Helpful Resources for Members

Access to Care Standards

Through its Physician Advisory Group and Quality Improvement Committee, Blue Cross NC has established Access to Care Standards so that you'll know you can get the care you need, when you need it. Blue Cross NC and Blue Cross NC contracting physicians are committed to meeting these standards in order to provide the best service possible.

Find a Drug

Search for prescription drugs and pharmacy services, or obtain a list of Pharmaceuticals

Prior Review and Limitations for Medications

Some medications require more than a provider's prescription in order to be covered by Blue Cross NC. These medications require that you meet certain criteria. Your provider must also answer specific questions prior to coverage. This allows all of us to work together to provide you with the safest, most effective and cost-efficient medications.

Care Management and Operations

The Blue Cross NC Care Management & Operations (CM&O) Department works with physicians and members to facilitate the most medically appropriate, cost-effective, quality care for our members. In Care Management & Operations find out about:

  • Access to utilization management staff
  • Protecting your health care needs

Healthy Outcomes Program

Blue Cross NC offers a suite of health management programs for select health conditions for our commercial members called Healthy Outcomes. This confidential program is available to eligible members at no cost. Members can visit Blue Connect for more information and to take advantage of our helpful online tools, trackers, modules and articles to help them manage their health.

Continuous Quality Improvement

At Blue Cross NC, we want to help improve the health and well-being of our members, as well as encourage simplicity and affordability in health care. To meet these goals we continually review our quality processes, assess member programs and offerings, and ensure care is based on strong clinical evidence. Learn more about what we're doing to improve health care quality.

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