Non-contract post service provider appeals are available to physicians, physician groups, physician organizations and facilities and are handled by Blue Cross NC.
Non-contact providers will have 60 calendar days from the date of the Explanation of Payment (EOP), notice of the organization determination, to submit a non-contracting post-service appeal. However, if the non-contract provider does not complete the Waiver of Liability statement within the appeal time frame, Blue Cross NC will forward the case to the Independent Review Entity (IRE), MAXIMUS with a request for dismissal.
This process is voluntary; however, a third party (such as a provider billing agency) cannot act on the provider's behalf in the appeal process.
For each step in this process, there are specified time frames for filing an appeal and for notification of the decision. Non-contract provider appeal reviews are completed within 60 calendar days of receipt of all information.
To begin the non-contract post-service provider appeal process, providers can download, print and fill out the Provider Non-Contract Appeal Form or mail in a written request and the Waiver of Liability statement.
The provider may attach supporting documentation, such as a copy of the original claim, denial notice and any clinical records and mail to the following address within the required time frame.
Blue Medicare HMO/PPO
Attn: Non Contract Appeals and Grievances
P.O. Box 17509
Winston-Salem, NC 27116-7509
Blue Connect