Blue cross of nc providers

Blue cross of nc providers. If you get health coverage through an employer: Contact your group administrator or HR department to make changes to your account. By phone: Blue Cross NC Utilization Management - 800-672-7897. This includes Provider Blue Books, enrollment forms and more. In-network D/HME providers should participate in a Blue Plan in the state the Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue ©2024 Blue Cross and Blue Shield of North Carolina. It is a health insurance plan offered by Blue Cross NC that provides access to Atrium Health Wake Forest Baptist's comprehensive network of providers. Box 2291 Durham, NC 27702-2291. m. com. The Blue Cross NC Care Management Department works with physicians and members to facilitate the most medically appropriate, cost-effective, quality care for our members. 3200 ©2024 Blue Cross and Blue Shield of North Carolina. The percentage of medical doctors and hospitals is based upon the number of providers that applied for a Blue Cross NC provider number and then contracted with us versus the total number of providers who applied. To obtain prior review, always enter the Carelon Provider Portal in Blue e, regardless of Blue Cross NC COB carrier status (primary, secondary or tertiary). 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. Contact Network Management to obtain information about credentialing, provider numbers, contracts and sample fee schedules. Claims/Customer Service. Fax: 919-765-4349. Some of the specific changes you’ll notice include: The new tool offers a more straight-forward way to get the information you need. To help North Carolinians know who is eligible and how to apply, the North Carolina Department of Health and Human Services (NCDHHS) has a website that contains a bilingual toolkit and a sign-up form to stay updated on the most current information about how Nov 1, 2022 · For existing Blue Cross NC groups, Blue Cross NC will transfer medical and pharmacy authorizations to Brighton by Jan. Monday through Friday, 8 a. All NC Providers must provide their 5-digit Blue Cross Blue Shield of North Carolina (Blue Cross NC) provider ID# below. As a Blue Medicare PPO or HMO member, you may have access to more than 60,000 providers 1 state-wide. Providers looking to join can find out more about these networks. The vendor will bill Blue Cross NC directly. com (Accessed July 2022). Feb 23, 2022 · Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) implemented benefit changes for Point of Service (POS) Individual Under 65 (IU65) ACA products, which includes Blue Home, Blue Local and Blue Value (see below for specific health care systems). 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. www. Please complete forms related to pre-certification, behavioral health treatment, and other similar cases before rendering service. Provider Information Management & Operations (PRIMO) Removal, Termination, and Transfer Requests ® Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. These tools are offered for your convenience and should be used only as reference tools. Date of Request Patient Name Patient Blue Cross NC ID Number Patient Date of Birth Call us to get answers to your Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan, bill or claims questions. 16, 2003, as well as 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. 800-777-1643. The latest version will provide a more intuitive user experience and more accurate results. 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. Patients may be covered for a restricted medication if providers tell Blue Cross NC in writing that: Source: U. Find the best doctors and hospitals in your network and save on your health care costs with our online tool. Providers can proactively send medical records and other required documents to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) before claims are processed to help avoid denials or delays. 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. 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. Blue Cross and Blue Shield of North Carolina provides fee schedule information electronically to participating physicians. For admissions and private duty nursing. 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. 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. Blue Cross and Blue Shield of North Carolina 4615 University Drive Durham, NC 27702. Physical address: Blue Cross NC 5901 Chapel Hill Road Durham, NC 27707 Welcome to BCBSNC, the official website for Blue Cross and Blue Shield of North Carolina providers. 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. *If you are not registered to use Blue e, click on the . Feb 15, 2023 · As part of the Consolidated Appropriations Act (CAA), Blue Cross Blue Shield of North Carolina (Blue Cross NC) will require all practitioners to update and confirm their demographic information (e. Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. O. Blue Cross NC and Blue Cross NC contracting physicians are committed to meeting these standards in order to provide the best service 1 day ago · 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. Get insurance delivered through your local BCBS agency. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is an independent licensee of the Blue Cross and Blue Shield Association. Proof of prior dental coverage with less than 63 days lapse in coverage is required. Forms to add or remove a Blue e user or NPI. . This results in faster payment than paper checks. please contact the Blue Cross NC Provider Service department at 1-800-777-1643, Option 6. Terms of Use Find resources for Blue Cross NC Providers in- and out-of-network to manage patient claims and appeals, eligibility, prior authorization and more. Whether you are searching by a provider’s name, a Provider data last updated: Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Our provider network includes: Hospital systems like Atrium, Cone Health, Duke Health, Mission Health, Novant, and UNC Health Care. Our science-based resources and health guidelines help Blue Cross NC provider networks bring the most cost effective, quality health care to our members. 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. 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 The examples provided on this page relate to in-network services only. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. ET After hours, you may leave a voice message. bcbsnc. Blue Cross NC will update the MY 2024 Provider Reference Guide at that time if any changes are needed. Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of months of prior dental coverage. 1, 2023, for any Brighton-administered member benefits, so there is no need to act on any previously scheduled and authorized services/procedures. But telehealth has benefits beyond the pandemic, as well. News & World Report's "Best Medicare Advantage Plan Insurances Companies of 2022" Accessed 10/2021. Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Mar 1, 2024 · 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. Visit any of our locations for help understanding or purchasing a new health plan from Blue Cross NC. Take care of your dental health by making the most of your Dental Blue Select℠ plan. You can also call us to learn more about purchasing a plan. 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 NC Provider Appeal Department PO Box 2291 Durham, NC 27702 Or fax the completed form and supporting documents to: Billing/coding denials: 919-287-8708 Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross NC requires that patients first try a medication or device that is not restricted before a restricted medication will be approved. Under the Centers for Medicare & Medicaid Services (CMS) regulations for Medicare Advantage plans, non-contract providers have the right to request reconsideration for a post service denial of payment by Blue Medicare HMO and Blue Medicare PPO if the payment was denied following an organization determination. It also means not having to worry if a check is lost, stolen or damaged. Get the Blue Cross NC forms and documents for providers that you need all in one place. Blue Cross Blue Shield Association internal data; February 2023. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. Blue Cross NC Provider Reference Guide This version of the MY 2024 Blue Cross NC Provider Reference Guide is based on the preliminary HEDIS Specifications. Blue Cross and Blue Shield Plans. Continuity of Care Form (PDF) Mail: Blue Cross and Blue Shield of North Carolina Care Management PO Box 2291 Durham, NC 27702-2291; Fax: 800-228-0838 Linking your Blue Connect account helps you quickly access:. Blue Cross NC members can visit any licensed dentist they choose but can save money using in-network providers. g. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. This effort resulted in more than 28,000 providers partnering with the Plan for transparent and affordable health care. Mail: Blue Cross NC P. 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. With the BlueCard® program, Blue Cross NC members can get health care services and benefits while traveling or living in another Blue Plan’s service area. Access to a doctor without leaving your home A process by which the organization provides members with access to health care information and tools to better manage their health. Be advised that certain self-administered drugs have been excluded from Blue Cross NC's medical benefits but are covered under the prescription drug benefit. By calling 800-672-7897, Care Management staff are available to assist with arranging care for services for our commercial and State Health Plan membe These forms are specific to Healthy Blue + Medicare HMO D-SNP and are required when doing business with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). For help with Blue Premier registration or account management, please contact your account administrator. S. ©2024 Blue Cross and Blue Shield of North Carolina. Register for Blue e hyperlink found on the Providers home page of . Medical Oncology Program resources Get more information on the program, worksheets, an interactive tutorial and other helpful tools on Carelon's Blue Cross NC provider page . (Blue Cross NC 2024) Enhanced PPO Plan (80/20) North Carolina State Health Plan. Technical Information. Experience Health Providers. Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal. Allows members and their dependents to continue receiving care from a provider who is no longer in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network. 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. Please contact 888-206-4697 ( TTY : 711) for assistance. Electronic Funds Transfer (EFT) allows providers to receive electronic payments directly in their bank account. Get help with all your health care needs at the Blue Cross NC Centers. If a member-specific, dose-specific injectable drug is ordered from a network vendor - do not file a claim with Blue Cross NC for the drug. Get an Enrollment and Change Application from Customer Service (call the number on the back of your member ID card) or through your employer. HIPAA affects almost the entire health care industry, including employers. 1 Count on the name trusted for over 90 years ©2024 Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers training and tutorials to support providers in continuing their education. Blue e services are available for both the local proprietary format and HIPAA compliant transactions. Email: ProviderUpdates@BCBSNC. Providers can continue any previously scheduled and approved services/procedures. Access tools, policies and the latest information to help you care for our members. You can also access Blue e, the secure online portal that lets you check eligibility, claims status, and more. Incomplete forms may delay processing. geo-blue. 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. Individual and family plans (under age 65) Explore the health insurance options offered by Blue Cross and Blue Shield insurance agencies. com . When you choose dental and vision coverage with Blue Cross and Blue Shield . Mar 30, 2020 · When the pandemic hit, Blue Cross and Blue Shield of North Carolina expanded virtual access to health care providers. Our Provider Search and Cost Estimator Tool has been upgraded. BEFORE YOU START: Your local Blue e Administrator should have already given you a Blue e user account, with the EFTFULL user role. Communicating information to member's that specifies their rights and responsibilities related to a mutually respectful relationship with the organization, addressing complaints and appeals, benefits and access to medical services, choosing physicians and Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's PPO network as of July 28, 2022. Blue Cross and Blue Shield Association Internal Data: about. , practice name, address, phone number, email, and specialty) published in the Blue Cross NC provider directory every 90 days. Members may also wish to discuss their questions and individual medical situation with their physician. Medicaid Expansion Tools and Resources. SM, ® marks of the Blue Cross and Blue Shield Association. ; not all Blue Cross NC plans provide benefit coverage for autism treatment services. Sapphire365 - Blue Cross NC. As of December 1, 2023, more North Carolinians are able to get health coverage through Medicaid. of North Carolina (Blue Cross NC), you take a big step toward protecting your . . 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. Blue Cross NC and Duke Health, two of the most trusted and innovative names in health care, have come together to create Experience Health, a locally owned and operated, non-profit health plan for seniors. The Blue Cross NC business edits are also listed in Appendices B and C of the Blue Cross NC Companion Guide to EDI Transactions. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services Provider Blue Line 800-214-4844 Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Members should work with their providers to request prior approval from Blue Cross NC or may contact Customer Service on their own to obtain a continuity of care request form within 45 days of either their effective date or the date they receive notification of a provider's termination from a Blue Cross NC network. Blue Cross Blue Shield of North Carolina 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. BNCCARE-0147-21 June 2021 519143NCPENABS Please note, this form applies to Healthy Blue + MedicareSM (HMO D-SNP) offered 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. About Blue e Provider Portal Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Unlisted and Miscellaneous health service codes should only be used if a specific code has not been established by the American Medical Association. Terms of Use 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). 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. Learn more about our non-discrimination policy and no-cost services available to you. Presentations, videos and other training documentation will be added as they become available. Aug 29, 2024 · Effective November 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will transition medical necessity review of outpatient therapy services for Commercial Fully Insured members (including professional and home) to Carelon Medical Benefits Management (Carelon). This is critical to ensure BCBSNC and Blue Medicare HMO and Blue Medicare PPO members can access Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC’s PPO Network as of July 28, 2022. to 5 p. Blue Cross NC has collaborated with Atrium Health Wake Forest Baptist to bring you Blue Local with Atrium Health. Log in or register today to get started. health and saving money by catching problems when they’re small. Here you can find the latest news, updates, and resources to help you deliver quality care to your patients. We have options for every budget, and you can buy dental and vision plans even if Members should work with their providers to request prior approval from Blue Cross NC or may contact Customer Service on their own to obtain a continuity of care request form within 45 days of either their effective date or the date they receive notification of a provider's termination from a Blue Cross NC network. See important dates, forms, resources, policies and more. 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. Those transmitting 834 files are notified of business edits 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. Blue Cross NC is made up of multiple networks, including FEP, Medicare and Medicaid. The Blue Cross NC library of news articles helps providers stay up to date on health insurance rates, billing and reimbursement, incentive programs and more. 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. This Blue e account will have a unique User ID. 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. Try our Find Care search tool to find them. Business edits are identified by either the Blue Cross NC Claims Audit Report (for 837 Claims filings) or by the paired transaction to a 270, 276, or 278. Learn about Experience Health, a new and innovative insurance company owned by Blue Cross NC. Submission of this form is only a request for services and does not guarantee approval; not all Blue Cross NC plans provide benefit coverage for PHP. Through its Physician Advisory Group and Quality Improvement Committee, Blue Cross NC has established Urgent Care Facility and Medical Record Standards so that you'll know you can get the quality care you need. Final HEDIS Specifications are not released by NCQA until March 2024. L33, 3/20 Medicare Advantage Provider Appeal Form NOT to be used for Federal Employee Program (FEP) or Commercial Find a doctor or health care provider that fits your personal needs. tkp vbm ebwaa vvva pnib fnmdu ttxgxi assjt olinrlq jvlpm