Teleservices

This benefit policy applies only to Blue Cross and Blue Shield of Nebraska (BCBSNE) members, excluding any Federal Employee Program or out-of-state BCBSNE members. BCBSNE will consider reimbursement for Nebraska-network providers for telemedicine when all the following conditions are met:  

1. All services provided are medically appropriate and necessary.  
2. Services are within the provider’s scope of practice as defined by state law.  
3. The service takes place via an interactive audio and video telecommunications system. Interactive telecommunications systems must be multi-media communication that, at a minimum, includes audio and video equipment permitting real-time consultation among the patient, consulting provider and referring provider (as appropriate).  
4. A service provided to a member located in Nebraska is rendered by a provider licensed to practice independently in the state of Nebraska.  
5. A permanent record of online communications relevant to the ongoing medical care and follow-up of the patient is maintained as part of the patient’s medical record.  
6. BCBS providers must deliver services via a secure and private data connection. All transactions and data communication must follow the Health Insurance Portability and Accountability Act (HIPAA). 
7. Providers performing and billing teleservices must be eligible to independently perform and bill the equivalent face-to-face service.  

Exclusions for teleservices: 

1. Services that occur the same day as a face-to-face visit, when performed by the same provider and for the same condition. 
2. Triage to assess the appropriate place of service and/or appropriate provider type. 
3. Patient communications incidental to E/M, counseling or medical services covered by this policy, including, but not limited to: 
   1. Reporting of test results. 
   2. Provision of educational materials. 
4. Administrative matters, including but not limited to; scheduling, registration, updating billing information, reminders, requests for medication refills or referrals, ordering of diagnostic studies and medical history intake completed by the patient. 
5. Medical interpretation or translation services. 
6. There will be no additional reimbursement for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service. 
7. Costs associated with enabling or maintaining contracted providers’ telemedicine technologies.  
8. Interprofessional telephone or internet consultations.  

BCBSNE reserves the right to audit these procedures at any time. This includes but is not limited to demos of technology, onsite visits and review of medical records.