This article is for all providers caring for our members
Beginning January 1, 2021, we will make changes to our health plans and benefits. Because of these changes, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits using Online Services, or another similar technology.
Virtual fitness programs
We have expanded coverage for virtual fitness programs due to the COVID-19 public health emergency. This includes virtual or online fitness memberships, subscriptions, programs, or classes that provide cardiovascular and strength-training using a digital platform. This applies to all commercial products and Medex.
Change to coverage for dental services under medical plans
In 2021, we’ll no longer cover the removal of impacted teeth under some members’ medical benefits. This change will separate dental services from those covered under the medical plan. For more information about this benefit change, see our October 1 News Alert.
To access this News Alert, log in and go to News. Look for the News Alert dated October 1 for oral surgeons and dentists called “Change to coverage for dental services under our medical plans.”
Expanding behavioral health services for children, adolescents
To comply with the Massachusetts Division of Insurance Bulletin 2018-07 regarding access to services to treat child and adolescent mental health disorders, we will cover two new intermediate care services for members under age 19*:
These services will go into effect when accounts renew starting January 1, 2021. This policy applies to all fully-insured accounts, excluding our Medicare Advantage and Federal Employee Plans; self-insured accounts may opt out of coverage.
Intensive Community-based Treatment (ICBT) offers clinical services intended to keep the patient in their home and community. For more details, see our fact sheet.
*We will continue to cover adolescent members engaged in an ongoing course of treatment beyond their 19th birthday until the course of treatment is complete.
Blue Plans to offer new national network plans
In 2021, you may begin to see members with health plans that use the Blue High Performance Network SM (Blue HPNSM), including members of other Blue plans who get their care in Massachusetts. Blue HPN is a new, limited network of providers that members can access across the U.S.
To recognize Blue HPN patients, look for the “HPN” in the suitcase logo on the front of the member’s Blue Cross ID card (shown below). Please follow the same procedures to file claims, and check eligibility and benefits as you would for any BlueCard member. Be sure to recommend these members to other Blue HPN providers for in-network care.
Sample ID card
You may see members from other Blue plans in with this ID card in 2021.
Advantage Blue Performance will use the Blue High Performance Network
In Massachusetts, we’re offering Advantage Blue Performance, an Exclusive Provider Organization (EPO) plan that is paired with the Blue HPN limited network. EPO benefits are limited to emergency care at a hospital facility only for non-Blue HPN providers. We currently do not have any local members enrolled in these plans. When we do, we’ll provide more details to help you identify these members.
Effective January 1, 2021, Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgently needed services and outpatient mental health services:
Change to coverage for kidney acquisition costs
Today, we cover kidney acquisition costs for your Medicare Advantage patients who need a transplant. Starting January 1, 2021, per a CMS rule, original Medicare will cover the acquisition costs for these patients. Therefore, beginning January 1, you’ll need to bill Medicare for kidney acquisition costs. For more information, see CMS’ Final Rule (FR 85 33796) dated June 2, 2020.
Partnering with new vendors for routine vision and hearing services
In 2021, we are making the following changesfor Medicare Advantage members:
This means that for dates of service on and after January 1, 2021, only contracted EyeMed and TruHearing providers will be reimbursed for these services for our Medicare Advantage members.
For more information on this benefit change, see our September 8 News Alert for audiologists or our October 21 News Alert for optometrists and ophthalmologists.
To access these News Alerts, log in and go to News. Look for the News Alerts dated:
Post-hospitalization meal program
Members being discharged after an inpatient stay at a hospital may be eligible for up to eight weeks of meals delivered to their home, at no cost, while they recover from their illness or injury.
This benefit is managed by our Care Management team who will work with you to coordinate medically tailored meals. To refer a member for this program, please send an email to MedAdvCMReferrals@bcbsma.com.
The following changes will be made to our Federal Employee Program Standard Option, Basic Option, and FEP Blue Focus plans starting January 1, 2021.
For more details on FEP benefit changes, download plan brochures at fepblue.org/plan-brochures.
In a September 1 News Alert, we announced changes we are making to our members’ benefits and coverage for their medications. These include:
To access our News Alert, log in and go to News. Look for the News Alert (indicated with an exclamation mark) dated September 1, 2020, called "Medication coverage changes starting Jan 1."