Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has partnered with Brighton Health Plan Solutions (Brighton) to administer claims and member and provider services on behalf of Blue Cross NC to select self-insured employer group customers. Brighton is a national Third-Party Administrator (TPA).
Blue Cross NC will still contract with groups but select ones will have benefits administered by Brighton. If you are a participating provider with Blue Cross NC’s PPO Network, you will remain a participating provider for members that have Brighton-administered benefits.
Two self-insured employer groups will have benefits administered by Brighton effective Jan. 1, 2023. Blue Cross NC expects less than 10,000 members total nationally across these two groups.
Points of contact for providers
- For benefits, pre-certification, and claims inquiries, providers will call Brighton using the number indicated on the back of the member’s ID card.
- Brighton will launch its provider call center on Dec. 21, 2022. Until then, providers with questions can call the Blue Cross NC Provider Call Center at (800) 214-4844 for support.
- Providers will continue to use the Blue e provider portal to access information on member eligibility, claims status, claims entry, authorization and claim edits. There will be links within Blue e to provider policies that apply for Brighton-administered benefits.
- If your practice does not have access to Blue e, you can easily register online. If you have questions about how to enroll as a Blue e user or how to use Blue e transactions, please call Blue Cross NC’s eSolutions HelpDesk at 1-888-333-8594 or email us at Bluee.HelpDesk@bcbsnc.com.
- Providers will continue to send and receive HIPAA EDI transactions (837 claims, 270/271 eligibility, 276/277 claims status, 835 remittances, 278 prior authorization) as they do currently to Blue Cross NC and will require no changes for submission and receipt with claims for Brighton-administered claims.
Explanations of Payment (EOPs)
- If Brighton is providing the claims administration, your Explanation of Payment (EOP) will have a new look and format.
- These EOPs are clearly branded with the Blue Cross NC logo and will also indicate that Brighton is the administrator.
- Providers submitting claims for a member with Brighton-administered benefits will follow the same process as they would for Blue Cross NC members by using Blue e for electronic claims submissions. If you need to file a paper claim, please follow these instructions and mail the claim to:
Blue Cross and Blue Shield of North Carolina
PO Box 35
Durham, NC 27702
- Providers will be responsible for obtaining prior authorization when necessary for members with Brighton-administered benefits. Brighton’s policies may differ from Blue Cross NC policies. Providers will be able to access Brighton’s medical and administrative policies and prior authorization list by visiting: https://ncproviders.brightonhps.com/.
- Note: Providers can search by keyword for medical and reimbursement policies but not by CPT code in this portal.
- For existing Blue Cross NC groups, Blue Cross NC will transfer medical and pharmacy authorizations to Brighton by Jan. 1, 2023, for any Brighton-administered member benefits, so there is no need to act on any previously scheduled and authorized services/procedures. Providers can continue any previously scheduled and approved services/procedures.
- Blue Cross NC is transferring any applicable authorizations that span benefit years to Brighton to administer benefits.
- Starting Jan. 1, 2023, all pre-certification communications from Brighton will be co-branded with the Blue Cross NC logo accompanied by “Administered by Brighton Health Plan Solutions, LLC.”
- Members who are currently accessing services from a Blue Cross NC participating provider or Blue Cross and Blue Shield Association (BCBSA) National Provider will not need to change their provider. They will continue to have access to all providers that they have today, including the Blue Cross NC providers and BCBSA National Providers through the BCBSA BlueCard program.
Member ID cards
- A few changes were made to member ID cards for claims and member services that are administered by Brighton. Members with Brighton-administered benefits will have a new member ID card with a new member ID number.
- Member ID cards will still display the Blue Cross Blue Shield logo, as well as the BlueCard PPO suitcase indicating network coverage, however, the Member ID will be different.
- If Brighton is the administrator for a particular member, you will notice the following text on the front of the member ID card, “Brighton Health Plan Solutions administers claims and member services on behalf of Blue Cross NC. See back for contact information.”
- Brighton’s contact information for providers and members can be found on the back of the member ID card and is clearly labeled “Brighton.”
- Impacted members with Brighton-administered benefits effective Jan. 1, 2023, will receive their member ID cards on or after Dec. 15, 2022.
*ID cards above are samples and do not reflect finalized contact numbers.
Points of contact for members
- Impacted members will use Brighton’s CREATE platform instead of Blue Connect to review claims and find providers.
- Brighton’s contact information for providers and members can be found on the back of the new member ID card and is clearly labeled “Brighton.”
- Brighton will launch its member call center on Dec. 21, 2022. Until that time, members can continue to call the Customer Service number on the back of their Blue Cross NC member ID cards.
Regarding Explanations of Benefits (EOBs)
- If Brighton is providing the claims administration, the member's Explanation of Benefits (EOB) will have a new look and format.
- These EOBs are clearly branded with the Blue Cross NC logo and will also indicate that Brighton is the administrator.