemedicine care, with the exception of subsequent hospital care. Hospital care is limited to one telemedicine visit every three days and subsequent nursing facility care is limited to one telemedicine visit every 30 days.

New patients are eligible for telemedicine. However, new inpatient consultations and initial inpatient care are not eligible.

The federal Health and Human Services Department has waived HIPAA enforcement regarding platforms. This allows providers to use any reasonable means of communication to work with their patients. However, we encourage the use of secure technology whenever possible. Providers should review new standards announced by the U.S. Department of Health and Human Services’ Office of Civil RightsU.S. Department of Health and Human Services’ Office of Civil Rights opens a dialog window.

For the provider to be reimbursed for telemedicine services, either the provider or the member has to physically be in New Jersey at the time services are provided. The member must be active with Horizon NJ Health.