Contact Us
Home Provider COVID-19
» Welcome to Wellmark
» BlueInk
» BlueCard® Program
» Claims and Payment
» Medical Policies and Authorizations
» Health Management Programs
» Medical, Dental, and Pharmacy
» Credentialing and Network Participation
» Communications and Resources
» COVID-19
Coronavirus (COVID-19) Frequently Asked Questions (FAQ)

Wellmark Blue Cross and Blue Shield (Wellmark) has received inquiries related to the communications that Wellmark issued on March 17, 2020, and March 19, 2020, and is providing additional clarification regarding these messages along with answers to frequently asked questions.

 

It is important that providers sign up for Wellmark Information Notification System (WINS) .

Virtual visits

Q1. What does a ‘virtual visit’ pertain to?

 

A1. A virtual visit refers to a telehealth visit. Wellmark defines a telehealth visit as a method to provide health care services to patients through real-time video interaction between a provider and the patient. Virtual visit involves only the patient at the originating site (i.e., patient’s home) and a provider at the distant site. Wellmark will continue to allow telephonic visits when video interaction is not accessible until further notice.

 

Q2. Which providers can provide a virtual visit?

 

A2. A Wellmark participating provider may provide services via virtual visit (telehealth) if the services are medically appropriate to be delivered via telehealth. Health care services must be delivered in accordance with generally accepted health care practices and standards prevailing at the time the health care services are provided, including all rules adopted by the appropriate professional licensing board, having oversight of the health care professional providing the service.

What members does this communication apply to?

Q1. How does Wellmark define “commercial members?”

 

A1. Commercial members include Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Wellmark Value Health Plan and Blue Cross and Blue Shield of South Dakota members. It excludes other Blue Cross and Blue Shield Plan members (for example, Blue Cross and Blue Shield of Nebraska) and members of the Federal Employee Program (FEP).

 

Q2. When checking a Wellmark member’s benefits online, I see that the member does not have telehealth benefits or is required to use Doctors on Demand for telehealth services. Can an in-network provider provide a virtual visit to these members?

 

A2. For dates of service from March 16, 2020 - June 16, 2020, Wellmark is expanding virtual visit (telehealth) coverage for these members. Member copays, coinsurance and deductibles for virtual visits will be waived. This is only applicable to in-network providers. Effective June 17, 2020, through Aug. 31, 2020, Wellmark will waive cost share for its fully insured plans and will work with self-funded plans that want to implement a similar benefit for their members. Beginning Sept. 1, 2020, fully insured members' benefits will default back to their standard benefits, including cost shares as stated in plan documents. Wellmark will work with self-funded plans that want to extend the telehealth cost-share waivers and/or enhanced telehealth benefits for their members beyond Aug. 31, 2020.

 

Q3. Does this guidance apply to the Federal Employee Program (FEP)?

 

A3. FEP has expanded telehealth service beyond Teladoc®. FEP will cover remote visits from Wellmark network providers. FEP has different claim filing guidelines than Wellmark for these virtual visits. Get more information on FEP and coronavirus.

 

Q4. Does this guidance apply for other Blue Cross and Blue Shield plans?

 

A4. No, providers must continue to check benefits for other Blue Cross Blue Shield members as their coverage of virtual visits may vary.

Cost share

Q1. What does "other cost shares" refer to?

 

A1. "Other cost shares" include coinsurance and deductibles.

 

Q2. What if a provider collects cost shares for virtual visits ?

 

A2. If a provider collects cost share for virtual visits, the cost share must be returned to the member in the following circumstances:

  • All cost-shares must be returned for all virtual visits performed from Mar. 16, 2020 to June 16, 2020.
  • From June 16, 2020, to Aug. 31, 2020, cost-shares must be returned for virtual visits provided to all commercial members unless a self-funded group has chosen not to continue the telehealth cost-share waiver.
  • After Aug. 31, 2020, a provider should be collecting and keeping cost-shares for virtual visits provided to all commercial members unless a self-funded group has chosen to continue the telehealth cost-share waiver.

 

Q3. How is member cost share waived when the COVID-19 testing is not included on the claim?

 

A3. The claim would either need to include a diagnosis of Z03.818, Z20.828, Z11.59, or utilize the CS modifier. Cost share will be waived for the medically appropriate testing-related services that result in an order for, or administration of, a COVID-19 diagnostic test, but only to the extent that the items or medically appropriate services relate to the:

  • Furnishing or administration of the test, or
  • Evaluation of such individual for purposes of determining the need of the individual for the test as determined by the individual's attending healthcare provider.

 

Q4. Will there be a member cost share for the COVID vaccine administration?

 

A4. COVID vaccine administration is treated as an ACA preventative. As required by the CARES Act, there would be no member cost share for members of Non-Grandfathered plans. Grandfathered plans are not required to waive member cost-share for COVID-19 vaccine administration under the CARES Act. However, during the public health emergency declared by HHS, Wellmark has decided to waive member cost-share for its fully-Insured members of Grandfathered plans, and most self-funded Grandfathered plans have followed suit.

 

Reimbursement and billing guidance

Q1. Is Wellmark reimbursing all codes performed via a virtual visit at 100 percent of the Maximum Allowable Fee (MAF)?

 

A1. Wellmark will extend payment parity for Iowa providers until June 30, 2021 and South Dakota providers until further notice for medically appropriate codes. See a listing of the codes reimbursed at 100 percent.

 

Q2. What are the CPT codes and Place of Service that can be used for virtual visits?

 

A2. Providers should use the same codes they would use if the services were provided in person. Practitioners should bill using Place of Service 02 (telehealth). For example, a provider who previously billed a 99213 using Place of Service 11, will bill 99213 using Place of Service 02 (telehealth) to indicate that the service was done via a virtual visit. Ensure that you are communicating with any third-party billing vendors regarding the correct usage of Place of Service 02 (telehealth).

 

Q3. Do you use a modifier to bill a virtual visit?

 

A3. No, do not use a modifier to bill virtual visits to Wellmark. Virtual visits should be billed using Place of Service 02 (telehealth).

 

Q4. Is Wellmark using the billing guidance released from Medicare?

 

A4. No. Providers should use the same codes they would use if the services were provided in person. Providers should bill using Place of Service 02 (telehealth). For example, a provider who previously billed a 99213 using Place of Service 11, will bill 99213 using Place of Service 02 (telehealth) to indicate that the service was done via a virtual visit. Ensure that you are communicating with any third-party billing vendors regarding the correct usage of Place of Service 02 (telehealth).

 

Q5. Can I bill codes 99441-99443 and 99446-99452?

 

A5. For dates of service from March 16 until further notice, Wellmark will allow telephonic visits when video interaction is not accessible. Refrain from filing telephonic and non-face to face codes (99441-99443) and (99446-99452) as the claim will deny. For the claim to process, practitioners should use the same codes they would use if the services were provided in person and Place of Service 02 (telehealth). Do not use a modifier.

 

Q6. How do I document that a telephonic encounter occurred?

 

A6. Providers conducting telephonic-only visits with Wellmark’s members during this period must document in their medical records that the visit was conducted via telephone. Providers should only provide telephonic visits when appropriate and necessary.

 

Q7. Do providers need to credential differently to provide virtual visits?

 

A7. No, virtual visits services (telehealth) are not considered a provider specialty for network participation. For example, the provider type/specialty would be Family Practice MD, and this does not change if the provider is practicing through a virtual visit (telehealth).

 

Q8. Can a provider perform virtual visits from their home?

 

A8. Practitioners performing virtual visits (telehealth) do not need to meet the Practice Location requirements to provide a virtual visit and can provide virtual visits as long as it is within Wellmark's geographic service area (i.e., Iowa and South Dakota). Do not add a home location via E-Cred Central as a service location for virtual visits performed from March 16 until further notice.

 

Q9. How does a facility bill for telehealth when medically appropriate?

 

A9. Include a GT modifier on the claim lines that are telehealth services. Include a comment in the free form section of the claim stating the care was delivered via telehealth.

  • In the electronic 837 facility, the required comment should be placed in a claim level note Loop 2300 NTE.
    • NTE01=”ADD”
    • NTE02= telehealth

 

On the UB-04, the required comment should be placed in form locator 80.

 

Q10. Will telehealth visits apply toward a member’s accumulations?

 

A10. Yes, a telehealth visit would count toward accumulations.

 

Q11. How should an encounter for the pre-operative COVID-19 testing be coded?

 

A11. For encounters April 1, 2020, and after, the claim should include one of the pre-operative diagnosis codes sequenced first from subcategory Z01.81, Encounter for pre-procedural examinations, (i.e., Z01.812-Encounter for preprocedural laboratory examination) with the appropriate COVID-19 testing HCPCS code.

 

Q12. How should an encounter for COVID-19 antibody testing be coded?

 

A12. For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.

 

Q13. Will Wellmark cover the cost of COVID-19 at home testing kits?

 

A13. Both Wellmark and self-funded health plans are required to pay for at-home COVID-19 testing if ordered by a physician. Claims will be member submitted.

 

Q14. Will Wellmark cover services for adverse reactions to the COVID-19 vaccine?

 

A14. Wellmark covers adverse reactions for covered services. The claim will process based on the members benefits.

 

Q15. Is there a specific diagnosis code providers should use for an adverse reaction to the COVID-19 vaccine?

 

A15. The appropriate diagnosis code would be T50.B95A for an adverse COVID-19 reaction. Please note that this is also the same code used for an adverse influenza virus vaccine reaction.

 

Q16. Is Wellmark requesting a special indicator for the services related to an adverse reaction to the COVID-19 vaccine?

 

A16. Currently, no.

 

Q17. If Wellmark never received a claim for a member’s COVID-19 vaccine administration but it then receives a claim for that member’s adverse reaction, will it process correctly?

 

A17. Yes, it should process correctly.

 

Claims processing

Q1. Is Wellmark expecting claims processing delays during this time?

 

A1. At this time there are not any claims delays related to the COVID-19 pandemic.

 

Q2. Is the supply code 99072 a payable code?

 

A2. 99072 is not separately payable and will bundle with primary services on the claim. 99072 is not payable as a standalone charge. The denial is provider liability and cannot be balance billed to the member.

 

Q3. Is a follow up visit for return to normal activity a covered benefit for a Wellmark member following a COVID diagnosis?

 

A3. Yes, it is a covered benefit.

 

Q4. Is there specific coding guidance for a COVID follow up visit for return to normal activity?

 

A4. Code with the appropriate evaluation and management (E/M) code (i.e., 99211–99215).

 

Q5. How should an Ambulance provider file a claim for a confirmed or potential COVID-19 patient?

 

A5. When transporting a patient who either (i) has been diagnosed with COVID-19, or (ii) is reporting COVID-19 symptoms or exposure, please append the CS modifier to the claim. The CS modifier will serve as an indication for Wellmark to review the ambulance claim and corresponding facility claims and to determine the ambulance claim’s eligibility for potential member cost-share waivers in connection with COVID-19 diagnostic testing and testing-related services or COVID-19 inpatient treatment. Inclusion of the CS modifier does not guarantee a member’s cost-share will be waived.

 

Health management

Q1. How will Wellmark be handling authorizations for surgeries that were scheduled prior to COVID-19 or outdated histories and physicals (H&P’s) more than 30 days old for those same surgeries?

 

A1. Wellmark will be extending authorizations out until June 16. As long as surgery is completed within the approval period (including if it is completed during the time the approval is extended through), we will not require any additional clinical information for review. The approval will be based on the clinical information at the time of the initial decision.

 

Q2. If a provider is delivering speech therapy via telehealth, is a new/separate PA required?

 

Speech therapy does require a prior approval. Once a prior approval is approved by Wellmark the services can be delivered either face to face or via telehealth.


» Register now

[X]

I need secure access to:

Tools and resources related to:

  • Claims
  • Payment
  • Benefits
  • Authorizations

Take me there.

Or

E-credentialing Central to access these tools:

  • Application Tool
  • Change Request Tool
  • Recredentialing Tool
  • Provider Directory Update Tool
  • Submission Status Tracker
  • Submission History Tool
  • View my Organization
  • Manage my Users

Take me there.


Quick Links

» Claims/Benefits Lookup
» Manage Authorizations
» Authorization Tables
» Drug Information
» Find a Provider or Facility
» Forms
» Medical Policies A-Z
» Provider Guide
» Submission Status Tracker
» WINS - instant updates
FacebookTwitterInstagrampinterestLinked InYou Tube