Providers

For Medical, Dental, and Blue Medicare

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


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

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 

Login

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.


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

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.

More Information:


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

Standards and Requirements

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.

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.


Blue Medicare

 

Servicing Blue Medicare HMO and Blue Medicare PPO members

Medicare Fast Track Appeals PDF Icon
(Training for Skilled Nursing, Home Health and Comprehensive Outpatient Rehabilitation facilities only)

Medicare Fast Track Appeals - Workflow Process Chart PDF Icon

Medicare Fast Track Appeals - Notice of Medicare Non-Coverage (NOMC) Form PDF Icon

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)


Please Note the Following Network Exceptions:

Physical Therapy professional commercial networks are closed to new providers in select counties. (See the list of closed counties.)

Optometry and Ophthalmology commercial networks are closed in all counties. Optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC). Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at providers@cecvision.com and by phone. (CEC 888-254-4290)

Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.