Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2019-12-10

Effective January 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will manage behavioral health services for the following members:

  • Commercial
  • Federal Employee Program (FEP)
  • Blue Medicare members.

Please note - State Health Plan members are not affected by this change.

Key Points

Authorization Requests (Prior Plan Approval)

  • Please click here for details on prior-approval requirements and instructions on how to submit requests.
  • As a reminder, we do not require you to give clinical information over the phone. Our fax forms, available December 16, include all the information necessary for approval decisions. (Click here for instructions on finding the appropriate fax form.)
  • Specific services (e.g. neuropsychological and psychological testing, ECT, and TMS) provided in an inpatient setting require a separate authorization from the facility authorization.
  • Authorization for treatment in a Residential Treatment Center (RTC) must be obtained prior to admission. If authorization is requested after the member is admitted, reimbursement for the entire RTC stay may be denied.

Claims Processing

  • Effective January 1, 2020, Blue Cross NC will process commercial HMO and Blue Medicare behavioral health claims. (We currently process behavioral health claims for all other commercial and FEP members.)
  • Between now and December 31, 2019, please follow these guidelines:
    • For admissions to inpatient care on/before December 31, 2019, claims for the entire stay should be filed with Magellan, even if the discharge date is on/after January 1, 2020.
    • For professional office visits, claims should be submitted to Magellan or Blue Cross NC according to the date of service:
      • On/before December 31, 2019, professional office visits should be submitted to Magellan.
      • On/after January 1, 2020, professional office visits should be submitted to Blue Cross NC.
  • The most efficient way to have your claims processed is to file them electronically. Information and instructions on submitting electronic claims can be found here.

Questions?
Please contact the Provider Blue Line at 1-800-214-4844.