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 (Blue Cross NC) commercially offered PPO network), AND
- Provides services to patients enrolled in the North Carolina State Health Plan, AND
- Is interested in supporting the Clear Pricing Project (CPP) by joining the NC State Health Plan Network for the services that you provide to patients enrolled in the North Carolina State Health Plan.
Please Note: Providers currently participating in Blue Options PPO but electing not to support the Clear Pricing Project by participating in the NC State Health Plan Network may continue to provide services to State Health Plan members in 2023 under their current Blue Cross NC commercial PPO contract and rates.
In an effort to lower health care costs for members and to support CPP providers, the North Carolina State Health Plan offers significant copay reductions for members who visit a CPP provider. Details regarding these reductions are available on the North Carolina State Health Plan Network page at www.shpnc.org/ncshpprovidernetwork.
The information below outlines the process to provide in-network services to State Health Plan members under the NC State Health Plan Network contract and fee schedules, beginning in 2023 and beyond.
- Enrollment in the Network is open June 1 to June 30, 2022, to providers who currently treat North Carolina State Health Plan members via Blue Cross and Blue Shield of North Carolina’s commercially offered PPO network for a January 1, 2023 effective date.
- To learn more about participation and initiate this process, visit the North Carolina State Health Plan Network page at www.shpnc.org/ncshpprovidernetwork. You’ll find details there about the contract documents, network participation, and reimbursement for in-network services.
- All contract requests must be submitted no later than June 30, 2022. The form to use can be found at www.shpnc.org/ncshpprovidernetwork.
- Once your contract request is approved, you will receive a copy of the contract documents for your electronic signature. You will have 10 calendar days to electronically sign the NC State Health Plan Network contract for the contract to be effective on January 1, 2023.
- Providers will receive an executed contract through the AdobeSign process, for a January 1, 2023, effective date, once the contract with the provider’s electronic signature has been received and processed.