Access detailed submission instructions for each member plan type.
Yes. The pre‑service review process hasn’t changed. If a pre‑service request is denied, you can contact American Imaging Management (AIM), Member Health Partnership Operations (MHPO), or ValueOptions to request a pre‑service Provider Courtesy Review (PCR).
If the PCR is denied, the member may request a Level I pre‑service appeal. If the service is performed and the claim is denied, both you and the member may request a post‑service Level I appeal, depending on the reason for the denial.
If the service is performed and denied as not medically necessary, both you and the member have appeal rights.
If the service is performed and denied due to no prior review, and the charges are determined to be provider liability, the denial is contractual and neither you nor the member may appeal.
Understanding the denial reason helps determine whether appeal rights apply and which options are available.
In most cases, no. The Level I Provider Appeal process has replaced the post‑service Provider Courtesy Review.
No. There is no right for providers to appeal a denial for no prior review. These denials are considered administrative and are not eligible for review.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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