Providers


Your resource for member eligibility, claim status,
claims entry, and more​

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Telehealth Support & Coverage

Blue Cross NC is committed to telehealth coverage now and in the future.

Telehealth Services

COVID-19

We continue to be committed to the safety of the patients and communities that we serve together.

COVID-19 Support Measures

Stay Up-to-Date

Join our email registry for ongoing news, policy changes and more related to our providers.

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Commercial Product Providers

Quick Links


eManuals
Information on our products, services, claims billing, policies and much more.


Medical Record Submission Process
Review the CPT, HCPCS, revenue and diagnosis codes that most often necessitate provider initiated medical record submissions

Manage Claims and Inquiries:


Forms and Documentation
Appeals forms, enrollment applications and credentialing forms.

Pharmacy Program


InterPlan Programs (BlueCard)
Resources for providers who service out-of-state Blue Cross/Blue Shield members


Blue High Performing Networks (BlueHPN)


Quality-Based Programs
Programs that recognize doctors and facilities for excellence in care


Network Participation
Find out how to become part of the Blue Cross NC network of providers.

Dental Providers

Dental Blue

Check a claim status or verify benefits.

Dental Provider Login

Join the Dental Network
See enrollment and credentialing guidelines specific for dental providers.

Blue Medicare Providers

News and Information


Risk Adjustment Coding and Documentation Tips
Find brief education documents to describe proper documentation and coding of risk adjustment diagnoses.


Medicare Policies and Responsibilities
Find information on specialty networks, credentialing, and the responsibilities of primary care physicians.


Drug Information
Find detailed information regarding covered drugs and drugs that require prior approval including how to submit a request for prior approval.

Resources and Forms
Find essential resources and forms including prior authorization, Medicare payer sheets and provider newsletters.


Medical Management Programs and Services
Get information including case management, health care services and quality improvement.


2019 Medical Record Submission Process Change

Learn more about the process for submitting Blue Medicare medical records.

CPT and HCPCS Code List
Review the CPT, HCPCS, revenue and diagnosis codes that most often necessitate provider initiated medical record submissions

Post-Service Provider Appeals
Learn about the process for Level I, Level II and Non-Contract providers.


Network Participation
Find out how to become part of the Blue Cross NC network of providers.


More Information:


 

Healthy Blue + Medicare (HMO D-SNP)

D-SNP resources, training and contact information.

Experience Health Providers

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 plan for seniors. Experience Health is committed to developing affordable and accessible products and services focused on:

  • Encouraging stronger patient-doctor relationships, enhanced communication and team-based care
  • Using advanced data and analytics to provide optimal care to patients with chronic health challenges   
  • Improving care coordination so patients have clear treatment goals, and
  • Simplifying appointments, billing and timely access to health care professionals

 

Experience Health Providers Home

Healthy Blue (Medicaid) Network Participation

Healthy Blue NC

Network Development Representatives are available to assist providers Monday through Friday, 8 am to 5pm ET.
(844) 594-5072 Toll Free or NC_Provider@healthybluenc.com

Federal Employee Program

FEP Medical Records Code List

Review the codes that most often require provider initiated medical record submissions. 

2019 FEP Medical Record Submission Process Change

Learn more about the process for submitting FEP medical records. 

Standards and Requirements

Quick Links


Changes, Updates and Industry Requirements
View legislative changes and updates that affect health care and providers.


HIPAA Version 5010
Get information and a compliance timeline.

Practice Quality Standards
See the standards Blue Cross NC and our contracting physicians must meet to provide the best service possible.


National Committee for Quality Assurance (NCQA)
See the quality standards Blue Cross NC managed care plans has met for accreditation.


No Surprises Act
The No Surprises Act ensures price consistency and protects patients against surprise medical billing, including limitations on provider balance billing.

Network Participation

Find out how to become part of the Blue Cross NC network of providers.

Become a Blue Cross NC Provider  Recredential Now