Access detailed submission instructions for each member plan type.
Yes. The member appeal process is not changing.
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.
The pre-service review process is not changing. If a pre-service request is denied, you can contact American Imaging Management (AIM), Member Health Partnership Operations (MHPO), or Value Options for a pre-service Provider Courtesy Review (PCR). If the PCR is denied, the member can request a Level I pre-service appeal of the decision. If the service is performed and the claim is denied, both the member and the provider have the right to request a post-service Level I appeal. If the service is performed and is denied as not medically necessary, the member and the provider both have appeal rights. If the service is performed and the claim denies for no prior review and charges are provider liability, neither the member nor the provider may appeal as this is a contractual denial.
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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