Explore provider resources, self-service tools, and network details.
Access the resources, documents, and tools you need to complete common provider tasks faster.
Want to join our network or make changes to your practice information?
Find information on how the No Surprises Act protects patients from balance billing and the steps for disputing a qualifying payment amount. This includes how to initiate the open negotiation process by completing the Qualifying Payment Amount (QPA) Dispute Form.
Stay informed about important provider updates. This includes changes to health insurance rates, application dates, deadlines, billing and reimbursement, incentives, immunization and behavioral health programs, and more.
Use Blue e to look up patient eligibility, submit claims, check claim statuses, and more. Whether you’re part of a small practice or a large hospital system, the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provider portal lets you manage your critical patient and administration tasks. Plus, there's no cost to use it.
In the near future, score cards will be created and discussed with providers.
Direct Senders of electronic transactions will need to do the following:
- Complete a copy of the Blue Cross NC Trading Partner Agreement (TPA), available on the HIPAA information page. You need to complete a TPA even if you do not need to test.
- Return an original copy of the TPA, signed by authorized personnel, to Blue Cross NC EDI Services (see Trading Partner Agreement Instructions online for more details).
- Complete an Electronic Connectivity Request (ECR) form for each type of transaction you want to transmit. These ECR forms are available on the HIPAA information page.
Indirect Senders who transmit electronic transactions to Blue Cross NC via another party (billing service, clearinghouse, or service bureau) will need to do the following:
Complete ECR forms for each type of transaction you want to submit or receive. These ECR forms are available on the HIPAA information page and may be completed and submitted on your behalf by your clearinghouse or service bureau.
The Council for Affordable Quality Healthcare is a not-for-profit collaborative alliance of the nation's leading health plans and networks, including Blue Cross NC. CAQH's mission is the improvement of healthcare access and quality for patients and the reduction of the administrative burden for healthcare providers and their office staff members.
An appeal form is available for most member plan types. Go to the Claims, appeals and inquiries page, find the member's plan type and then select File Appeal. You can find the corresponding appeal form on the plan type Appeals and Inquiries page.
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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