Blue cross shield nc providers

Blue cross shield nc providers. 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. As a Blue Medicare PPO or HMO member, you may have access to more than 60,000 providers 1 state-wide. 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. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. U10160c, 2/24 2 © 2024, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. 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. It’s designed to deliver enhanced quality and lower costs by partnering with providers who are committed to – and accountable for – improving care today and in the future. 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). Feb 21, 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. Brighton is a national Third-Party Administrator (TPA). Blue Cross and Blue Shield of North Carolina is now sending some Healthy Blue bulletins, policy change notifications, prior authorization update information, educational opportunities, and more to providers via email. Call us to get answers to your Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan, bill or claims questions. Blue Cross NC electronically forwards 835 remittances for Medicare crossover claims received from other BCBS plans to providers with NPIs registered with Blue Cross NC to receive them. Find out if your doctor, drug, or pharmacy is in-network, or explore other care options. Program details Any disputes regarding these products and services may be subject to the Blue Cross NC grievance process. 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 ©2024 Blue Cross and Blue Shield of North Carolina. . The following links are intended to facilitate documentation, HCC (hierarchical condition category) Risk Adjustment ICD10 coding diagnoses and services that are provided to patients with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) coverage: Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Find the best doctors, clinics, specialists and hospitals outside the U. 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 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. 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. 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. The Blue Book is designed to assist you in understanding and administering Blue Cross NC health insurance products, health coaching and intervention 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. Find a Select Network doctor or facility in or outside of your home area. Incomplete forms may delay processing. This is critical to ensure BCBSNC and Blue Medicare HMO and Blue Medicare PPO members can access Use this form when giving Medicare services to members who have additional coverage with a different Blue Cross and Blue Shield (BCBS) plan. Shop plans for Medicare, Medical, Dental, Vision & Employers. 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. Provider data last updated: Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. That’s why Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is excited to offer Blue High Performance Network (BlueHPN ℠). 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. Members are still expected to select a primary care physician (PCP). Unlisted and Miscellaneous health service codes should only be used if a specific code has not been established by the American Medical Association. 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. ©2024 Blue Cross and Blue Shield of North Carolina. O. Hospitals can earn a reimbursement increase if they meet quality and performance targets. Members may also wish to discuss their questions and individual medical situation with their physician. 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. com . HIPAA affects almost the entire health care industry, including employers. S. Find results using these care categories. Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's PPO network as of July 28, 2022. Final HEDIS Specifications are not released by NCQA until March 2024. Blue Medicare HMO Enhanced, HMO Essential and Blue Medicare PPO Enhanced share the same Medicare prescription drug list. It is designed to be user friendly and gives you flexibility when scheduling Healthy Blue training for yourself and your staff. • Equipment that is purchased without prior rental will be owned by the patient. m. If you’re a member, you can access additional provider information (such as address, phone number and specialty) by searching for providers using your MyBlue account. Blue Cross and Blue Shield Association Internal Data: about. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. Providers. Nov 11, 2019 · HealthEquity is the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) preferred partner for all Fund Management Accounts, including the HSA. Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. . (Blue Cross NC 2024) Enhanced PPO Plan (80/20) North Carolina State Health Plan. 888-234-2416 x: 919-765-2322 M-F 8AM to 6PM: State Health Plan c/o BCBSNC Appeals Department PO Box 30055 Durham, NC 27702: Base PPO Plan (70/30) & Enhanced PPO Plan (80/20) Members: Smart NC is a program provided by the NC Department of Overseas Providers. Claims/Customer Service. All appointment times are guaranteed by our Wake Forest 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. 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. Try our Find Care search tool to find them A process by which the organization provides members with access to health care information and tools to better manage their health. Please contact 888-206-4697 (TTY: 711) for assistance. 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 e services are available for both the local proprietary format and HIPAA compliant transactions. 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. www. Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of months of prior dental coverage. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice 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. Blue Cross Blue Shield Association internal data; February 2023. Access to a doctor without leaving your home Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Blue Cross NC members can visit any licensed dentist they choose but can save money using in-network providers. Together, we can help the whole person thrive by bringing physical and behavioral health together. 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. All other marks are the priority of their respective owners. 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. Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. 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 can also call us to learn more about purchasing a plan. Each medication plan comes with a list (or formulary) that shows you what medications are covered. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. ®, SM are marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Official Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. 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 Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. 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. The new tool offers a more straight-forward way to get the information you need. 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. All appointment times are guaranteed by our Charlotte Doctors. 16, 2003, as well as Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. Individual and family plans (under age 65) Find a doctor or health care provider that fits your personal needs. These tools are offered for your convenience and should be used only as reference tools. By choosing Student Blue, you get several important benefits: 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. All other marks and names are property of their respective owners. Blue Cross Blue Shield of North Carolina Jul 9, 2024 · The Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provider directory is created from information provided by our network providers, facilities and Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. Access tools, policies and the latest information to help you care for our members. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). All appointment times are guaranteed by our Greensboro Doctors. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. 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. ET. SM, ® 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. Provider Pathways is a 24/7 educational resource that offers a foundation for doing business with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). NGFEPO-I, 5/23. geo-blue. 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. HQIP is Blue Cross NC's Pay-for-Performance program for acute care hospitals. 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 NC Provider Appeal Department Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Please contact 888-206-4697 ( TTY : 711) for assistance. 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. Blue Cross NC makes health insurance easy. Learn more about our non-discrimination policy and no-cost services available to you. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Appeals & Grievances (Blue Cross & Blue Shield of NC) To appeal a claim decision or to file a grievance. Browse by Category. 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. 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. Dec 13, 2022 · 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. Receive Healthy Blue emails from Blue Cross and Blue Shield of North Carolina. Carelon Provider Portal in Blue e; Prior Plan Approval: Commercial/Medicare; The prior review code list requires prior authorization through the Carelon Provider Portal or by phone at 866-455-8414 Monday through Friday, 8 a. Shatterproof, a national non-profit dedicated to reversing the addiction crisis in the 4 days ago · Find Blue Cross Blue Shield Doctors in Greensboro, North Carolina & make an appointment online instantly! Zocdoc helps you find Doctors in Greensboro and other locations with verified patient reviews and appointment availability that accept Blue Cross Blue Shield and other insurances. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. These tools are offered for your convenience and should be used only as reference tools. The benefit of using HealthEquity when you have a Blue Cross NC medical plan is that your account will be fully integrated. Disclosure: Blue Cross NC has collaborated with Atrium Health Wake Forest Baptist to bring you Blue Local with Atrium Health. Mar 30, 2020 · When the pandemic hit, Blue Cross and Blue Shield of North Carolina expanded virtual access to health care 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. All NC Providers must provide their 5-digit Blue Cross Blue Shield of North Carolina (Blue Cross NC) provider ID# below. 3200 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). 2 days ago · Find Blue Cross Blue Shield Doctors in Charlotte, North Carolina & make an appointment online instantly! Zocdoc helps you find Doctors in Charlotte and other locations with verified patient reviews and appointment availability that accept Blue Cross Blue Shield and other insurances. 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. Better care starts here. provider will collect the equipment. The program links participating health care providers with the independent Blue Cross and Blue Shield Plans across the country, and in more than 200 countries and Blue Cross and Blue Shield of North Carolina 4615 University Drive Durham, NC 27702. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. But telehealth has benefits beyond the pandemic, as well. • DME rental rates and maintenance fees should be calculated for payment on a prorated basis, based on provider contracted rates, when a full 30 days are not utilized by the member. Our overseas network includes over 11,000 providers. Blue Cross and Blue Shield of North Carolina is an independent Blue Cross and Blue Shield of North Carolina offers three drug formularies (drug lists) so Medicare beneficiaries can have options for their prescription needs. Find which documents are required and where to send them based on your patient’s health plan. 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. This program may be modified or 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. Get insurance delivered through your local BCBS agency. 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 Jul 15, 2024 · Starting August 21, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin reimbursing additional behavioral health inpatient and outpatient services performed via Telehealth visits. 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. Use our search tool below to find a plan provider close to home. The examples provided on this page relate to in-network services only. Proof of prior dental coverage with less than 63 days lapse in coverage is required. Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal. 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 Student Blue ℠ from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provides quality health insurance that meets the specific needs of college and university students. com (Accessed July 2022). bcbsnc. 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. Explore the health insurance options offered by Blue Cross and Blue Shield insurance agencies. Developers can register for access here and find the resources they need to build an application programming interface ( API ) to a member’s 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. 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. You can search by name, specialty, location and more. 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 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. This effort resulted in more than 28,000 providers partnering with the Plan for transparent and affordable health care. 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. 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. Explore dental network resources through Blue Cross and Blue Shield of North Carolina, including filing claims, benefit eligibility and information, and provider news. If you're a provider looking for information about eligibility, claims status or other details, log in or register with Blue e. HQIP was inspired by the Institute for Healthcare Improvement's "Triple Aim" initiative to improve health system performance in three areas: Patient experience (including quality and satisfaction), Health outcomes and reducing Experience Health Providers. Blue Cross NC will update the MY 2024 Provider Reference Guide at that time if any changes are needed. 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. 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. to 6 p. Provider/Other Professional Provider: Aug 20, 2024 · Find Blue Cross Blue Shield Doctors in Wake Forest, North Carolina & make an appointment online instantly! Zocdoc helps you find Doctors in Wake Forest and other locations with verified patient reviews and appointment availability that accept Blue Cross Blue Shield and other insurances. njlrkwp liuv jvvbyl krjnvy lskm gvou qlrt hcbwe zqtvyg spvdz