Blue cross nc provider search. All appointment times are guaranteed by our Effective January 1, 2023, the following Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Individual Under 65 ACA Point of Service (POS) products will transition to Exclusive Provider Organization (EPO) products: Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has released the updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2024. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to being a valued health care partner in identifying ways to achieve better health outcomes, lower costs and deliver access to a better health care experience for our members. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is insourcing utilization management (UM) and intensive care management (CM) behavioral health services previously provided by Beacon Health Options in two phases. Blue Cross and Blue Shield Licensees have made reasonable efforts to validate that the information displayed is up to date and accurate. These new monthly reports replace all previous gap care reports and are designed to help point out patient care gap areas. Blue Cross NC and its facility providers share a common goal – to provide the best quality care for their patients. Explore care options, or log in to Blue Connect to search existing coverage. They can connect you to various specialists when needed. Largest Blue Cross NC provider and hospital network; Integrated Rx drug benefit Find in-network doctors, facilities, prescriptions, and more. By calling 800-672-7897, Care Management staff are available to assist with arranging care for services for our commercial and State Health Plan members. The new effective date for this policy revision is August 1, 2024. Username is invalid Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. By Rose Hoban. The Blue Cross NC business edits are also listed in Appendices B and C of the Blue Cross NC Companion Guide to EDI Transactions. Getting a referral from your primary care provider is important if you have an HMO plan and want to save money. Care for Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. As part of Blue Cross NC’s NCQA accreditation requirements, the Provider Network Operations department will be conducting an annual assessment of its provider directories for:. Search for a physician, specialist or hospital near you! National Provider Search. 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 While the statewide average rate increase for Blue Cross NC ACA plans is 3%, regional rate changes range from an average of -0. Blue Cross NC remains committed to measuring Effective October 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin transitioning at-home medical care of Medicare Advantage seniors and other adults with unmet well-being needs from Landmark Health to ConcertoCare. 5% to 6. 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. Providers can proactively send medical records to Blue Cross NC before claims are processed and help avoid medical-necessity denials that 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. Look Up a Doctor or Drug. These tools are offered for your convenience and should be used only as reference tools. Explore care options, or log in to Blue Connect℠ to search existing coverage. 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. This is a correction from our previously posted communication stating providers could use the Council for Affordable Quality Healthcare (CAQH) to ©2024 Blue Cross and Blue Shield of North Carolina. 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. Care Management staff Effective October 10, 2024, Blue Cross and Blue Shield of North Carolina Search by Individual NPI. Password is invalid 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 Vision plans from Blue Cross NC support early detection of diseases that could affect both your eyesight and your overall health. gov/ with your Medical Policies Search. Effective November 1, 2021, EnrollSafe replaces CAQH Enrollhub as the electronic funds transfer (EFT) enrollment portal for providers. There are several types of Medicare Advantage plans. Please call the provider prior to scheduling an appointment to verify that the provider This story was reported and edited through a joint partnership between The Assembly, NC Health News, and The Charlotte Ledger. In an effort to promote effective health care, Blue Cross NC is committed to fostering relationships of mutual respect and cooperation between our members and healthcare providers. Individual premiums HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. Changes will be posted to the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) website by the 10th day of January, 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 ℠ Medicaid Expansion Tools and Resources. Blue Blue Cross and Blue Shield of North Carolina (“Blue Cross NC,” "Company," "We," “Our” or “Us”) respects your privacy and is committed to protecting it. Use our provider search tool to find other healthcare professionals in the Healthy Blue Medicaid network. Below is a summary of the six quality standard categories Blue Cross NC follows per NCQA's Guidelines and Standards for the Accreditation of Health Plans. Minnesota Health Care Programs. Close Providers. You can search by specialty, location or network to find the healthcare provider that meets your needs. 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 Blue Cross and Blue Shield of North Carolina is now sending some Healthy Blue bulletins, policy change notifications, prior authorization update information, educational Blue E. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Electronic Funds Transfer (EFT) allows providers to receive electronic payments directly in their bank account. 1-888-234-2415 As previously communicated, Blue Cross and Blue Shield of NC (Blue Cross NC) has been experiencing delays enrolling new providers. I am A member A provider An employer An agent. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is investing in a joint venture that will support independent physicians and help them strengthen their practices. Shop plans for Medicare, Medical, Dental, Vision & Employers. A HIPAA 270 inquiry transaction may be sent with a Name and DOB only as well as a plan year 2022 date of service, and Blue Cross NC will Providers in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network recently received a Provider Relationship Survey in their email. , and The Dental Network, Inc. Try our Find Care search tool to find them. Search using natural language, filter by availability, medical specialty and more to browse doctors and locations before scheduling online. Blue Cross NC will discontinue our no-interest loan program for North Carolina ©2024 Blue Cross and Blue Shield of North Carolina. Blue Cross NC Blue Cross and Blue Shield of North Carolina (Blue Cross NC) implemented a number of measures to support members and providers during the COVID-19 pandemic. You can also contact Customer Service at 877-258-3334 for help locating a provider. The vendor will bill Blue Cross NC directly. Blue Cross NC may contract with independent third-party vendors for the provision of certain ©2024 Blue Cross and Blue Shield of North Carolina. Final HEDIS Specifications are not released by NCQA until March 2024. 1-800-222-4739. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Provider Name Phone Number Address City State Zip MOORE PEDIATRIC THERAPY SERVICES: 704-550-5554: 1021 OLD CHARLOTTE RD: ALBEMARLE: NC 27292 AUTISM IN MOTION CLINICS LLC: 919-589-4523 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. For D1, Blue Cross NC 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. As a BCBS member, your coverage travels with Try our Find Care tool to search for in-network psychiatrists, social workers, therapists, psychologists, and counselors. Individual and Family Plans. Name, NPI, IRS Number, Locations) and the termination date must be provided. Source: U. What does this mean for providers? As previously communicated, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is experiencing significant delays in enrolling new providers. Patients may be covered for a restricted medication if providers tell Blue Cross NC in writing that: It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). In 2020, Blue Cross NC saw members’ telehealth usage increase by more than 7,500%. MHK=Pharmacy Vendor (access through Blue E only By clicking on the link, you will be sent to the corresponding program page for more information regarding the specific authorization process. Restrictions may also apply based on state law. If you're struggling with a Find the right Medicare plan for you, in just one call. On behalf of Blue Cross NC, EyeMed Vision Care (EyeMed) assists in the network services of our Blue 20/20 product. Members are encouraged to visit their PCP before seeing a specialist. 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 Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced in March 2024 the offering of an interest-free provider loan supporting our smaller, independent providers facing financial burden due to the Change Healthcare (CHC) outage. Blue Cross NC accepts the upfront submission of medical records when the supplied records help document the medical necessity of services or supplies already provided to our commercially-insured members. Look Up 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. Find in-network doctors, facilities, prescriptions, and more. Please note that the search is not updated in real time, This list is subject to change at least once per quarter. Blue Cross NC members can call 800-755-0798 or log in to Blue Connect ℠ and fill out a mental health referral form. These tools make it easier than ever for you to access information and services when and where you need them. 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. The new entity will provide services to enable physicians to focus more on high-quality, cost-effective patient care while also offering practices the ability to HealthEquity is the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) preferred partner for all Fund Management Accounts, including the HSA. Care Navigation services are available to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) members 1 of all ages, from children to geriatric members. Precertification. Please enter your username. Accurate provider directories are critical for members to identify and access timely, affordable, and high-quality care. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Use the Blue Cross NC drug search to find your approved medications. Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. In addition, when a provider search is done in your geographic area. BlueCross BlueShield of Tennessee is How we pay for care matters because it signals what we value the most: quality, health outcomes and patient experience. and Blue Cross and Blue Shield of Kansas City are both Blue Cross NC members can visit any licensed dentist they choose but can save money using in-network providers. Healthy Blue is our health plan for Medicaid members. Blue Cross and Blue Plus have many different health plans and networks. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. Missouri Care, Inc. See the Blue Cross NC in-network doctors, pharmacies and drugs for your Medicare plan, plus information and changes on prescription drug lists and coverage. Please note, this communication applies to Healthy Blue + Medicare ℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC). It also means not having to worry if a check is lost, stolen or damaged. This person knows your medical history and care plan. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue 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. The telehealth policy covers doctor visits by video or phone the same as face-to-face visits. 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. Search Find care that's right for you. Find out if your Go to our Find Care page to search for a doctor or hospital. Search for in-network providers using our Find Care tool. Recently, Blue Cross NC became aware of At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we provide our customers with the tools and resources needed to help them make the best decisions for themselves and their families. EyeMed is an independent company that is solely responsible for the services it Provider Manual. Chat about your healthcare needs and your budget with a licensed Find Blue Cross Blue Shield of North Carolina Doctors & Providers with verified reviews. With the implementation of Healthy Blue Medicaid Managed Care plan on July 1, 2021, and Healthy Blue + Medicare on January 1, 2021, Blue Cross and Blue Shield of Blue Cross NC Internal records; SR100 Summary Report, May 2024 (Accessed July 2024). Health Plans for Individuals and Families; Experience Health Providers. Since 1933, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has helped millions of North Carolinians get and stay healthy. 22, 2022 Update: This communication has been updated to reflect the new anticipated date that Blue Cross NC will return to normal inventory levels. This results in faster payment than paper checks. bcbsnc. These areas can range from telling when a patient is overdue for a screening to This is a reminder for all eligible providers to be credentialed and complete all necessary enrollment applications with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Enrollment in the Network is open June 1 to June 30, 2021, to providers who currently treat North Carolina State Health Plan members via Blue Cross and Blue Shield of North Carolina’s commercially offered PPO network for a January 1, 2022 effective date. Blue e services are available for both the local proprietary format and HIPAA compliant transactions. As required by the Women's Health and Cancer Rights Act of 1998, your health insurance policy provides benefits for mastectomy-related services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. We are working diligently to return to normal inventory turnaround times for new enrollments . In the United States, Puerto Rico and U. A notice letter detailing the policy update will be emailed to providers, along with a copy of the full 2024 MA QIP Policy. 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 Search. Calling Blue Cross Blue Shield FEP Dental at 1-855-504-BLUE (2583), dial 711 for TTY relay services. If preferred, providers can also search by the group NPI; Search our in-network providers Each Blue Cross and Blue Shield of North Carolina (Blue Cross NC) health plan has its own network of covered health care providers. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Anthem - Provider Finder is a platform to locate in-network Anthem providers and estimate healthcare costs. 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 Blue Cross and Blue Shield of North Carolina (Blue Cross NC) requires participating providers to provide, as part of their credentialing process, Clinical Laboratory Improvement Amendments (CLIA) certification if laboratory services are rendered in an office, reference laboratory or facility setting. 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. Search for specialized care local to Texas. Sending a letter to Blue Cross Blue Shield FEP Dental, P. Also, many employers have a directory in their Human Resources department. 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. We're here to help you navigate your plan, understand your bill, renew your coverage, If you're a provider looking for information about eligibility, claims status or other details, log in or register with Blue e. 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 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 is an independent licensee of the Blue Cross and Blue Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC’s PPO Network as of July 28, 2022. The Provider Search information is updated weekly. Research published in the Journals of American Medicine Association Blue Cross and Blue Shield of North Carolina’s Risk Adjustment Coding Provider Education and Engagement Team is offering Microsoft LIVE meetings in Q1 and Q2. With this in mind, we are pleased to announce a Site of Care program Search. Prior to the acquisition, Blue Cross NC was Blue Cross NC provides fee schedule information electronically to participating physicians. 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. Get information on your policy using the state website found on your membership ID card. Notice: Incomplete requests will not be accepted for processing. Our employees bring energy and creativity to the workplace and it shows in our innovative approach to improving the health and well-being of North Carolinians. Home; Find a Doctor Select your health plan below to access your Find a Doctor tool. Beginning July 1, Carelon will retire the “Check Order Status” on the portal, and providers should instead use “Order Search” going forward. To locate a provider within your plan’s network, you will need to know the name of your plan. You can search our nationwide directories of Preferred providers—those providers who are in our network. Blue Cross NC continues to reevaluate the expiration dates for those measures based on the current state of the pandemic and public health data. Not long ago, Andrea Stubbs – a Blue Cross Blue Cross and Blue Shield of North Carolina 4615 University Drive Durham, NC 27702. We'll show you which drugs are covered, as well as which need prior authorization. Blue Cross NC will officially end working with Landmark Health by the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) communicated revisions to the professional pathology billing guidelines policy (PDF) on September 29, 2020. The total Linking your Blue Connect account helps you quickly access:. Important information about Changes to this Directory. Login to the MyNCID portal at https://myncid. Call 1-800-755-0790. Finding a CPP Provider (BCBS) Step-by-step instructions for finding a Clear Pricing Project provider in the Blue Cross NC network for 2024. About Blue e Provider Portal Search. com . Search for keywords Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. For admissions and private duty nursing. Blue Distinction is a designation awarded by Blue Cross NC and other Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality health care. , an Independent Licensee of the Blue Cross Blue Shield Association. 8%. Monday through Friday, 8 a. The BlueCross Total SM and BlueCross Total Value SM Preferred Provider Organization (PPO) plans provide in-state and out-of-state coverage. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina. These events will focus on coding educational topics On February 21, 2024, Blue Cross and Blue Shield of North Carolina’s (Blue Cross NC) pharmacy benefit manager, Prime Therapeutics, alerted us of a nationwide system outage affecting the company, Change Healthcare (CHC). Find a Doctor. are independent licensees of the Blue Cross and Blue Shield Association. Contact us for more details about our These instructions are for Individual and Business users only, not Local and State Government users. Case Management . ET After hours, you may leave a voice message. www. As of December 1, 2023, more North Carolinians are able to get health coverage through Medicaid. About Healthy Blue. Most plans are covered 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. Sept. Communications issued by Capital Blue Cross in Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Getting a patient’s prescriptions covered doesn’t need to be difficult. 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. Or, log into Blue Connect, choose Find a Doctor, and we'll show you doctors in your network automatically. Blue Cross NC members can search for in-network care locations through the Blue Connect portal. Skip to header Skip to navigation Healthy Blue is administered by Missouri Care, Inc. The company, working with Avalon Healthcare Solutions, a leading lab benefits manager, generated $112 million in cost savings and quality improvements for Blue Cross NC ©2024 Blue Cross and Blue Shield of North Carolina. Make an appointment online instantly with Doctors that accept Blue Find in-network doctors, facilities, prescriptions, and more. Those transmitting 834 files are notified of business edits HQIP is Blue Cross NC's Pay-for-Performance program for acute care hospitals. NC Provider Search. See your payment history, use AutoPay for monthly premiums, view invoices, and more. Log In. We are pleased to share that through measures taken to improve the process, we are currently enrolling new providers on a 60-day timeframe. 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. Explore Care Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is enhancing our ability to accept prior authorization requests electronically. By phone: Blue Cross NC Utilization Management - 800-672-7897. Parents, universities and colleges have trusted Blue Cross NC health insurance to protect their students, post docs, TAs, and RAs for more than 90 years. In-Network Providers. S. to 5 p. Please complete forms related to pre-certification, behavioral health treatment, and other similar cases before rendering service. Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC’s PPO Network as of July 2024. Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. This PDF report provides performance metrics for all measures and shows how your practice is performing according to HEDIS quality measurement standards and the Medicare Star system. , practice name, address, phone number, email, and specialty) published in the Blue Cross NC provider directory every 90 days. BHOD will serve as a same-day access point for care and provide a safety net for those who require assistance. They include: Members who have been diagnosed with stage four or five chronic kidney disease and those diagnosed with end-stage renal disease receiving dialysis services and; Members on fully insured, administrative services only* or Federal Employee Program plans and For this reason, starting July 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement the Autoimmune Pathways Program through program vendor Outcomes Matter Innovations (OMI) with the goal of preserving outcomes and reducing costs for members with chronic inflammatory disease. All other marks and names are property of their respective owners. If you have any problems logging in to the Blue e network or Blue Premier, please call the Linking your Blue Connect account helps you quickly access: Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of Find a Doctor. Providers can directly enter an individual practitioner NPI number to view their specific fee schedule. Our science-based resources and health guidelines help Blue Cross NC provider networks bring the most cost effective, quality health care to our members. Our current enrollment times are in most cases processing at a turnaround time of 120 days. The requirements are outlined currently in ©2024 Blue Cross and Blue Shield of North Carolina. Llame al Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is disabling the Utilization Management (UM) capability within Provider Link at the end of 2021 in an effort to streamline the exchange of records and communication with providers. BlueCross Secure SM Health Maintenance Organization (HMO) plans provide in-state coverage, with out-of-state coverage limited Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's PPO network as of July 28, 2022. The Provider Quality Reports use Blue Cross NC claims data to rank performance according to nationally accepted standards and measures. 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 Medicare Advantage networks. The In March 2020, Blue Cross NC was one of the first insurers in the nation to quickly respond to the pandemic by expanding telehealth coverage to pay doctors and facilities the same as in-person visits for all video and audio-only visits. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will continue to support the improved quality and decreased total cost of care through integrated treatment of mental and physical health – a Collaborative Care Model (CoCM). Use the Find Care search tool in your Blue Connect member portal to locate one in your area and when you travel. Patients may be covered for a restricted medication if providers tell Blue Cross NC in writing that: Search. 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). Inpatient admissions, services and procedures received on an Effective July 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is excited to announce the Blue High Performance Network ℠ (BlueHPN ℠) is now available to Fully Insured Groups in addition to the current Administrative Services Only (ASO) offering. We work with thousands of doctors, specialists, and hospitals throughout North Carolina, and we partner with many local organizations to 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. About Blue e Provider Portal Medical Record Submission Helpful Resources. Check the following information listed under the "Overview" and "Claim Details" sections of your EOB carefully for accuracy:. Blue Cross and Blue Shield of North Carolina is an independent licensee of the 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 Search for your providers here if you have an individual and family plan or medical insurance through your employer. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to improving collaboration with providers / ACOs in our value-based reimbursement programs (Blue Premier ℠ and Medicare Advantage Quality Incentive Program). For questions regarding Blue e, The Centers for Disease Control and Prevention (CDC) recommends that you receive a flu shot if you meet their criteria of high risk or fall under one of the following categories:Anyone who wants to reduce the risk of contracting the flu; People over the age of 50; People with high blood pressure, irregular heartbeat, history of stroke or heart attack, a chronic Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Show. The form below is the easiest way to report acquisitions and buyouts and provide us with the necessary information to process your acquisition. m. 1-800-672-7897. This policy describes the types of information we may collect from you or that you may provide when you visit or use our Website, including any subdomains (“Website”), our The joint venture between Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Deerfield Management Company has begun operating under the name Alo, a practice management resource for independent physicians. BCBS members can search for doctors, hospitals and dentists. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or Provider information contained in this directory is refreshed nightly with the exception of Pharmacy (refreshed monthly). Currently, Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor. Update May 23, 2023: Please see our full updated communication. For 90 years, Blue Cross NC has been a constant in the state: the largest health insurance provider across all 100 counties, a ubiquitous advertising and philanthropy presence, and one of Effective July 1, 2024, Carelon is changing the functionality of its Provider Portal. HIPAA affects almost the entire health care industry, including employers. 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 Search. All members within the Exclusive Provider Organization (EPO Benefit Primary care providers (PCPs) serve as a hub for your health and wellness needs, coordinating your care as issues arise. Explore. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue About Blue e Provider Portal Additional information about these codes can be found below. You can also find a range of health care providers to help you care for the whole you. We continue to add new enrollment staff, introduce automation and will be implementing It's important to make sure the information on your EOB, such as claim details and services you received, are correct. However, many adults don't have a PCP. Agents have been choosing Blue Cross and Blue Shield of North Carolina (Blue Cross NC) since 1933. Ask your doctor for a recommendation or referral. Starting in late March and continuing through August 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will communicate the importance of having an Annual Wellness Visit to Medicare Advantage members. Forgot User ID? Forgot Password? Don’t have an account? Register Now. ***Effective 1/1/2021 LabCorp/Fortrea ASO Group members require PPA for ALL DME ITEMS over $500 (excluding hearing aids)*** About Blue e Provider Portal Search. The designation is based on rigorous, evidence-based selection criteria established in collaboration with expert physicians and medical organizations. You personal details, such as your name and subscriber ID; Billed amounts from your health care provider 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. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has found success in delivering cost savings in another area of health care – laboratory services. Requests that are incomplete or are missing Blue Cross and Blue Shield of North Carolina (Blue Cross NC) proporciona asistencia gratuita a las personas con discapacidades, así como servicios lingüísticos gratuitos para las personas cuyo idioma principal no es el inglés. Access our Blue Connect member site to find an in-network provider. You can see a full list of network providers once you become a Blue Connect Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has created this page to help you understand how your plan works. 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. This effort resulted in more than 28,000 providers partnering with the Plan for transparent and affordable health care. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue 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. The new program will consider the medical necessity of studies and the clinical appropriateness of a facility- or home-based test. Search. 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 and Blue Shield (BCBS) members can search for doctors, hospitals and dentists. Explore your health Take a class or learn how to manage your health. ABT refers to behavioral and developmental interventions that can reduce challenges due to Autism Medical Guidelines Reason for Update; Ablative Techniques for the Myolysis of Uterine Fibroids (PDF)Updated Billing/Coding section to remove CPT code 0404T and added 58580, effective 1/1/2024. Supervising physicians need to be credentialed with Blue Cross NC first before we can offer a contract. Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of months of prior dental coverage. ©1998-BlueCross BlueShield of Tennessee, Inc. That’s why Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is excited to offer Blue High Performance Network (BlueHPN ℠). On January 1, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) introduced a new product in the Triad and Charlotte areas called the Blue High Performance NetworkSM (BlueHPNSM). Find Care. News & World Report's "Best Medicare Advantage Plan Insurances Companies of 2022" Accessed 10/2021. Web Content Viewer - Fixed Context Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. 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. Many of the health care providers in our network join quality programs. . Please check your benefit booklet for details. Outside the United States *Select Blue Cross Blue Shield Global™ or GeoBlue if you have additional international coverage and need to find care outside the United States. In this way, Blue Medicare HMO and Blue Medicare ©2024 Blue Cross and Blue Shield of North Carolina. 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. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a new Sleep Management Program. Find a Doctor, Drug or Facility; Shop Plans. Username is invalid Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex Oct. Blue Cross Blue Shield of North Carolina P. Complete provider details (e. Box 551, Minneapolis, MN 55440-0551. Search by Group NPI. If you would like to confirm this, we can Blue Cross NC is now offering Behavioral Health On Demand (BHOD), a virtual urgent care alternative for members who would otherwise visit the emergency department for urgent behavioral health needs. The organization does not use quality measures, member experience measures, or cost related measures to select any of our practitioners or hospitals for participation in the network, this includes those treating our Marketplace ©2024 Blue Cross and Blue Shield of North Carolina. Blue Cross NC helps you find a formulary, search for meds, and get prior approvals. Join Blue Cross NC for provider coding education to learn about HCC risk adjustment ICD10 coding diagnoses and services, chart retrieval and disease coding. 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. Members are still expected to select a primary care physician (PCP). 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 ©2024 Blue Cross and Blue Shield of North Carolina. (Effective April 1, 2017) This program includes online access to support tools for selecting cancer treatment Providers and practices who are going through an acquisition or are acquiring another practice are required to report any changes to Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Eligible members can access these Official Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. If your plan does provide coverage for gender-affirming care, some limitations and exclusions may still apply. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced today its expanded telehealth policy will remain in place through March 31, 2022. An accurate provider directory is an essential first step to accomplishing our mutual goal. there are specified time frames for filing a The Blue Cross NC Medical Oncology Program promotes optimal support for our members' cancer care needs, while reducing the costs for managing one of the most complex, expensive and prevalent diseases they can encounter. Use our search tool below to Find Care Near You with the Find a Doctor Tool. We would like to know about your experience as a partner of Blue Cross NC. Virgin Islands. We are working diligently to return to normal inventory turnaround times for new enrollments. Policies, Guidelines & Codes Use the Look up Doctor or Drug search to find an in-network doctor or facility. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue ©2024 Blue Cross and Blue Shield of North Carolina. nc. The results are based on Blue Cross NC claims data as well as patient health care records. But that can be a frustrating experience when it comes to finding mental health care. If a provider does not have an ID Card for a State Health Plan member, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provides two methods of inquiry to obtain the information. Call us directly to compare Medicare plans in your area. Effective October 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will now consider all Medicare claims with total charges of $100,000 or greater on On April 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a Notification of Policy Revision announcing that prior authorization for all Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) would be required effective July 1, 2024. Review our Blue Cross NC RxDC prescription reporting page for help reporting employer group data about prescription drugs and health care spending. Claims/Customer Service. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. is a group of doctors, clinics, hospitals and other health care providers that you can see for a lower cost. Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will require prior authorization for Adaptive Behavioral Treatment (ABT) for ALL Commercial products/plans that provide benefits for this therapy. Access tools, policies and the latest information to help you care for our members. Search for a provider for you and your family. accuracy of office locations and phone numbers; accuracy of hospital affiliations; accuracy of accepting new patients Blue Cross NC=Blue Cross UM . Eligible providers also include mid-level practitioners. : Allergy Immunotherapy (Desensitization) (PDF)References updated. We have since learned that the CHC outage has prevented some providers and hospitals using CHC as a vendor for their Blue Cross NC does not recommend, endorse, warrant or guarantee any specific vendor, product or service available under or through third parties. 6, 2022 Update: Provider enrollments currently have 60-80 days of turnaround time. As an independent licensee of the Blue Cross and Blue Shield Association, we are a trusted health insurance leader 2 and our network is As we previously communicated, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) was experiencing significant delays in enrolling new providers. O. Locate vision care providers, mental health professionals, virtual care options, and more. Search for a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced that its industry-leading Blue Premier program improved quality of care for patients and saved nearly $164 million in health care costs in 2022, helping curtail the impact of medical cost inflation for members and small and large businesses. These vendors do not offer While all standard Blue Cross NC plans cover gender-affirming care, some employer groups may choose not to provide this coverage. Username is invalid. The upcoming changes to our processes will improve quality and timeliness in onboarding our new providers/practitioners to Blue Cross NC. Use our National Doctor and Hospital Finder tool to see if your doctor is Blue Cross NC locations are dedicated to helping you get the insurance support you need. About Blue e Provider Portal For reference, a Group may find their Form 5500 plan number by visiting the US Department of Labor Form 5500 Search Tool. Blue Cross Effective November 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin utilizing the Council for Affordable Quality Healthcare (CAQH) ProView universal credentialing application. 1 These categories are central to Blue Cross NC's Quality Improvement Program designed to improve quality, safety, and member experience. Eligible members are automatically included in the program. Hospitals can earn a reimbursement increase if they meet quality and performance targets. Flexible and convenient care options Of course, you can use our search tools to find doctors and hospitals that take your insurance. 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 Your choice of providers. Developers can register for access here and find the resources they need to build an application programming interface (API) to a member’s health data or to ©2024 Blue Cross and Blue Shield of North Carolina. 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). Use the Find Care tool above or the BCBSTX mobile app to search for in-network doctors who specialize in your diagnosis. 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. For many of us, the natural place to begin looking for providers is to search online. Blue Cross NC will be partnering with providers to increase efficiency through the expansion On September 28, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a communication regarding the new Musculoskeletal Program and Interventional Pain Management program, effective October 1, 2023, through Carelon Medical Benefits Management (Carelon). Password is invalid If you have questions about this change, call 800-214-4844 for the Blue Cross NC Provider Blue Line. Box 35 Durham, NC 27702 Customer Service. Please share your honest feedback on your satisfaction level as a participating Blue Cross NC network Blue Cross NC members across 20 counties in Western North Carolina will benefit from the care they receive at Mission Health providers and facilities, including six hospitals and more than 1,000 physicians. ©2024 Blue Cross and Blue Shield of North Carolina. and hospitals under contract with your Blue Cross NC plan for discounted rates. Only CMM (including State Health Plan), HMO and PPO lines of business have fee schedules in Bue e. g. By clearly defining the rights and responsibilities of our insured members, we hope to encourage a spirit of understanding and cooperation between our members, our FastMed locations in North Carolina will continue serving all North Carolinians and those visiting the state regardless of their health insurance or carrier, not just Blue Cross NC members. Our directory allows you to search by provider last name or type of provider. This policy is in effect as of March 9, 2021, and is available on our Medical Policy updates page . As a part of this effort, Blue Cross NC will be implementing an annual Preventive care is covered at 100% when 1) it is provided by an in-network doctor, 2) the claim is filed as a preventive visit and 3) services are identified as preventive care under the Affordable Care Act (ACA). It is designed to be user friendly and gives you flexibility when scheduling Healthy Blue training for yourself and your staff. We are dedicating significant resources to establish one of the most advanced value-based care initiatives in the nation, working together with providers to help simplify and improve the health system for members in Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. in cooperation with Blue Cross and Blue Shield of Kansas City. Get in touch with your local Blue Cross and Blue Shield company. If you're a provider looking for information about eligibility, claims status or other details, log in or register with Blue e. Find care in minutes with Novant Health's brand new Physician Finder, an online scheduling tool that empowers the patient to easily find the right provider at the right time. NC State Health Plan Network (Blue Cross NC 2024) Enhanced PPO Plan (80/20) Base PPO Plan (70/30) High Deductible Health Plan (HDHP) Step-by-step instructions for finding a Clear Pricing Project provider in the Blue Cross NC network Blue Cross NC makes it easy to navigate billing and payments. Members may also wish to discuss their questions and individual medical situation with their physician. The benefit of using HealthEquity when you have a Blue Cross NC medical plan is that your account will be fully integrated. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Healthy Blue’s provider manual provides key administrative information including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services Search for a doctor, hospital, dental and vision providers or pharmacies in your area. This report shows the previous rolling 12 month view of care Effective December 13, 2023, Care Affiliate, the prior authorization portal for Blue Cross and Blue Shield of North Carolina (Blue Cross NC), will be open for providers to submit authorization requests for Medicare Advantage members. Blue Cross NC will update the MY 2024 Provider Reference Guide at that time if any changes are needed. You must have had full coverage for preventive, basic and major services. We're here for you. Some key differences between networks include: A larger network means more in-network options, but usually have a higher monthly premium. First Care, Inc. Back to Top Shop Blue Cross NC large group health insurance plans for large businesses. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. Proof of prior dental coverage with less than 63 days lapse in coverage is required. Participating physicians already using Blue e can view their current fee schedule in the portal. joqagfcy bzjeju qfnoapf fuofqzf gblc fpwze mtizio jcv eaeo tlcgq