BCBSIL COVID-19 Questions and Answers
The ILABA Insurance Task Force has been working with BCBSIL ABA leadership to gather information about procedures for conducting telehealth services for members. Be sure to follow the guidelines in the memo sent Friday, March 20th. If your member has a fully-funded commercial insurance plan, and you are requesting an additional 4 hours or fewer of 97156 to be conducted via telehealth, you can begin providing services immediately. The BCBSIL Care Coordinators will backdate any requests that fall within this guideline. Self-funded plans are regulated by the employer, so you will need to conduct a benefit check to determine if ABA via telehealth is allowed.
The modifier BCBSIL is using is 95, place of service 2.
On March 19th, 2020, the ILABA Insurance Task Force met with BCBSIL ABA leadership to discuss ABA providers conducting services via telecommunication platforms. Below is a summary of questions that you may have. As with much of our lives right now, things are evolving and changing with time. Any additional updates to the information below will be shared as we receive them.
Q: Is BCBSIL allowing for services to be provided via telehealth?
A: When the member has telehealth benefits, BCBSIL will authorize services to be conducted via telehealth. They are lifting the limit on rural Health Professional Shortage Area (HPSA) and allowing all members to receive telehealth services based on plan allowances.
Q: What types of platforms are acceptable for telehealth?
A: Phone or a HIPAA-compliant platform for video conferencing only. MDLive is not required. There are many HIPAA-compliant platforms available that are easily accessible. Ensure you are taking all steps to protect patient health information when providing telehealth services.
Q: What codes will be authorized to be provided via telehealth?
A: 97156 will be authorized to be conducted by a BCBA or BCaBA (receiving adequate supervision). Units currently authorized may be used via telehealth. If you would like additional hours, up to 4 hours will be authorized per week without any additional information proving medical necessity. 97151 may be used per AMA guidelines as authorized during the current auth period. If a member requires additional units, that approval will be based on medical necessity and should be submitted as a request (including an updated treatment plan and information outlining the medical need).
Q: How can I request additional units or codes?
A: All approvals beyond an additional 4 hours per week of 97156 will be subject to approval based on medical necessity. Submit any documentation to support the need to BCBSIL in accordance with all other submissions for request for treatment.
Q: What steps do I need to take to check benefits and receive approval for services to be delivered via telehealth?
A: Download the attestation form here. Fill it out (Do not check the 2nd box stating that you can provide support that the member is in a rural HPSA) and fax it in ALONG WITH the ABA Clinical Service Request Form OR a letter stating the number of hours for 97156 you are requesting be delivered via telehealth. You only need to fill out the section that requests the number of units you’re requesting. If you are requesting an increase in 97156 for 4 or less additional hours per week, you do not need to provide additional information. If you are requesting additional units for the authorization OR additional units via telehealth, you will need to submit proof of medical necessity.
Q: How should I document that telehealth sessions took place?
A: As stated in the BCBSIL ABA Clinical Payment and Coding Policy, documentation should include a parent/caregiver’s signature and data point(s) regarding the member’s progress for the day. They ask that providers continue to do their due diligence in documenting these sessions, and provide frequency or narrative data to document the session. They also understand that not all providers use platforms that allow virtual signatures. In that case, providers may choose to get parent signatures once face-to-face sessions resume, or document electronic signatures via an email.
Q: Should face-to-face sessions still be continuing at this time?
A: BCBSIL advises that providers follow WHO and CDC guidelines that recommend social distancing and quarantine. Continue to remain updated on recommendations, including those from the BACB.
The BCBSIL ABA leadership team recognizes that this is a difficult time for members and providers, and there is likely going to be fewer goals met and the risk of regression for members. This may mean that they did not meet projected goals for the next review. They will continue to remain in contact with ILABA as any changes occur. If you have any questions, please direct them to your provider rep. ILABA is committed to supporting our membership and will continue to do so during this unprecedented time.
Brigid McCormick, MA, BCBA
Chair, ILABA Insurance Task Force
Board Member at Large, Illinois Association for Behavior Analysis