Telehealth Support & CoverageBlue Cross NC is committed to telehealth coverage now and in the future.
COVID-19We continue to be committed to the safety of the patients and communities that we serve together.
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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:
- Blue e for Web-based services
- eSolutions for HIPAA-regulated transactions
- Code Set information
- Paper Claim Filing pointers
Forms and Documentation
Appeals forms, enrollment applications and credentialing forms.
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
News Updates
- Provider (Individual/Group) Credentialing and Enrollment Process Change Effective November 1, 2022
- Read the latest Dental Provider news
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Popular Information
- Payment Options
- Setup Automatic Payments
- Blue Book Dental eManual - Online reference guide
- Update Your Demographic Information - Report changes to your practice
- What is the GRID?
Join the Dental Network
See enrollment and credentialing guidelines specific for dental providers.
Blue Medicare Providers
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:
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
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
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
- How Our Health Insurance Works
- Medical Policy Updates
- Fee Schedules for participating Blue Cross NC physicians.
- Resources and Tools
- Annual Provider Update
- Patient Education Materials
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.
Blue Medicare
Servicing Blue Medicare HMO and Blue Medicare PPO members
Medicare Fast Track Appeals
(Training for Skilled Nursing, Home Health and Comprehensive Outpatient Rehabilitation facilities only)
Medicare Fast Track Appeals - Workflow Process Chart
Medicare Fast Track Appeals - Notice of Medicare Non-Coverage (NOMC) Form
Blue Connect