North Carolina providers or specialists in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network will request prior review for you. You may want to check with your health care provider to make sure that prior review and authorization was obtained before you have a service or procedure.
You are responsible for making sure out-of-network doctors and providers have requested prior review and authorization from Blue Cross NC before a service is performed.
This also applies to BlueCard® providers outside of North Carolina (these are out-of-state providers who contract with other Blue Cross Blue Shield plans).
Your Benefit Booklet has more information about prior review and authorization specific to your policy.
In case of emergency, prior review and authorization is NOT required.
Blue Cross NC should be notified of an urgent or emergency admission by the second business day after the admission.
This list is provided for member information only. It's a provider tool and is updated on a quarterly basis, within the first 10 days of January, April, July and October.
If there is no update within this time period, the list will remain unchanged until the following quarter.
Prior review and certification ensures that:
Note: Blue Cross NC may authorize a service received out-of-network at the in-network benefit level if the service is not reasonably available in-network or if there is a continuity of care issue.
Whether prior review and authorization is required may depend on your Blue Cross NC benefit plan. Always check your Benefit Booklet for specific information about your plan.
The following procedures typically require prior review and authorization:
Contact Blue Cross NC Utilization Management to request prior review and authorization by calling 800-672-7897, Monday through Friday, 8 a.m. to 5 p.m. ET.
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.
© 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.