Providers

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

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Telehealth Provider and Member

Make the Change

Member health and safety is our top priority - now more than ever. Make the move to Telehealth, video or phone appointments! Tell your patients to stay home. We’ll cover the cost while you cover care.

Our COVID-19 Efforts

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STAY UP TO DATE

Want COVID-19 updates? Join our email registry for ongoing news, policy changes and more related to our providers.

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Commercial Product Providers

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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


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

COVID-19 Updates for Dental Providers

Join our email list to get the latest dental news from Blue Cross NC delivered right to your inbox.


Payment Information

Payment Options 

Setup Automatic Payments 

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Check a claim status or verify benefits.
 

Dental Provider Login


Blue Book Dental eManual
View or download our online reference guide for dental providers.
Update Your Demographic Information 
Use this form to report demographic changes to your practice.
Join the Dental Network
See enrollment and credentialing guidelines specific for dental providers and apply today!

Blue Medicare Providers

News and Information


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


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

Drug Information

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


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


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

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

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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.


Continuous Quality Improvement
Find out what Blue Cross NC is doing to improve members' health, care and well-being.

Network Participation

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

Become a Blue Cross NC Provider  Recredential Now

Update Contact and Demographic Info (pdf)