Members can access their medically necessary, covered benefits through providers who deliver services through telemedicine. Many of our members also have access to various telemedicine vendors, such as MDLIVE.
Telemedicine services will be provided consistent with the terms of the member's benefit plan. As of Jan. 1, 2021, for our state regulated fully insured HMO and PPO members and our self-funded employer group members, providers will be able to deliver services which may include but are not limited to codes from the:
- Centers for Medicare and Medicaid Services (CMS) code list
- American Medical Association (AMA) codes list
- Applied behavior analysis (ABA) services
- Intensive outpatient program (IOP) services
- Partial hospitalization programs (PHP)
- Physician therapy (PT)
- Occupational therapy (OT)
- Speech therapy (ST)
You can reference the full code list here.
Our self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.
We recommend the following:
- Consider telemedicine a mode of care delivery to be used when it can reasonably provide equivalent outcomes as face-to-face visits.
- Choose telemedicine when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
- Integrate telemedicine records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.
Providers can use telemedicine for members with the following types of benefit plans. Care must be consistent with the terms of the member's benefit plan.
- State-regulated fully insured HMO and PPO plans
- Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement (see Medicare info in related resources Telemedicine 2021)
- Self-funded employer group plans
- Healthy Montana Kids
We will continue to follow applicable state and federal requirements.
If you need assistance, please contact Network Management .