Bcbsnc provider

Bcbsnc provider. 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. Campbell University: 800-579-8022. (26) Patient Account No. These programs also help direct members to participating providers who embrace quality improvement. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). Call Provider Services at 1-844-594-5072. gov) Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. Precertification. Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue 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. Specialty Pharmacy Services include injectables and infusion therapies, and high-cost and complex care therapies. Providers. Normal processing time can vary between requests sent to Commercial or Blue Medicare. The specialist will schedule a same-day appointment with an On Demand provider when available. With this network, providers can have member-specific, dose-specific drugs delivered directly to their office, and the network vendors will bill Blue Cross NC directly for the drug. Reimbursement guidelines are developed by clinical staff and include yearly coding updates, periodic reviews of specialty areas based on input from specialty societies and physician committees and updated logic based on current coding conventions. 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. We will help connect you to a high-quality behavioral health provider or program. Not all providers offer acupuncture service. 4. However, you can enroll multiple providers to the same bank account. 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. To find a provider in the Healthy Blue network, click the search for a provider button below or contact Member Services at 844-594-5070 or TTY 711. com. . Provider Services. Required field. Blue Cross NC makes health insurance easy. Or by fax at 888-348-7332. You are leaving Anthem. O. Forms and resources If you're having problems logging in, call 1-888-868-5598 1-888-868-5598 H3449_3777, 9/6/07 2008 Provider Directory PARTNERS National Health Plans of North Carolina, Inc. Have you already registered your NPI? If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us. The provider will use a personal ID and password to directly access the database over the internet. 1-800-222-4739. Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. For all other covered services received outside of North Carolina, you are responsible for ensuring that you or your provider requests prior review by Blue Cross 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. A: For the most up-to-date provider information, access our online Provider Search. Blue Cross and Blue Shield of North Carolina (BCBSNC). Members are financially liable for ancillary services not covered by their benefits. Claims/Customer Service. Welcome to BCBSNC, the official website for Blue Cross and Blue Shield of North Carolina providers. If my provider number changes, do I need to re-enroll for EFT ? Yes, if your BCBSNC PPN changes, or you get an additional PPN you will need to enroll for EFT. Get the Blue Cross NC forms and documents for providers that you need all in one place. Your doctor can also find pre-approval forms on our provider prior authorization page . Find affordable health plans with exclusive benefits, extensive provider networks, and caring customer service. It is a participating provider’s/group’s contractual obligation to notify BCBSNC of any change to the Notice Contact. • Do not file a claim if the provider is filing for the same services or if the provider is in-network. 1 Support for agencies of all sizes Our team is ready to support yours. • Attach Explanation of Benefits if these services are covered by another insurance policy. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. • Providers may be paying a billing service to resubmit a claim that was already in process to pay within a few days. They can address your concerns in the office or refer you to a behavioral health provider. Here, providers are located by name, specialty, county or zip code. 6. Get a health insurance quote today. The fixed dollar amount, (for example, $15) you pay upfront to a health care provider for a covered service. Learn how to qualify for these programs, the benefits of participating plus how to use quality reports to identify care gaps. The provider will perform a clinical assessment and may treat the member with one of the following services: Medication management; Therapy; De-escalation (if / when necessary) The Office-Administered Specialty Pharmacy Network is available to supply providers with select specialty injectable drugs for the treatment of Blue Cross NC patients. • Claims must be filed within 18 months from the date services were received, or they will be denied. The examples provided on this page relate to in-network services only. For more details view our Provider Fee Schedules in Blue e Q&A (PDF) . Copayment amounts can vary depending on the service, the type of health care provider, and whether the provider is in or out of network. An out-of-network or out-of-state provider will not be familiar with BCBSNC's prior plan approval requirements. PARTNERS is a Blue Cross BCBSNC will work with you to resolve the issue. Incomplete forms may delay processing. Theme does not exist. Welcome to BCBSNC 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. Choose option Find out how to join the network of providers who partner with BCBSNC to deliver quality health care to our members. Name, NPI, IRS Number, Locations) and the termination date must be provided. 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. You will need to contact Blue Cross NC Provider Service at 800-777-1643. Providers 800-214-4844. Yes. ID Flag: Populates automatically with either S for the Social Security Number or E for the Employer Identification Number. Participating physicians who wish to view a special or supplemental fee schedule can contact their Network Management service representative to request a hard copy of the fee schedule. If the member’s group is not enrolled in the Carelon program indicated, PPA is not required for that procedure/drug in the specified place of service. All providers and mid-level practitioners must be credentialed through BCBSNC Electronic Funds Transfer (EFT) is a requirement of the BQPP program Learn more about applying for credentialing or email your questions about credentialing, provider numbers, contracts and sample fee schedules to network management at: NMSpecialist@bcbsnc. The “Notice Contact” may be different from your billing address and physical address. Providers Home Before you make your appointment for these services, have your doctor or provider call us at 800-222-4739. A detailed www. Use our search tool below to find a plan provider close to home. Average processing time will be between 10 to 30 business days. Y0114_20_122379_U CMS Accepted 05/08/2020. 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. Search for many different types of providers, like: Linking your Blue Connect account helps you quickly access:. You can also access Blue e, the secure online portal that lets you check eligibility, claims status, and more. Each provider name represents a provider vendor to whom we send separate payments. Eligibility verification — Prompt 1; Authorizations and precertification — Prompt 2; Claims status — Prompt 3; Provider relations — Prompt 4; Pharmacy department — Prompt 5; Care management — Prompt 6; Inpatient coordination — Prompt 7 To determine coverage of a particular service or procedure for a specific member: Access eligibility and benefits information on Availity. • For Compass Group Gold Plus Out-of-Area, Silver Plus Out-of-Area, or Bronze Plus Out-of-Area Plans - enter "CID"a as the identification prefix to find participating providers in the Classic Blue Network or click here. We have consolidated our resources for dental providers to make it easier to find the tools and information you need. A list of in-network participating providers may be obtained by contacting the BCBSNC Provider Blue Line SM at 1-800-214-4844 or online at www. bcbsnc. Call Blue Cross NC: 800-359-2422. These guidelines provide claims payment editing logic for CPT, HCPCS and ICD-10-CM coding. Members are still expected to select a primary care physician (PCP). Access tools, policies and the latest information to help you care for our members. But if you go to an out-of-network eye doctor, you'll be responsible for filing your own claims and may have to pay a higher fee for services. • Provider office staff loses office time completing and submitting the second claim. Access resources, forms, and more. Blue Cross Blue Shield of North Carolina P. Our large provider network gives them access to care across all 50 states and nearly 200 countries and territories around the world. 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 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 you are a participating provider other than a Blue Cross NC contracted medical doctor or doctor of osteopathy, you need to contact BCBSNC Network Management to obtain a current copy of your fee schedule. blue. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Complete provider details (e. All NC Providers must provide their 5-digit BCBSNC provider ID# below. Talk to your primary care provider. Blue e services are available for both the local proprietary format and HIPAA compliant transactions. In-network providers outside of North Carolina, except for Veterans' Affairs (VA) and military providers, are responsible for requesting prior review for inpatient facility services. Requests can be emailed to providerupdates@bcbsnc. Forms to add or remove a Blue e user or NPI. Providers may transmit the completed application electronically, or if they do not have Internet access, may call the CAQH Help Desk at 888-599-1771 and request an application to be sent by mail. The Provider Search information is updated weekly. g. You can search by name, specialty, location and more. false Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. Box 35 Durham, NC 27702 Customer Service. false. Find out how to join, update or access the Blue Cross NC network of providers. com . com or faxed to 919-765-4349. (PARTNERS) offers Blue Medicare HMO. You can reach our Blue Cross NC team by chat, phone, secure message or visiting a store. Due to legislation changes, Blue Cross NC now covers acupuncture services for Medicare Advantage members. BCBSNC will continue to conduct data verification and review and The BCBSNC Fee Schedule transaction is available only for participating professional medical doctors. BCBSNC can access the credentialing information anytime as long as the provider has given authorization. <br/>Your support ID is: 0. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services Blue Cross NC members have access to wellness resources, information about their health insurance plan, dedicated customer service support and more. Get tips on how to talk to your doctor about mental health. Explore dental network resources through Blue Cross and Blue Shield of North Carolina, including filing claims, benefit eligibility and information, and provider news. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Log in or register today to get started. Student Blue Appalachian State: 888-351-8283. The figures on this page are for illustrative purposes only. provider agreement and the provider manual for more details. A medical drug is a medication that will be billed under a member's medical benefit, including "buy and bill" scenarios (IV medications, injections administered in a provider’s office). If you have questions regarding this list, please contact Blue Cross NC Utilization Management at 1-800-672-7897 or your provider relations representative. Explore our affordable health insurance plans with coverage for people under the age of 65. For help with Blue Premier registration or account management, please contact your account administrator. The provider simply completes the paper copy and Quality-based programs recognize providers offering outstanding quality care to members. Your provider's office will submit claims for you when you visit an in-network eye doctor. They can also submit claims for Federal Employee Program members via mail. BCBSNC agrees to inform the Authorized Signatory by email, and to provide confirmation, by US postal service, of any creation of or change to the record. Q: How do I appeal a claim payment or denial? A: You have the right to request a formal appeal of the claim payment or denial. 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. Dec 31, 2012 · Providers can easily update their information anytime and will be asked quarterly to verify the accuracy of the information on file. Providers Home Contact us for more details about our plans, coverage, costs and more. Please view our list of acupuncture providers (PDF) to find providers in your area that may offer acupuncture. Then the specialist will add the member to the queue to visit a provider. If you have any questions about EFT, please contact your Healthy Blue Provider Relations representative or call Provider Services at 844-594-5072 for more information. 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. © 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. You can also contact Customer Service at 1-877-258-3334 for assistance in locating a provider or to obtain a paper copy of a directory. Title: Level One Provider Appeal Form (Do not use for FEP or Blue Medicare) Created Date: 20230731101421Z Jul 3, 2024 · To initiate post service review, please contact Carelon or log on to the Provider Portal within 10 days The results of the approved procedure will be required to complete the post service review. Provider News Get the latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription Some prescriptions may require prior authorization or prior plan approval. BCBSNC codebook for Providers Data 9 PROVIDER_CITY City of provider's address Char 25 Up to 25 characters 10 PROVIDER_STATE State abbrev/province of Providers can submit claims for members with FEP plans electronically. For provider questions and claims issues: Phone: 1-844-594-5072. Find a doctor or health care provider that fits your personal needs. This includes Provider Blue Books, enrollment forms and more. 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. 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. Providers looking for past allowed fee schedule amounts should contact Network Management. 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. Use the Prior Authorization Lookup Tool within Availity or. It is the provider’s responsibility to request payment directly from the member for noncovered In-network D/HME providers should participate in the Blue Plan in the state the equipment is shipped to, or the location of the store if it is purchased at a retail location. Better care starts here. Here you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to Healthy Blue members. Not prescribed or performed by or under the direction of a dentist or other provider Received prior to the member’s effective date Received on or after the coverage termination date, regardless of when the treated condition occurred or whether the care is a continuation of care received prior to the termination Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. In-network allowed amount is based on our negotiated rate with the provider; out-of-network allowed amount is based on the 90th percentile of usual and customary and out-of-network providers may bill you for amounts above the allowed amount. 6 days ago · The dates below are used for Medicare compliance and do not apply to provider data updates. Log in to Blue e portal to manage claims, eligibility, prior authorization and more. Requesting Provider Information Servicing Provider Or Facility Location (for services to be performed outside of the physician office) Provider Name Servicing Provider/ Facility Name Provider #, Tax ID # or NPI Servicing provider or Blue Cross NC health insurance and Blue Connect for members lets you choose from a comprehensive network of thousands of caring doctors and providers. Here's what you need to know about Blue Cross and Blue Shield of North Carolina's coverage. Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. BCBSNC Medical Policy Use the Medical Policy search to review medical guidelines and payment guidelines. This field populates automatically with the tax ID on record at BCBSNC for this provider. The Blue e User you identify for EFT access is designated as the Authorized Signatory of the Electronic Funds Transfer record. Medical drug requests submissions are preferred electronically through MHK Provider Portal (accessed via Blue e) only. Copayments do not count toward your deductible or out-of-pocket maximum. Access the forms you need to make service requests requiring prior plan approval, pre-certification, or certification when being reimbursed through the benefits of members of Blue Cross and Blue Shield of North Carolina. If prior plan approval is not obtained, BCBSNC will not pay for the scan and you will be responsible for the bill (this does not apply if you see an in-network provider). com to register for our web portal and find policies, forms, and the latest newsletter. We are committed to supporting you in providing quality care and services to Healthy Blue members. Blue e provides details regarding how claims were adjudicated by BCBSNC, including BCBSNC will assist you in finding a network provider for any future services before the 90-day period expires. The default theme will be used. Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's PPO network as of July 28, 2022. For each step in the appeals process, there are specified time frames for filing a grievance and for BCBSNC to notify you or your provider of the decision. About Mental Health (cdc. Visit Anthem. Here you can find the latest news, updates, and resources to help you deliver quality care to your patients. These tools are offered for your convenience and should be used only as reference tools. Please enable JavaScript to view the page content. Only providers with a Blue Cross NC contract can receive direct payment. Q: How do I change my primary care provider? A: To change your primary care provider, you can either call Customer Service at 1-877-258-3334 or visit My MemberServices at bcbsnc. Notice Date: In-network allowed amount is based on our negotiated rate with the provider; out-of-network allowed amount is based on the 90th percentile of usual and customary and out-of-network providers may bill you for amounts above the allowed amount. Health care providers, find a Blue Cross NC phone number for info on eligibility, benefits and claims status, plus medical policies, contract updates and more. Duke University 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 DOWNLOAD US - The free LIBERTY Dental mobile app gives you access to all our self-service tools 24/7. patao yjmm mjjvil qfm sktqdbj bql ecu fqmks qujej tmvcbe