CurrentBlue Cross Blue Shield - WisconsinPolicy N/A

Telehealth services participation and reimbursement

Governs Anthem/Blue Cross Blue Shield - Wisconsin participating providers' ability to deliver, bill, and be reimbursed for telehealth services in accordance with Connecticut statutory requirements; affects participating providers/groups and their telehealth vendors.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTelehealth services participation and reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit claims for telehealth services unless a Telehealth Compliance Certification Form is signed and Anthem has validated the telehealth solution.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

oneTelehealth Certification Form on file

noFacility fee permitted

real-time & store-and-forwardPermitted modalities

may be deniedClaims risk if not validated

Telehealth Coverage Conditions

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Telehealth Services must be delivered via a medium that meets Connecticut statutory requirements (the Statute). Anthem will not reimburse for Telehealth Services delivered through a medium that does not meet the requirements of the Statute.
Anthem's approved telehealth solution (LiveHealth Online Practice Edition) is an established option that meets the Statute's requirements; providers using other solutions must demonstrate those solutions meet the Statute.
A Telehealth Compliance Certification Form must be signed and returned to Anthem and Anthem must validate the telehealth solution before claims will be paid; claims submitted without an active Certification Form or Anthem validation will be considered incomplete and will not process.
Compliance monitoring and consequences
- Anthem may track/audit provider and vendor compliance with all applicable criteria.
- Initial failures to document or provide compliance documentation will result in a warning; repeat failures may result in disciplinary action up to denial of telehealth claims or termination of participation.
- If Anthem determines a provider/group is not compliant with the Statute, services provided via telehealth shall be considered non-covered and the provider may not bill or seek payment from the member under any circumstances.

ALL of the following

Providers must not bill or seek payment from the member (including cost shares) for telehealth interactions if the Telehealth Compliance Certification Form is not on file or Anthem has not validated the telehealth solution.
A claim submitted without an active Certification Form or Anthem written notification that the solution meets legal requirements will be deemed not a clean claim and will not process until the Certification Form is signed and Anthem determines services were rendered in accordance with the Statute.

ALL of the following

Providers must ensure their telehealth medium and vendor comply with all applicable legal requirements; in no event shall a participating provider/group provide telehealth services through a telehealth solution that does not meet legal requirements.

Coding and Prescribing Rules

Controlled substances prescribing restrictionmixedCovered

No codes listed

inv-03: Wait time standard — industry standard / reasonable expectation for wait times

Wait time expectationWait times for a telehealth visit or appointment must meet prevailing industry standard(s); if no such standards exist, wait times must be reasonable.

ApplicabilityApplies to telehealth visits and telehealth appointment scheduling for participating providers/groups in Connecticut.

Provider responsibilityProviders/groups must maintain and document wait times that meet standards or are reasonable when standards do not exist.

inv-08: Controlled substance prescribing — definition/summary of prescribing restriction for controlled substances via telehealth

General restrictionThe Statute prohibits a Telehealth Provider from prescribing Schedule I, II, or III controlled substances through the use of telehealth, with limited exceptions.

Exception for psychiatric/substance use treatmentAn exception allows prescribing and/or electronic submission of a prescription for a Schedule II or III controlled substance (other than an opioid) for treatment of a person with a psychiatric disability or substance use disorder, including medication‑assisted treatment, consistent with federal law (Ryan Haight Act).

Related requirementsPrescribing via telehealth must comply with applicable federal law and Statute conditions; other prescribing by telehealth is prohibited.

Provider Obligations and Billing

Denial Risk

Claims Submission Requirement — Certification & Validation

If a participating provider/group does not sign and return a Telehealth Compliance Certification Form to Anthem, or Anthem is unable to validate the telehealth solution used by the provider/group, the provider/group will not be paid for telehealth services rendered. Providers may not bill or seek payment from the member (including cost shares) for telehealth interactions in this circumstance.

Telehealth Compliance Certification Form must be signed and on file
Anthem validation of the telehealth solution is required for payment
Claims submitted without certification or validation risk denial

Note

How to Contract for Telehealth Services

Contact your designated Anthem Network Relations Consultant to contract for Telehealth Services. Anthem will communicate compensation terms to participating providers/groups; payment remains dependent on member benefits and all applicable Anthem policies and procedures.

Reach out to your Anthem Network Relations Consultant to begin contracting
Compensation details for Telehealth Services will be provided by Anthem
Payment is subject to member benefits and Anthem policies

Key Definitions

inv-06: Telehealth Provider — who is considered a telehealth provider under the policy

DefinitionTelehealth Provider: practitioners defined by the Connecticut Statute and may include physicians, advanced practice registered nurses (APRNs), physician assistants (PAs), occupational or physical therapists, naturopaths, chiropractors, optometrists, podiatrists, psychologists, marital and family therapists, clinical or master social workers, alcohol and drug counselors, professional counselors, board certified behavior analysts, and licensed dietitian/nutritionists.

Licensure requirementMust be licensed in the State of Connecticut and authorized under the Statute to provide services via telehealth.

Provider obligationsMust provide patient with license number and contact information, have access to patient history or records, conform to profession's standard of care, and obtain/document patient notice and consent at the first telehealth interaction.

inv-07: Telehealth modality — permitted modalities (real-time and store-and-forward) and excluded modalities (fax, audio-only, consumer VOIP)

Permitted modalitiesReal-time, interactive two-way communication technologies and store-and-forward technologies are permitted modalities under the Statute and policy.

Excluded modalitiesTelehealth does not include the use of fax, audio-only telephone, email, or videotelephony products (consumer VOIP) such as FaceTime or Skype.

Anthem solution complianceAnthem's LiveHealth Online Practice Edition is an established option that meets the Statute's requirements and may be used for compliant telehealth delivery.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTelehealth services participation and reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit claims for telehealth services unless a Telehealth Compliance Certification Form is signed and Anthem has validated the telehealth solution.

SourceLink

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