Blue Cross NC members can file a claim, appeal a denial of benefits, and learn more about their coverage depending on their type of plan. Please note, most providers in the Blue Cross NC network will file a claim on your behalf. Also view our tips for submitting claims to avoid claim mail backs.
For benefits received on a cruise ship, please submit the domestic claim forms.
The claim form only applies if your health plan offers a travel benefit. You must sign the form to verify that you traveled out of state for a medical service covered and approved by your health plan.
These appeals forms are unintended for appealing underwriting decisions. If you wish to appeal an underwriting decision, try one of the following:
In most instances you do not have to file your own claim. Usually, the participating provider will file a claim for you. However, you may need to file claims for vision and dental products or services.
If you need a claim form or help on how to file a claim, log in to Blue Connect and select Claims or call Customer Service at 877-258-3334 or write to:
Blue Cross NC Customer Service
P.O Box 2291
Durham, NC 27702-2291
Please mail dental claims to:
Blue Cross Blue Shield of North Carolina
Attn: Dental Blue Claims Unit
PO Box 2100
Winston-Salem, NC 27102
OR
Blue Cross Blue Shield of North Carolina
Attn: Dental Blue Select Claims Unit
PO Box 2400
Winston-Salem, NC 27102
To file a claim for prescription drugs you purchased from an out-of-network or non-participating pharmacy:
Please see your Member Benefit Booklet to confirm that your pharmacy benefits are offered through Blue Cross NC. In some cases, employers purchase prescription drug plans that contract with a vendor separate from Blue Cross NC.
If your member ID card says Prime Therapeutics on the back, complete this Prime Therapeutics claim form (PDF) and mail it to:
PrimeMail
PO Box 650041
Dallas, TX 75265-0041
If you need to submit a claim, please mail it in time to be received by Blue Cross NC within 18 months after the service was provided. Claims not received within 18 months from the date the service was provided will not be covered, except in the absence of legal capacity of the member.
You have the right to request a formal appeal of the claim payment or denial. A detailed description of this process may be found in your Member Guide. Customer Service can also assist you in starting the appeal process.
Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.
You can check the status of a claim by logging in to Blue Connect. With Blue Connect, you can access the following information regarding a submitted claim:
Blue Cross NC will mail a comprehensive Benefit Booklet to your home after you enroll. It has detailed information about your specific benefits and covered services.
You'll find a lot of information on benefits, claims and other member services on our website and in your Blue Connect member portal. Log in to Blue Connect to see your:
Need help?
You can send a secure email anytime to Customer Service through Blue Connect or call 877-258-3334, Monday to Friday, 8 a.m. to 7 p.m. ET.
If you do not receive prior approval or certification for services (except emergency care or maternity), your claim may be denied, paid at a lower benefit or a penalty may be applied.
Prior approval and referrals depend on your plan. To learn more, log in to your member portal on Blue Connect where you can find the rules for Prior Approvals and Authorizations in your Benefit Booklet.
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. Learn more about our non-discrimination policy and no-cost services available to you.
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© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.