Coronavirus (COVID-19) Provider Information for ERS Participants

Updated: 11/15/2021

The Employees Retirement System of Texas (ERS) is the administrator of the HealthSelect of Texas^® and Consumer Directed HealthSelect^SM self-funded plans. ERS has provided the following policy for administration of benefits during the COVID-19 crisis.

Because this is a rapidly changing situation, BCBSTX will continue to monitor the situation and provide updates as they become available. Check back often for updates.

Prior Authorizations

This benefit policy was in place between March 16, 2020 through May 31, 2020. This benefit policy expired May 31, 2020. Prior authorizations for all initial/concurrent requests received without clinical documentation will be approved for a short period of time according to medical necessity and benefits covered under the health plan.

This includes:

• inpatient acute,
• inpatient post-acute,
• physical therapy, occupational therapy, speech therapy,
• home health and
• elective ambulatory transport.

This benefit policy was in place from March 16, 2020 through February 28, 2021, expiring Feb. 28, 2021. The benefit policy was also in place from August 24, 2021 and expired October 31, 2021. Prior authorization is not required for an interfacility transfer to a medically appropriate lower level of care through October 31, 2021. This will accelerate and simplify the transfer and discharge of patients from acute level facilities to the safest, clinically appropriate lower level setting of care (e.g., Long Term Acute Care Hospitals, Skilled Nursing Facilities, and others).

This benefit policy expired Dec. 31, 2020. BCBSTX will honor all prior authorizations on non-emergency/elective surgeries, procedures, therapies and home visits that were approved or scheduled between Jan. 1 and June 30, 2020.

• (Expired): These prior authorizations are approved through Dec. 31, 2020, so approved procedures can be rescheduled before Dec. 31, 2020.
• (Expired): Therapy sessions and home visits authorized for a specific number of visits between Jan. 1 and June 30, 2020 will have the same number of visits available through Dec. 31, 2020.

Health care providers should call the BCBSTX prior authorization number at 1-800-344-2354 for questions regarding a prior authorization request.

Referrals

This benefit policy was in place March 16, 2020 through May 31, 2020. This benefit policy expired May 31, 2020. HealthSelect participants do not need a referral from their primary care provider (PCP) to see an in-network specialist (this does not apply to services received from out-of-network providers). This allows providers to focus on providing care and saves time and effort for both participants and providers.

If you expect to see a participant beyond May 31, 2020, you must have a referral on file to get in-network benefits. Reference the Master Benefits Plan Document (MBPD) for services that require a referral or authorization outside of this designation time period.

Referrals for Monoclonal Antibody IV Therapy: BCBSTX will waive the primary care provider (PCP) referral for claims billed with Monoclonal Antibody (MAB) IV Therapy as approved under emergency use authorization during the public health emergency when medically appropriate in accordance with all other benefit plan provisions. Providers should visit the Food and Drug Administration (FDA) website for the most up to date information regarding Emergency Use Authorizations.

Telehealth

A participant’s PCP or specialist may be able to provide services via telemedicine/telehealth platforms. MDLive and Doctor on Demand are also a covered means of telehealth for HealthSelect participants.

Non-COVID-19 related in-network telemedicine services
This benefit policy was in place March 27, 2020 through June 30, 2021. This benefit policy expired June 30, 2021 for non-COVID-19 related, in-network telemedicine and Virtual Visits through Doctor On Demand and MDLIVE. Non-COVID-19 related in-network telemedicine services are covered at no cost to HealthSelect participants for covered services. Participants are encouraged to contact their providers’ office(s) to ask if this service is available.

COVID-19 related in-network telemedicine services
COVID-19 related in-network telemedicine services are covered at no cost to HealthSelect participants for covered services. In accordance with FFCRA, this policy will extend through the end of the public health emergency.

COVID-19 Lab Testing

Lab testing for COVID-19 is available to HealthSelect participants for both in-network and non-network labs at no member cost share. If you test a member when it’s medically necessary, medically appropriate and in accordance with generally consistent medical standards, submit the claim to us using the appropriate code. Member cost-share will be waived. In accordance with FFCRA this policy will extend through the end of the public health emergency.

PLEASE NOTE: COVID-19 tests required as condition for employment (including Workers’ Compensation) and tests that are not appropriate, medically necessary or approved under the public health emergency are not covered.

COVID-19 Coding and Guidance

For more details on COVID-19 coding and guidance, refer to the:

• American Medical Association website  and
• Centers for Disease Control and Prevention guidelines  .

Have Questions?

If you have any questions or need additional information, please contact your BCBSTX Network Management Representative.