blue cross blue shield federal covid test reimbursement

COVID-19 Temporary payment policy (includes telehealth). For neuropsychological testing services listed in ourmedical policythat require prior authorization, we typically give the member 365 days to complete the authorized services. How am I reimbursed for at-home tests if I use FSA, HSA, or HRA funds? These amounts not paid by the plan may be the responsibility of the member. https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F Network of Preferred Providers: Effective March 10, 2020, we expanded the telehealth benefit and removed the member cost (copayments, co-insurance, and deductibles) for all COVID-19 related telehealth services, member cost will apply when billed with the appropriate modifiers. For information about your insurer's reimbursement process, see the information below. If you havent used Dental Connect before, youll need toregister for Dental Connect using partner codeBCMA01DPS(this is an important step for registration; Blue Cross Blue Shield of Massachusetts sponsors monthly fees for this service. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. At-home COVID-19 testing. People may also access free or affordably priced testing in the community. That form will be replaced on Jan. 23 once the insurer develops . The temporary cost share waiver for non-COVID medical and behavioral telehealth service will expire, reinstating member cost. Wait for our systems to identify the claim and correct it, Call Provider Service and ask us to reprocess the claim at one of the following toll-free numbers. In a hospital (including emergency room). COVID-19 Vaccine Information | CareFirst BlueCross BlueShield At-Home Rapid Tests Are Now Covered Over-the-counter COVID-19 tests are now covered for qualifying members. Your claim represents your attestation that you provided the service to the patient via telehealth. COVID-19 test reimbursement. Can I get reimbursed for multiple packages? The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Talk to board-certified doctors24/7 by phone or video. As of January 1, 2022, most members can get reimbursed for up to eight OTC at-home tests per member per month without a provider order. News & updates When you provide any services by phone, do not bill the specific telephonic CPT codes. Test kit cost $ Members need to submit a separate claim form for each family member. *UB-04 billers do not need to submit place of service code. You can use Dental Connect for Providers to verify member eligibility and benefits. Reimbursement Process Link or Description: BinaxNOW COVID-19 Antigen Self-Test (Abbott), BD Veritor At-Home COVID-19 Test (Becton Dickinson), CareStart COVID-19 Antigen Home Test (Access Bio), Celltrion DiaTrust COVID-19 Ag Home-Test (Celltrion), CLINITEST Rapid COVID-19 Antigen Self-Test (Siemens), Flowflex COVID-19 Antigen Home Test (ACON), iHealth COVID-19 Antigen Rapid Test (iHealth Labs), QuickVue At-Home OTC COVID-19 Test (Quidel), SCoV-2 Ag Detect Rapid Self-Test (InBios), See a complete list of authorized tests on the FDA's web page. Coverage for Medi-Cal and Cal MediConnect members, Local updates on COVID-19 from the State of California, Vaccine information from the Centers for Disease Control and Prevention (CDC). The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. COVID-19 Coverage for Members Your health is always our priority. The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. Most diagnostic and screening tests are covered for the majority of Blue Shield members. Health plans are offered by Blue Shield of California. All rights reserved. Bill all covered services that you render either by telehealth/video or telephone as if you are performing an in-person service using the codes that are currently on your fee schedule. For our Medicare Advantage members, coverage is through original Medicare. Bill as if you are performing an in-person service, using the revenue and HCPCS/CPT code combinations that you would normally bill on a facility claim. For more resources, visit myturn.org and the CDC websites. Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. The program is . 6Neither diagnostic nor screening testing is covered through pharmacy benefits. This policy applies to Blue Cross Blue Shield of Massachusettsmembers*in the following plans: Note: Employers who are self-insured may choose not to offer waived cost share for their employees. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ. The policy only covers over-the-counter Covid-19 tests authorized and approved by the U.S. Food and Drug Administration (FDA). If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. In a statement, Blue Cross Blue Shield said, "We are also working on . Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. 1-800-316-BLUE (2583), Dental Network Management Click Reimbursement Form. This helps make sure you dont have to pay more out-of-pocket. Reimbursement for tests purchased before January 15, 2022: The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. Related fees may include specimen collection or processing fees. Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. Proper documentation will need to be submitted. Its important not to fall behind on preventive care visits. 8*Self-funded group plan antibody tests are covered when ordered by a provider unless the group has opted in to offer coverage in alignment with SB 510. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. 800-942-0954 (main). We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. The member will be responsible for any unrelated fees charged by an out-of-network provider. Learn about what coverage and care you can receive through your Blue Shield, Blue Shield Promise Medicare Advantage, or Medicare Supplement benefits. Please enter the NDC or UPC number from the cash register receipt. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. DIFS is not responsible for any costs incurred in reliance on this information. We removed all member cost for in-person doctor, urgent care, and emergency room visits related to the testing, counseling, vaccination, and treatment of COVID-19. For example, a physician, a nurse practitioner, or a physician assistant. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html, https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, : https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdf, https://covidtest.optumrx.com/covid-test-reimbursement, In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA, COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF], https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, https://www.humana.com/coronavirus/coverage-faqs, https://www.mclarenhealthplan.org/mhp/are-you-a-member, https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049, https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, https://www.hioscar.com/at-home-covid-test-reimbursement, https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F, https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, https://www.phpmichigan.com/?id=175&sid=1, https://www.priorityhealth.com/covid-19/vaccine, https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Life Insurance and Annuity Search Service (LIAS), Health Insurer FIS 322 Submission Application, Financial Education (Banking, Credit Union and Credit Information), Establishing a program to have tests mailed directly to you upon request, or. This policy update applies to all medical providers. UB-04 billers do not need to enter place of service codes when billing for telephonic services. To make sure the associated costs for getting diagnostic tests are covered by your BCBSIL plan: As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. Some out-of-network providers may charge added fees. These actions will apply to all FEP members of the 36 U.S. and Puerto Rico-based BCBS companies, including those members located overseas, when applicable. That being said, I called my insurance provider, Blue Cross Blue Shield of Texas (BCBSTX) to ask if I could submit a claim for my test from last week. Members can also call the National Information Center at 1-800-411-BLUE (2583). Contact the company for the latest information. Virtual visits are covered. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. An attending health care provider may order a test. Note: These changes do not apply to our Medicare Advantage members. Reimbursement Process Link or Description: Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you access to the care you need during the COVID-19 pandemic. Reimbursement Process Link or Description: Some examples of authorized tests include: See a complete list of authorized tests on the FDA's web page. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Effective July 1, 2021, we reinstated member cost copayments, co-insurance, and deductibles for non-COVID telehealth visits, including all mental and behavioral health services. However, they will not be able to order a COVID-19 test for you. See the information below to determine if your insurer is reimbursing for these tests. Network of Preferred Providers: Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. For example: COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. Otherwise, contact your employer, plan sponsor, or benefits administrator. FEP to eliminate restrictions on prescription drug refills, waive pre-authorization, deductibles and copays for diagnostics, treatment, Blue Cross and Blue Shield Federal Employee Program Waives Cost Shares and Prior Authorization to Support Members Care for Coronavirus, Site-Neutral Payments Would Save Nearly $500 Billion Over 10 Years, Blue Cross Blue Shield Association Statement on Medicare Advantage Risk Adjustment Validation Rule, Blue Cross Blue Shield Association Policy Solutions Could Lower Health Care Costs by $767 Billion, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. Licensees of the Blue Cross and Blue Shield Association. Patient symptoms are expected to improve with cognitive rehabilitation. Medicare members can get up to eight OTC COVID-19 home tests each calendar month. To meet this requirement, insurers may choose to provide direct coverage for tests by: If your insurer does not provide direct coverage, or if you purchase tests outside of your insurer's preferred provider network, you can request reimbursement for some or all of your out-of-pocket expense. I received a check from Blue Shield. Others may need a boost due to the vaccine becoming less effective over time. See the Notification of Enforcement Discretion for telehealth. Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. We will share additional information when available. Click Online Form. If you intend to seek reimbursement from Blue Shield, it is recommended that you do not use an FSA, HSA, or HRA debit card to purchase at-home tests. NDC or UPC number Date purchased / / Quantity of tests. Patient symptoms impair daily functioning and are unlikely to resolve on their own over time. Reimbursement Process Link or Description: If you plan to provide a previously approved service to a patient in 2021, please call our Clinical Intake Department at the appropriate number and we will create a new authorization or update the existing one. Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) has extended the suspension of the mandatory payment reductions known as sequestration through December 31, 2021. 24/7 access is provided at no cost. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. A list of reports produced by our Department. Network of Preferred Providers: Under the rule, insurance providers are . As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. When testing patients in a drive-through or other temporary setting (such as a tent), please use the following codes for claims with dates of service on or after March 1, 2020.These codes apply to all commercial, Medicare Advantage, and Federal Employee Program (FEP) members. COVID-19 Testing Coverage Website: Coverage is available when the pharmacy offers OTC COVID-19 tests and has them in stock. Does BCBSIL cover at-home test kits? Independence Blue Cross(Independence) is implementing the Biden administrations over-the-counter (OTC) testing program finalized earlier this month. . Then have an authorized representative of the group you are joining sign the form and send it back to PHEexpeditedCred@BCBSMA.com. 100748 0521 R3 Page 1 . For thehigh-technology radiologyandsleep testing and treatment servicesthat require prior authorization with AIM Specialty Health, during the public health emergency, we authorized new requests for 180 days to allow time to have services performed. *Reimbursement for these codes is included in the payment for an evaluation or management (E/M) service if reported by the same provider on the same day, for the same member. They can obtain the tests from pharmacies, retailers and online vendors. All rights reserved. Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. My Turn Questions about medical or prescription coverage? As announced on April 6, Blue Cross will also waive cost share for COVID 19 related inpatient care at both in- and out-of-network acute care facilities for our fully insured members. Some may choose to cover screening tests for employment purposes, return to school, or sports. To avoid paying any extra fees, please use. Vaccine and vaccine administration codes for COVID-19. Testing and Treatment Coverage Contact the company for the latest information. Verify your contact information. La compaa cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, pas de origen, identificacin con determinado grupo tnico, condicin mdica, informacin gentica, ascendencia, religin, sexo, estado civil, gnero, identidad de gnero, orientacin sexual, edad, ni discapacidad fsica ni mental. Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. DIFS Prohibition Orders for Consumer Finance and Credit Union. Get the Blue Shield at-home COVID test reimbursement claim form. 2023 Blue Cross Blue Shield Association. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. For eligible plans, you can fill out and mail a paper claim form. For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for COVID vaccines and COVID vaccine administration. See OTC at-home test sectionfor more details. For in-network outpatient professional behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule. Important note: This information only applies to the ancillary and behavioral health specialties on this list. Retroactive to March 6, 2020, we waive member cost (copayments, deductible, co-insurance) for medically necessaryinpatient acute care hospital serviceswhen the claim includes a diagnosis of COVID-19. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. Learn more about potential out-of-pocket costs from out-of-network providers. Per state mandate Chapter 260 of the Acts of 2020 Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting.1. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). Commercial members: Managed care (HMO and POS), PPO, and Indemnity. Your doctor may also offer virtual visits if you prefer. We have plans to help keep you covered. In accordance with the Centers for Disease Control (CDC) and the MA Department of Public Health guidelines, covered scenarios include (but are not limited to): * Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes). Members can also contact Customer Service at 888-327-0671 (TTY: 711). These may include fees for other tests or other services unrelated to the COVID-19 test. By doing this, we will be able to identify when members should receive the cost-share waiver for COVID-19 testing, and the claim will be . Blue Shield of California has neither reviewed nor endorsed this information. As of April 1, for the duration of the COVID-19 public health emergency, we have added a 10-day supply limit to these medications for: This supply limit applies to members who use our standard Blue Cross Blue Shield of Massachusetts formulary. The provider should mail you a refund check. Members will receive test kits from network pharmacies at no cost. For providers not in the Teladoc network, the applicable cost share applies (unless COVID-19 related). At the same time, Blue Cross Blue Shield of Massachusetts continues to monitor and comply with all applicable state and federal regulations, including regulation of opioid prescribing and dispensing. COVID-19 testing for routine travel does not qualify as urgent or emergency care. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020. . To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Please follow the billing instructions outlined in our COVID-19 Temporary payment policy. If you are currently seeing a mental healthcare provider, you can continue to see that provider virtually. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. If your provider has not submitted a claim to Blue Shield for you, Some out-of-network providers may charge added fees. Standard office visit copay may apply. Providing Support During the COVID-19 Pandemic Communities Leading through a public health crisis All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. Need to talk with DIFS? If you are interested in a rewarding position helping Michiganders apply today! OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered. Plan Brochures Plan Summaries Quick Reference Guides Videos Claim Forms Medical Forms Health Benefits Claim Form UB-04 billers do not need to enter a place of service when billing for services provided by phone. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. The federal government has officially launched a program requiring health insurance companies to cover the cost of at-home COVID-19 testing kits. Find out which COVID-19 tests are available to members and where to get tested. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. This change is described in our April 30, 2021 News Alert, "Lab claims must include ordering clinician NPI starting July 1. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. However, at-home COVID-19 tests are not qualified medical expenses when the costs are reimbursed by Blue Shield. If you have a self-funded group plan, OTC at-home tests are not covered or reimbursable if purchased prior to January 15, 2022, without a healthcare provider order, or purchased at any time for employment purposes. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Log in and to go Office Resources>Billing & Reimbursement>Fee schedules. When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. COVID-19 Testing Coverage Website: We want to help ease stress during these uncertain times. 4These can be group plans from employers, associations, trusts, etc. Type OTC or Home in the search bar to narrow the results for at-home tests. Please note that Blue Shield does not offer tax advice for HSAs. How our department monitors insurance market practices, Insurance Company Contract and Rate Filings. This will enable us to pay you the same rate we pay you for in-person visits. FEP and Blue Cross and Blue Shield (BCBS) companies are following CDC prevention guidelines and other federal recommendations and will continue to support and protect the health and well-being of its members, their families and the community. SECTION 2 - PATIENT INFORMATION Reason for the test cI was exposed to someone with COVID-19. Health plans are offered by Blue Shield of California. Network of Preferred Providers: https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, COVID-19 Testing Coverage Website: https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Reimbursement for tests purchased before January 15, 2022: The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. Below are the codes for providers and laboratories to test patients for COVID-19. Centers for Disease Control and Preventions web page. Members can submit a direct member reimbursement claim to McLaren using the form found by following the link: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049. Learn more about the COVID-19 vaccine booster. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. Members should call the number on the back of their ID card. Blue Shield and Blue Shield Promise will cover most COVID-19 tests at no out-of-pocket cost to you for specified plans noted below. Seewhichtestsarecoveredforyourplan. Reimbursement Process Link or Description: Phone Number: Medi-Cal members: Do not submit any claims to Blue Shield Promise. 8 At-Home Rapid tests per 30 days. Blue Cross Blue Shield of Massachusetts covers the following drugs when usedoutside a clinical trialfor patients who are in aninpatienthospital setting and require treatment beyond respiratory support, at the discretion of their treating provider: Please note that standard inpatient payment policy rules apply. If you use the online form, you must file a separate digital claim for each member and for each receipt. Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines.