Highmark BCBS Telehealth Provider Information and Guidelines

Highmark BCBS has a list of approved telehealth providers that you can choose from for your virtual visits. These providers have met the necessary qualifications and have the necessary equipment to deliver high-quality care remotely.

To find an approved telehealth provider, you can visit the Highmark BCBS website and search their provider directory. This directory allows you to search by name, location, or specialty.

Highmark BCBS also has specific guidelines for telehealth visits, including the need for a secure and private online platform to protect patient confidentiality.

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Highmark BCBS Telehealth is a service that allows you to access quality care from the comfort of your own home. This is made possible through the exchange of medical information between sites via electronic communication, also known as telemedicine.

Telemedicine is a broad term that includes a range of services using telecommunication technologies, such as videoconferencing. Highmark is committed to expanding access to quality care for its members by providing new options for more timely and convenient access to meet their needs.

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With Highmark BCBS Telehealth, you can receive services from approved telemedicine vendors who provide 24/7 access to a national network of board-certified physicians. These vendors use real-time interactive audio and video telecommunications technology to deliver care.

You can also have virtual visits with your trusted primary care providers and specialists using telecommunications technology. This is made possible through benefit enhancements that provide coverage for virtual visits with your healthcare providers.

Here are the ways you can access Highmark BCBS Telehealth services:

You can talk to a health care provider from your mobile device or computer. This is a convenient way to get the care you need without leaving home.

There are a number of ways to make a telehealth appointment.

Highmark BCBS telehealth services are available to participating primary care providers with the required telecommunications technology.

You can participate in Virtual PCP Visits and Virtual Retail Clinic Visits if you have the necessary technology and your services fall under your license scope.

The sessions must be conducted following Highmark's service and security guidelines.

Providing Virtual PCP Visits and Virtual Retail Clinic Visits is optional and not a requirement of network providers.

Most Highmark members with individual health plans and employer group coverage can access these services, including those with Federal Employee Program (FEP) coverage.

To provide telemedicine services to Highmark members, you must be an eligible provider. Highmark participating primary care providers who have the required telecommunications technology to support Virtual PCP Visits and Virtual Retail Clinic Visits may participate.

The services performed must fall under the scope of the provider's license, and the sessions must be conducted following Highmark's service and security guidelines.

Providing Virtual PCP Visits and Virtual Retail Clinic Visits for Highmark members is optional and not a requirement of network providers.

To be eligible, you must have the appropriate technology and follow the guidelines outlined by Highmark.

Eligible Highmark Blue Cross Blue Shield (DE) providers with the appropriate technology must follow the additional guidelines below:

Any member cost-sharing or visit limits under the PCP/Physician Office/Outpatient Visit benefits or the Retail Clinic benefit would apply. For example, if a member's benefit has a copay for a PCP visit, then the copay would be applied to Virtual PCP Visits.

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Updating Your Information in the Online Provider Directory is a straightforward process. You can update your information to indicate if you offer Virtual PCP Visits.

The Highmark Provider Directory is a valuable tool for members to find providers who provide the services they need in convenient locations. This directory is located on Highmark's public websites.

To update your information, follow the instructions in the section on Updating the Provider Directory for Virtual Services. This will allow you to note your ability to offer Virtual PCP Visits.

The online Provider Directory can also indicate if you offer other virtual telemedicine services, such as Virtual Behavioral Health, Specialist Virtual Visit, and Teledermatology. For providers in Delaware, it can also indicate telemedicine services as applicable under Delaware House Bill 69 and Delaware House Bill 160.

Updating your information is self-reporting, so it's up to you to supply Highmark with this information.

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The originating site is the location where an eligible member receives a specialist virtual visit. This can be either a medical site, such as a primary care physician's office, or a non-medical site.

To be eligible for an access fee, the originating site must be a medical site. Claims for the access fee can be submitted as either a professional claim or an outpatient facility claim.

The access fee cannot be billed to Highmark or the member by the medical originating site, and all contractual member hold harmless requirements must be met.

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Telehealth services have become increasingly popular, especially during the height of COVID-19 lockdowns. They offer the same quality as in-office visits with greater convenience.

Telehealth can effectively treat OUD (opioid use disorder) and eliminate geographic and transportation barriers that have traditionally limited access to opioid addiction resources. With providers like Ophelia, Pennsylvania residents can receive Suboxone prescriptions, guidance, and routine check-ins.

Highmark BCBS offers coverage for specialist virtual visits, which provide members with access to specialist services via telecommunications technology. This benefit enhancement provides coverage for specialist services for members who don't have readily available access to such specialty services.

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Virtual PCP visits and virtual retail clinic visits enable primary care providers to deliver primary care services remotely through secure real-time interactive audio and video telecommunications technology. This can increase access to primary care, especially for individuals with multiple chronic health conditions, those with severe illness and disability, and underserved populations in rural and remote areas.

Here are some benefits of virtual PCP visits and virtual retail clinic visits:

A specialist virtual visit is a real-time interactive audio and video transmission of a physician-patient encounter using telecommunications technology.

The patient can be located at a medical site, such as a primary care physician's office, or a non-medical site, like their home or office.

This type of visit connects the patient with a specialist at a distant site, allowing for coverage of the specialist's services and potentially an access fee billed by the medical originating site.

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Virtual PCP Visits and Virtual Retail Clinic Visits allow primary care providers to deliver primary care services remotely through secure, real-time interactive audio and video telecommunications technology.

This technology enables patients to receive care from the comfort of their own homes, offices, or other private settings.

Virtual PCP Visits and Virtual Retail Clinic Visits provide expanded access to services, especially for those with multiple chronic health conditions, severe illness and disability, and underserved populations in rural and remote areas.

These visits can be a cost-effective way to engage with patients and deliver care anywhere, anytime, while reducing administrative costs for the provider and travel costs for the patient.

Virtual visits can be used to triage cases and help reduce emergency room visits and hospitalizations by diverting members to less costly forms of care.

Here are some key benefits of Virtual PCP Visits and Virtual Retail Clinic Visits:

Telehealth Services are a game-changer for those in need of dermatological care. With teledermatology services, patients can receive faster and more convenient access to board-certified dermatologists, reducing wait times and potentially life-threatening delays in treatment.

For Highmark members, teledermatology services are eligible for reimbursement, making it a cost-effective option. These services are separate from telemedicine services provided by Amwell and Teladoc, independent companies that offer online medical consultation services.

The benefits of teledermatology are numerous, including flexibility for physicians and members alike. With secure technology, physicians can provide expertise online, reducing the time it takes to receive treatment and eliminating the need for in-person visits for minor skin conditions.

Here are the key benefits of teledermatology services for both physicians and members:

Teledermatology services can be provided using store and forward technology, which is secure and HIPAA & HITECH compliant. This technology allows members to log in, enter medical history, explain the issue, upload images, and submit a request to a doctor, all from the comfort of their own home.

Telestroke services are a vital part of telehealth, providing critical care to those in need. Telestroke allows specialists to remotely diagnose and treat stroke patients, reducing the time it takes to receive treatment.

In states like Delaware, Pennsylvania, and West Virginia, telestroke services are available to those who need it most. Telemedicine, the exchange of medical information between sites via electronic communication, makes this possible.

The specialist virtual visit benefit enhancement provides coverage for specialist services, including telestroke, for members who don't have easy access to specialty care. This means that patients in rural or underserved areas can receive timely and effective care.

Telehealth services like telestroke are a game-changer for patients and healthcare providers alike. By leveraging telecommunications technology, specialists can provide high-quality care to those who need it, regardless of their location.

Technology and Security is crucial for a seamless and secure telehealth experience.

Virtual PCP Visits and Virtual Retail Clinic Visits must take place via real-time audio and video telecommunications, with interactive technology that includes audio and video equipment for real-time consultation.

The aesthetic quality of the consultation should be comparable to that of an in-person consultation, with proper lighting, camera positioning, network connection, and a provider's monitor resolution of at least 512x512 at 8-bit pixel depth.

Highmark supports the highest standards to protect member information, but there may be risks in passing personal health information virtually.

To ensure a smooth and effective Virtual PCP Visit or Virtual Retail Clinic Visit, you'll need a stable internet connection with proper network connection to support real-time consultation.

The technology platform used by the provider will determine the specific equipment needed by the member. This could include a computer or mobile device with a high-quality camera and microphone.

The provider's monitor resolution must be at least 512x512 pixels at 8-bit pixel depth to ensure an aesthetically pleasing consultation. This means the provider needs a decent monitor to display the video feed clearly.

Members can participate in Virtual PCP Visits and Virtual Retail Clinic Visits from any location with a stable internet connection, as long as they have access to both audio and video streaming technology.

Security is a top priority when it comes to virtual healthcare visits. HIPAA and HITECH compliant telecommunications hardware and software must be used for Virtual PCP Visits and Virtual Retail Clinic Visits.

Highmark supports the highest standards to protect member information, but there may be risks in passing personal health information (PHI) virtually. This means that Highmark is not responsible for the security of virtual visits and does not validate the safeguards of any equipment and software used on either side of the virtual transmission.

To ensure security, providers must take the necessary steps to establish a doctor-patient relationship and conduct all appropriate evaluations and history consistent with traditional standards. This includes obtaining all relevant medical information and reviewing high-quality digital images (if applicable) prior to delivery of medical diagnosis and treatment.

Here are some key security guidelines for providers to follow:

Highmark BCBS offers virtual behavioral health options, including on-demand access to urgent care and mental health support through Well360 Virtual Health.

Virtual behavioral health visits are subject to cost-sharing under the member's Outpatient Mental Health benefit, making the member's cost-sharing the same whether the service is provided by the member's own provider or an Online Care Group provider.

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Highmark members must have both the Telemedicine Service benefit and coverage for Outpatient Mental Health services for behavioral health visits provided by Amwell's Online Care Group.

Most Highmark members have coverage for telemedicine services, but benefits can vary by product and group, so it's essential to verify a member's benefits prior to providing service.

The demand for behavioral health care services continues to increase, while access to qualified behavioral health specialists remains limited, resulting in longer wait times for patients to receive treatment.

Telemedicine is now allowing behavioral health specialists to provide their expertise remotely, offering more flexibility and reducing the time it takes for patients to receive proper treatment.

Highmark will reimburse mental health providers for outpatient care delivery via Virtual Behavioral Health, effective for dates of service on and after January 1, 2015.

Reimbursement for virtual behavioral health services is based on the fee schedule in place on the date of service and is subject to any applicable member cost-sharing.

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Highmark's reimbursement policy for telemedicine services is outlined in RP-046 Telemedicine and Telehealth Services. This policy ensures that providers follow specific guidelines to ensure continuity of care and accurate reimbursement.

To provide telemedicine services, providers must establish a doctor-patient relationship, conduct thorough evaluations and history, and ensure that services are medically necessary and within their licensure scope. This includes complying with local, state, and federal laws, as well as maintaining transparent mechanisms for follow-up and referrals.

Telemedicine services are not covered if providers fail to meet these criteria, and participating, preferred, or network providers can bill members for non-covered services. Reimbursement for telemedicine services is based on the fee schedule in place at the time services were rendered, with member cost-sharing and service limits applying if applicable.

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As a provider, it's essential to understand the guidelines for offering telemedicine services to your patients.

Services eligible under Delaware House Bill 69 are not intended to replace in-person visits, so you should consider whether an in-person office visit would be beneficial for the initial visit.

To provide telemedicine services, you must have the appropriate technology and follow the additional guidelines below:

• Provider must take the appropriate steps to establish a doctor-patient relationship and conduct all appropriate evaluations and history consistent with traditional standards.

• All services provided must be medically necessary and appropriate.

• Services performed must fall under the scope of the provider’s licensure.

• Providers shall comply with local, state, and federal laws and other regulatory agency requirements.

• Telemedicine treatment and consultations, including the authorization and dispensing of prescription medication(s), shall be held to the same professional standards of appropriate medical practice as those in a traditional in-office face-to-face encounter.

• Mechanisms to ensure continuity of care, follow-up, and referrals for emergency services must be in place and transparent to patients.

• Provider must obtain all relevant medical information (e.g., patient demographic information, chief complaint, history of present illness, allergies, medications, past medical/surgical/family history, and social history) combined with the appropriate review of high-quality digital images (if applicable) prior to delivery of medical diagnosis and treatment.

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• Documentation of the telemedicine service must be maintained in the patient’s medical record, as with in-person diagnosis and treatment services.

Reimbursement for all services will be based on the fee schedule in place at the time services were rendered, with member cost-sharing (copay, deductible, and/or coinsurance) and service limits applying if applicable.

Internet questionnaires are not an acceptable way to establish a provider-patient relationship. This method does not meet the standard of care required by Highmark.

Social media is also not a suitable way to establish a provider-patient relationship. This is because it lacks the necessary documentation and personal interaction.

Email messages are not a reliable way to establish a provider-patient relationship. They often lack the necessary information and personal touch.

Patient-generated medical history is not a valid method for establishing a provider-patient relationship. This is because it may not be accurate or comprehensive.

In Pennsylvania, audio-only communication is not allowed for establishing a provider-patient relationship. This includes interactive audio.

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Text messages are not a suitable way to establish a provider-patient relationship. They often lack the necessary information and personal interaction.

Facsimile (fax) machine is not a valid method for establishing a provider-patient relationship. This is because it lacks the necessary documentation and personal interaction.

Any combination of the above methods is also not acceptable for establishing a provider-patient relationship. This is because they do not meet the standard of care required by Highmark.

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Highmark BCBS Telehealth is a convenient option for those who need to see a doctor but can't make it to the office.

You can access Highmark BCBS Telehealth services through the company's website or mobile app, which is available for both iOS and Android devices.

Some services may require a copayment, but you can check your plan details to confirm what's covered.

In some states, telemedicine can only be delivered in certain ways. Telemedicine can be delivered via a real time 2-way audio-only conversation in Delaware, New York, and West Virginia.

To clarify, this type of telemedicine is limited to audio-only conversations in these states. However, in Delaware and New York, the patient must be unable to access the appropriate broadband service or other technology necessary to establish an audio and visual connection.

Delaware HB 69 requires that insured members are covered for telemedicine services on the same basis as an in-person visit to their provider.

Effective January 1, 2016, Highmark Blue Cross Blue Shield (DE) will provide coverage for the services of most physicians and many other providers performed via telemedicine.

This new law affects all fully insured commercial group and individual health care plans. Self-insured employer groups may or may not elect to provide coverage.

Medicare supplemental plans are exempt from this law.

Providers must verify a member's eligibility and benefits prior to rendering services.

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You can easily identify Highmark members with coverage for telemedicine services by requesting the consultation benefit through Eligibility and Benefits Inquiry or by using Additional Benefit Notes in Eligibility and Benefits Response. If a member has coverage for telemedicine services, the Telemedicine benefit will indicate “Yes.”

To verify a member's eligibility and benefits, use Availity's Eligibility and Benefits Inquiry or submit a HIPAA 270 transaction. This is a quick and easy way to confirm that the member's benefit plan provides the appropriate benefits for the anticipated date of service.

The "Telemedicine Service" benefit category under Professional Services in Availity's Eligibility and Benefits Inquiry is an indicator for Well360 Virtual Health and Teladoc services only. It does not indicate a member's eligibility for specialist virtual visits.

Always verify a member's eligibility and benefits prior to rendering services. This is the provider's responsibility to confirm that the member's benefit plan provides the appropriate benefits for the anticipated date of service.

In Availity, use Additional Benefit Notes in Eligibility and Benefits Response to verify if a member has coverage for Virtual PCP Visits and/or Virtual Retail Clinic Visits. The benefit category will indicate “Virtual Visits – Yes.”