Important Dates:
Annual Enrollment Period: Oct 15 – Dec 07
Open Enrollment Period: Jan 01 – Mar 31
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Submitting Medical Records for Experience Health
Forms and Resources
Get prior authorization forms, Medicare payer sheets, provider newsletters and more.
- Forms and Documentation
- Specialist Referral Form (pdf)
- Policies and Procedures (pdf)
- Experience Health Provider Administrative Manual
- Post-Service Provider Appeals
Medical Policies and Coverage
Find information on specialty networks, credentialing and the responsibilities of primary care physicians.
- Medicare Policies and Responsibilities
- Medical Policy Search
- Prior Plan Approval
- Prior Plan Approval Code List
Drug Information for Medicare Members
Get details about covered drugs, drugs that require prior approval, and submitting requests for prior approval.
- Prior Approval and Quantity Limits (pdf)
- Drug Search for PA and Step Therapy (pdf)
- Prime Therapeutics (Formulary)
Stay Informed and Connected
Get the latest news, quarterly briefs and contact information.
- Medical News and Information
- Provider Quick Reference Guide (pdf)
- Community Eye Care for Providers
- Electronic Solutions
- COVID-19 Information - Where Blue Cross NC references Medicare, the information also applies to Experience Health
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