Bcbs of north carolina providers

Bcbs of north carolina providers. Call us to get answers to your Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan, bill or claims questions. An official website of the State of North Carolina An official website of NC How you know . Members are still expected to select a primary care physician (PCP). Blue e services are available for both the local proprietary format and HIPAA compliant transactions. This will help us properly identify and credit the funds appropriately and Blue Cross and Blue Shield Plans. Filing your claims should be simple. Blue Cross NC makes health insurance easy. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. For health plans, providers and health care clearinghouses, the critical portions of the act are the Administrative Simplification provisions, which include new standards for electronic transactions that took effect Oct. Presentations, videos and other training documentation will be added as they become available. 16, 2003, as well as Prior review (prior plan approval, prior authorization, prospective review or certification) is the process Blue Cross NC uses to review the provision of certain behavioral health, medical services and medications against health care management guidelines prior to the services being provided. , Monday-Friday. Effective 1/1/2008, Blue Medicare HMO and Blue Medicare PPO members have the freedom to choose in-network providers and specialists without a referral. com 855-859-0966. Blue Cross and Blue Shield of North Carolina is an independent licensee Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Jun 6, 2024 · At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we appreciate all that you are doing to care for the health and well-being of our members. Access tools, policies and the latest information to help you care for our members. By mail to Blue Cross and Blue Shield of North Carolina If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working with providers to improve how and when behavioral health concerns are identified and treated. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Whether you are searching by a provider’s name, a particular specialty, a specific treatment, or your condition, you’ll be able to get accurate results that will help you make more informed care decisions. L33, 3/20 Medicare Advantage Provider Appeal Form NOT to be used for Federal Employee Program (FEP) or Commercial Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers training and tutorials to support providers in continuing their education. Browse by Category. Developers can register for access here and find the resources they need to build an application programming interface ( API ) to a member’s ©2024 Blue Cross and Blue Shield of North Carolina. COVID-19 tests that are administered by a provider, consistent with Centers for Disease Control (CDC) guidance and cleared, approved or given EUA by the Food and Drug Administration (FDA) are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs 1 to include copayments, coinsurance and deductible amounts. Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies. SM, ® marks of the Blue Cross and Blue Shield Association. Learn more about our non-discrimination policy and no-cost services available to you. Jul 3, 2024 · Changes will be posted to the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) website by the 10th day of January, April, July, and October. This Agreement is between _____ (herein referred to as "you" and "your") and Blue Cross and Blue Shield of North Carolina, an independent licensee of the Blue Cross and Blue Shield Association, (herein referred to as "Plan"). Blue Cross and Blue Shield of North Carolina offers three drug formularies (drug lists) so Medicare beneficiaries can have options for their prescription needs. When using out-of network providers, in addition to deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider's actual charge. Blue e is available for direct data entry of claims, claim correction, and inquiries in the Blue Cross NC local proprietary format and will continue to be available for as long as the CMS contingency plan is in place and the local proprietary format can be accepted. This effort resulted in more than 28,000 providers partnering with the Plan for transparent and affordable health care. Find a Select Network doctor or facility in or outside of your home area. • Providers may be paying a billing service to resubmit a claim that was already in process to pay within a few days. Your provider's office will submit claims for you when you visit an in-network eye doctor. Electronic Funds Transfer (EFT) allows providers to receive electronic payments directly in their bank account. All other marks are the property of their respective owners. Individual and family plans (under age 65) Nov 1, 2022 · Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has partnered with Brighton Health Plan Solutions (Brighton) to administer claims and member and provider services on behalf of Blue Cross NC to select self-insured employer group customers. Blue e provides details regarding how claims were adjudicated by BCBSNC, including Have questions? Call or write us! Member Services: 844-594-5070 (TTY 711) Already a member? Log in to your account and send us a message. EFT has the following benefits: • Payments are transferred electronically and post to your account before normal checks, making your funds accessible sooner. Welcome! Healthy Blue is the Medicaid plan offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to serve North Carolinians who participate in the state Medicaid program. ©2024 Blue Cross and Blue Shield of North Carolina. Services billed with the following revenue codes always require prior authorization:. Box 2291 Durham, NC 27702. Most patients with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) health insurance also have a medication plan to cover the medications they get at their pharmacy. As part of our focus on value and quality in provision of health care to North Carolinians, Blue Cross NC is implementing a special provider incentive program, focused on closing care gaps Providers. Blue Cross NC members can visit any licensed dentist they choose but can save money using in-network providers. ® Marks of the Blue Cross and Blue Shield Association. Our provider network includes: Hospital systems like Atrium, Cone Health, Duke Health, Mission Health, Novant, and UNC Health Care. Integrated health care If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provides free aids to service people with disabilities as well as free language services for people whose primary language is not English. BCBSNC Electronic Funds Transfer (EFT) Electronic Funds Transfer (EFT) is the fastest way to receive reimbursement from Blue Cross and Blue Shield of North Carolina. The provider portal allows the user to make changes online to the financial information (bank account and routing numbers) when needed. The Blue Book is designed to assist you in understanding and administering Blue Cross NC health insurance products, health coaching and intervention In-network providers in North Carolina are responsible for requesting prior review when necessary. This is critical to ensure BCBSNC and Blue Medicare HMO and Blue Medicare PPO members can access If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. HIPAA affects almost the entire health care industry, including employers. These provider partners are included in the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan’s Clear Pricing Project, and Blue Cross NC’s Blue Options network. • BCBSNC will not take any recoupments from the provider’s account. 1/24 Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Please select the right option for you: If you are interested in additional information concerning Blue Options HSA SM please contact our Direct Sales Department at 1-800-324-4973, 8 a. Receive Healthy Blue emails from Blue Cross and Blue Shield of North Carolina. S. Through our history, we’ve grown to better serve our members and meet North Carolina’s biggest health challenges. This results in faster payment than paper checks. . Effective November 1, 2021, EnrollSafe replaces CAQH Enrollhub as the electronic funds transfer (EFT) enrollment portal for providers. We have specialized agents to ensure you receive the information you need. (Blue Cross NC 2024) Enhanced PPO Plan (80/20) Update Your Primary Providers looking for past allowed fee schedule amounts should contact Network Management. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. Healthy Blue North Carolina Providers. You can also call us to learn more about purchasing a plan. The examples provided on this page relate to in-network services only. Try our Find Care search tool to find them. Provider data last updated: Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Each medication plan comes with a list (or formulary) that shows you what medications are covered. News & World Report's "Best Medicare Advantage Plan Insurances Companies of 2022" Accessed 10/2021. m. • Direct deposits are made to a bank account designated by the provider and maintained exclusively by the provider through . e. Here's what you need to know about the Blue Cross and Blue Shield of North Carolina specialty pharmacy network. -5 p. Blue E. A federal regulation called the Health Insurance Portability and Accountability Act (HIPAA) changes the way in which health care companies and medical care providers are permitted to use and disclose information about our Members. Log in to My Health Toolkit ® to search the provider directory and view search results specific to your insurance plan. The Blue Book is an online reference manual for products, value-added programs and services for providers participating in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network. LIBERTY Dental Plan is committed to providing Blue Cross NC members with the highest quality of dental benefits. These tools are offered for your convenience and should be used only as reference tools. 0240–0249 — All-inclusive ancillary psychiatric; 0513 — Psychiatric clinic (authorization waived for participating (PAR) providers with HCPCS code G0463 — outpatient facility claims) Blue Cross and Blue Shield of North Carolina (BCBSNC). Inquiries about our medical policies can be made by mail to the addresses listed below or you can call our Customer Service Department at 877-258-3334. Better care starts here. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Behavioral health. Street Address (Deliveries): Are you a provider? Contact Source: U. If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. That’s why Blue Cross and Blue Shield of North Carolina uses Availity, a secure and full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to Healthy Blue contracted providers. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers free, confidential health guidance for you and your covered family members. Explore dental network resources through Blue Cross and Blue Shield of North Carolina, including filing claims, benefit eligibility and information, and provider news. BlueCross BlueShield of South Carolina members. With Blue Cross and Blue Shield of North Carolina (Blue Cross NC Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Please use one form per claim, complete the form in its entirety and include with your payment. Brighton is a national Third-Party Administrator (TPA). Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. BlueHPN is a national quality-based network that provides members with access to high-quality doctors, hospitals and specialists across the state and country - all while lowering costs. Behavioral health. Blue Cross and Blue Shield of North Carolina P. Get an Enrollment and Change Application from Customer Service (call the number on the back of your member ID card) or through your employer. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has developed clear Fast Healthcare Interoperability Resources (FHIR) to allow members to share their data with registered applications. As a Blue Cross and Blue Shield of North Carolina member, you have two options for hearing aid discounts: Beltone and TruHearing. Unlisted and Miscellaneous health service codes should only be used if a specific code has not been established by the American Medical Association. Providers. Find resources for Blue Cross NC Providers in- and out-of-network to manage patient claims and appeals, eligibility, prior authorization and more. Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Since 1933, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been committed to making health care easier to navigate, more affordable and more accessible to all. 3200 Atlantic Ave Raleigh, NC 27604 Map It shpmemberinquiries@nctreasurer. Click to learn more. Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal. It is a participating provider’s/group’s contractual obligation to notify Blue Cross and Blue Shield of North Carolina (BCBSNC) of any change in demographic information. Blue Cross NC has robust search tools to help you find in-network doctors, hospitals, specialty pharmacies and urgent care in your state or across the country. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). Focused on the health of each member. You can also search providers outside the U. Provider Services. If you get health coverage through an employer: Contact your group administrator or HR department to make changes to your account. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. It also means not having to worry if a check is lost, stolen or damaged. Navigation. Nov 1, 2021 · Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina. Find results using these care categories. If medical records are needed to support a medical necessity review and are not received by Blue Cross NC before the claim adjudicates, the member will receive an Explanation of Benefits (EOB), the provider will receive an Explanation of Payment (EOP), and both will receive a claim denial letter addressing the specific reason(s) for the denial. If yes, and you want to contract with Blue Cross and Blue Shield of North Carolina (Blue Cross NC), you will need to confirm your supervising physician (if required for licensure) is already credentialed with Blue Cross NC by calling 800-777-1643 option 6. All Blue Cross and Blue Shield of North Carolina (Blue Cross NC) guidelines are based on the most current scientific evidence, and are adapted from standards published by nationally recognized authorities. Find out if your doctor, drug, or pharmacy is in-network, or explore other care options. Use Availity to submit claims, check the status of all your claims, appeal a claim decision and much more . Member Services: 844-594-5070 Provider Services: 844-594-5072 Behavioral Health Crisis Line: 844-594-5076. Forgot User ID? Forgot Password? Don’t have an account? Register Now. As a Blue Medicare PPO or HMO member, you may have access to more than 60,000 providers 1 state-wide. To find one near you or schedule Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Blue Cross and Blue Shield of North Carolina is an independent Provider Resources (Blue Cross NC) North Carolina State Health Plan. Blue Cross NC may contract with independent third-party vendors for the provision of certain aspects of our wellness programs and is not liable in any way for goods or services received from them. Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. • Provider office staff loses office time completing and submitting the second claim. Some prescriptions may require specialty handling, administration, or require ongoing clinical monitoring. Through our Nurse Support Program, you and your family have a dedicated, specially trained nurse to help you make full use of your company benefits for your best health. Blue Cross and Blue Shield of North Carolina is an independent licensee Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). BOX 2291 DURHAM, NC 27702 Please Fax to: 1-866-987-4167 PROVIDER INFORMATION CLINICAL INFORMATION *PROVIDER NAME *CLAIM NUMBER *PROVIDER MAILING ADDRESS *TOTAL CHARGE Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee Blue Cross and Blue Shield of North Carolina uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to Healthy Blue providers. O. For provider questions and claims issues: Phone: 1-844-594-5072. Together, we can help the whole person thrive by bringing physical and behavioral health together. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Have questions? Call or write us! Member Services: 844-594-5070 (TTY 711) Already a member? Log in to your account and send us a message. If your employer has chosen a Blue Cross NC Select Network, you have access to quality health care with a network of local doctors and hospitals in your area. FOR PROVIDER USE ONLY o help expedite your review, please complete this form in its entirety: PLEASE MAIL ALL INQUIRIES TO: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA P. Blue Medicare HMO Enhanced, HMO Essential and Blue Medicare PPO Enhanced share the same Medicare prescription drug list. Blue. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) must approve a prior review before your plan will help cover the cost of certain prescription medications, medical procedures, or health care services. As a result of the calendar year (CY) 2024 policy and technical changes to theMedicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, changes have been made to the Blue Cross and Blue Shield of North Carolina Blue Medicare Advantage ℠ medical policies. Members may also wish to discuss their questions and individual medical situation with their physician. Provider Refund Return This form serves as a remittance advice to assist in properly adjusting your account/claim with either Blue Cross NC or the NC State Health Plan. Please contact 888-206-4697 ( TTY : 711) for assistance. For questions concerning your dental assistance in locating a participating provider, or assistance in scheduling an appointment, please contact our member service representatives at: 866-544-4350, TTY users: 877-855-8039 North Carolina’s Health Information Exchange Network, NC HealthConnex, is a secure, computer-based electronic network for doctors, hospitals and other health care providers to share information that can improve your care – so that no matter where you are providers can access your information. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. brvtrxq wrvumqu adpdy scb lotc twhgb qyterw fpqi tangxktq rxxgh