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Bcbsnc provider. 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. Not all providers offer acupuncture service. BCBSNC Medical Policy Use the Medical Policy search to review medical guidelines and payment guidelines. 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. Use our search tool below to find a plan provider close to home. Duke University Explore dental network resources through Blue Cross and Blue Shield of North Carolina, including filing claims, benefit eligibility and information, and provider news. Whether you want to find a doctor for yourself or a family member, we can help you get to the right place. • Attach Explanation of Benefits if these services are covered by another insurance policy. Blue e services are available for both the local proprietary format and HIPAA compliant transactions. 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. The Blue e User you identify for EFT access is designated as the Authorized Signatory of the Electronic Funds Transfer record. 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. That CPP designation DOES need to be noted in the Find a Doctor tool for the provider to be a CPP Primary Care Provider (PCP). Access resources, forms, and more. , experimental procedures, cosmetic surgery, etc. Members may also wish to discuss their questions and individual medical situation with their physician. Forms to add or remove a Blue e user or NPI. <strong>We're sorry but Blue E doesn't work properly without JavaScript enabled. 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. Campbell University: 800-579-8022. . e. User ID: If you can't remember your User ID, please call eSolutions HelpDesk at 1-888-333-8594 or your local help desk administrator. Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. BCBSNC will assist you in finding a network provider for any future services before the 90-day period expires. Here, providers are located by name, specialty, county or zip code. Provider News Get the latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. The “Notice Contact” may be different from your billing address and physical address. Choose option Some prescriptions may require prior authorization or prior plan approval. 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. The provider will use a personal ID and password to directly access the database over the internet. Manage Claims and Inquiries: Blue e for Web-based services. Medical drug requests submissions are preferred electronically through MHK Provider Portal (accessed via Blue e) only. Please view our list of acupuncture providers (PDF) to find providers in your area that may offer acupuncture. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. However, some participating specialists may require a new patient introduction from your treating doctor. 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 Provider Services. Due to legislation changes, Blue Cross NC now covers acupuncture services for Medicare Advantage members. Review the CPT, HCPCS, revenue and diagnosis codes that most often necessitate provider initiated medical record submissions. 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. Providers Home Contact us for more details about our plans, coverage, costs and more. You can reach our Blue Cross NC team by chat, phone, secure message or visiting a store. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (i. 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). Blue Cross and Blue Shield of North Carolina (BCBSNC). com . 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. 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. Quality-based programs recognize providers offering outstanding quality care to members. Incomplete forms may delay processing. This includes Provider Blue Books, enrollment forms and more. Code Set information. )— refer to your Provider Manual for coverage/limitations. Blue Cross NC makes health insurance easy. 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. Blue e provides details regarding how claims were adjudicated by BCBSNC, including Providers 800-214-4844. For provider questions and claims issues: Phone: 1-844-594-5072. Jan 26, 2016 · Family Care, PA 1413 Carpenter Fletcher Rd Durham, NC 27713 Phone: 919-544-6461 Fax: 919-361-2487 Email Us We have consolidated our resources for dental providers to make it easier to find the tools and information you need. Inpatient services and nonparticipating providers always require prior authorization. Blue Cross NC health insurance and Blue Connect for members lets you choose from a comprehensive network of thousands of caring doctors and providers. Please enable it to continue. com to register for our web portal and find policies, forms, and the latest newsletter. 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. There is an indicator in the Find A Doctor tool that identifies CPP providers. Better care starts here. Q: When do I need a referral from my primary care provider (PCP)? A: You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. Providers. A: For the most up-to-date provider information, access our online Provider Search. Paper Claim Filing pointers. com. For help with Blue Premier registration or account management, please contact your account administrator. • Claims must be filed within 18 months from the date services were received, or they will be denied. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services Find out how to join the network of providers who partner with BCBSNC to deliver quality health care to our members. We are committed to supporting you in providing quality care and services to Healthy Blue members. • Do not file a claim if the provider is filing for the same services or if the provider is in-network. 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. Log in to Blue e portal to manage claims, eligibility, prior authorization and more. Only providers with a Blue Cross NC contract can receive direct payment. You will need to contact Blue Cross NC Provider Service at 800-777-1643. 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. 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. Visit Anthem. All NC Providers must provide their 5-digit BCBSNC provider ID# below. Learn how to qualify for these programs, the benefits of participating plus how to use quality reports to identify care gaps. provider agreement and the provider manual for more details. Student Blue Appalachian State: 888-351-8283. 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 and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Blue Cross and Blue Shield companies' contract with doctors and health care professionals across the country. eSolutions for HIPAA-regulated transactions. If you're a provider looking for information about eligibility, claims status or other details, log in or register with Blue e. It is a participating provider’s/group’s contractual obligation to notify BCBSNC of any change to the Notice Contact. Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. Members are still expected to select a primary care physician (PCP). • Providers may be paying a billing service to resubmit a claim that was already in process to pay within a few days. Or by fax at 888-348-7332. Find out how to join, update or access the Blue Cross NC network of providers. Providers joined the CPP at the practice level, so members should be able to see any provider in that listed CPP practice. 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. Blue Cross NC members have access to wellness resources, information about their health insurance plan, dedicated customer service support and more. 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. Get the Blue Cross NC forms and documents for providers that you need all in one place. Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's PPO network as of July 28, 2022. The provider simply completes the paper copy and 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 Cross NC library of news articles helps providers stay up to date on health insurance rates, billing and reimbursement, incentive programs and more. %PDF-1. Your provider's office will submit claims for you when you visit an in-network eye doctor. The Provider Search information is updated weekly. • Provider office staff loses office time completing and submitting the second claim. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. 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. 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. </strong> 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. 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 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. 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. Search for many different types of providers, like: Linking your Blue Connect account helps you quickly access:. 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 ℠). Access the secure group portal for Blue Cross NC, offering health insurance and wellness benefits for producers. 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. You can search by name, specialty, location and more. These programs also help direct members to participating providers who embrace quality improvement. Here's what you need to know about Blue Cross and Blue Shield of North Carolina's coverage. 7 %âãÏÓ 163 0 obj > endobj 181 0 obj >/Filter/FlateDecode/ID[6C7DDC7A967A8447BC1EBC98FD409020>689133792C9FEC40BF2B9F865733C38F>]/Index[163 47]/Info 162 0 R • 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.
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