Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2019-05-13

The following information is important if your health care organization currently:

  • Participates in Blue Options PPO (part of Blue Cross and Blue Shield of North Carolina’s commercially-offered PPO network) AND
  • Provides services to patients enrolled in the North Carolina State Health Plan

The information outlined below is about contract requirements affecting your ability to provide in-network services to State Health plan members, beginning in 2020 and beyond.

 

Beginning January 1, 2020, North Carolina State Health Plan members enrolled in benefit plans administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will have access to a new State Health Plan-specific provider network, called the North Carolina State Health Plan Network.

  • This network of providers will replace the Blue Options PPO plan available to State Health Plan members today.
  • Providers currently participating in Blue Options PPO, as well as other Blue Cross NC participating and non-participating providers who meet credentialing and other requirements are invited to sign up now for participation in the new North Carolina State Health Plan Network.

For Providers Currently Participating in the Blue Options PPO Network

If you already participate in the Blue Options PPO network and currently provide services to State Health Plan members, you may join the new State Health Plan-specific provider network by signing a contract for participation.

  • To initiate this process and learn more about participation, visit the new North Carolina State Health Plan Network page at BlueCrossNC.com/providers. You’ll find details about the contracts, network participation, and reimbursements for in-network services 

For Providers Not Currently Participating in the Blue Options PPO Network

Providers not currently credentialed and/or participating in the Blue Options network with Blue Cross NC are eligible to apply for participation in the North Carolina State Health Plan Network. However, depending on a provider’s specific contract participation and credentialed status with Blue Cross NC, differing eligibility requirements may apply:

  • Providers participating (and in good standing) in Blue Cross NC’s provider networks for our commercially-offered products, including the Blue Options network, as well as our other commercially-offered PPO, POS, and HMO products, are eligible to sign a contract for participation in the new North Carolina State Health Plan Network.
     
  • Providers participating (and in good standing) in Blue Cross NC’s Medicare Advantage networks but who are not in Blue Cross NC’s commercially-offered products, are also eligible to sign a contract for participation in the new North Carolina State Health Plan Network.
     
  • Providers not already participating and credentialed with Blue Cross NC may request to join the North Carolina State Health Plan Network but will be required to complete credentialing in advance of becoming contracted for participation. Credentialing with Blue Cross NC can be initiated by following the steps outlined on the Become a Network Provider page on the Blue Cross NC provider portal.

Important Dates and Reminders

  • Effective January 1, 2020, only providers contracted for participation in the new North Carolina State Health Plan Network will be eligible to provide in-network services to State Health Plan members.
  • The new North Carolina State Health Plan Network will be open for providers to join until July 1, 2019. Contract signature pages must be submitted to Blue Cross NC no later than July 1 to qualify for acceptance.
  • Providers currently participating in Blue Options PPO but electing not to participate in the North Carolina State Health Plan Network after December 31, 2019, will not be removed from Blue Cross NC’s PPO networks. However, the North Carolina State Health Plan will be excluded from the Blue Options network as of January 1, 2020.
  • Any provider not contracted for the North Carolina State Health Plan Network will be considered as out of network for State Health Plan members as of January 1, 2020, when the new North Carolina State Health Plan Network goes into effect.

Learn More

To learn more about the new North Carolina State Health Plan Network and to initiate your participation, please visit the North Carolina State Health Plan Network page on the Blue Cross NC provider portal.