North Carolina
State Health Plan Network

The extended deadline to join was August 5, 2019. If you would like to rescind your participation in the North Carolina State Health Plan Network and revert to the Blue Options contract, please send a copy of your signature page to NCSHPNetworkContracts@bcbsnc.com by 12 a.m. (midnight), August 15, 2019.

Frequently Asked Questions


To provide members with access to an adequate number of in-network hospitals, the Plan has decided to offer members a network that includes a combination of both the NC State Health Plan Network and the Blue Cross NC Blue Options PPO Network. If you agreed to join the NC State Health Plan Network and submitted your signature page for processing, you will be reimbursed at the rates outlined in that contract beginning with services provided on January 1, 2020 and after.

Since this approach is different than what was anticipated at the time that you signed the contract for the NC State Health Plan Network, the Plan would like to give your organization the opportunity to withdraw your signature page and go back to the rates that your organization negotiated with Blue Cross NC as part of our Blue Options PPO Network. It will be up to your organization to decide which option is best for you.

If you decide to stay in the Clear Pricing Project structure, Blue Cross NC will execute the signature page, at which point the contract will become binding for the period January 1, 2020, to December 31, 2020. After this initial one-year period, you may choose to leave the NC State Health Plan Network with 180 days’ notice.

If your organization would like to rescind its signature page and move back to the Blue Options PPO Network rates that you negotiated with Blue Cross NC, please send an email indicating you would like to rescind your participation and attach the signature page you previously submitted to NCSHPNetworkContracts@bcbsnc.com by 12 a.m. (midnight), August 15, 2019.

Frequently Asked Questions

 

The NC State Health Plan Network is effective January 1, 2020 and is a unique network that includes both providers who have signed the NC State Health Plan Network contract and providers who are participating in the Blue Options PPO contract with Blue Cross NC.  

The NC State Health Plan Network is effective January 1, 2020 and the applicable rates and contract provisions based on the agreement you have signed will apply at that time.

The NC State Health Plan Network does not impact the commercial lines of business, Medicare or Medicaid contracts, or other benefits for your Commercial PPO contract (e.g., Blue Options PPO).

The State Health Plan’s original approach was to create the NC State Health Plan Network and only offer that network to State Health Plan members. To provide members with access to an adequate number of in-network hospitals, the Plan decided to offer members a network that includes a combination of both the NC State Health Plan Network and the Blue Cross NC Blue Options PPO Network.

Reimbursement rates outlined in the NC State Health Plan Network Reimbursement Exhibit have not changed. The Blue Cross NC Blue Options PPO rates are those included in your current Blue Options contract.

 

Members will not have to choose a network, they will have access to and be able to view the consolidated network in the Find a Doctor tool during Open Enrollment for the 2020 benefit year. In the tool, members will be able to see all in-network providers. There are no copay incentives tied to each of these networks at this time.

Nothing has changed in terms of the reimbursement rates or confidentiality provisions set forth in the NC State Health Plan Network and Blue Options PPO contract. The Plan is not able to determine the reimbursement rates between providers and Blue Cross NC for their Blue Options network, those are confidential contracts. Providers must review both contracts to determine which network works best for their practice.  

Both NC State Health Plan Network providers and current Blue Options PPO providers will be included in the NC State Health Plan Network as of January 1, 2020.

The deadline to elect to participate in the NC State Health Plan Network under the Clear Pricing Project contract and pricing terms was August 5, 2019.  Providers who did not execute a contract signature page for NC State Health Plan network but are current Blue Options PPO providers will still be considered in-network for State Health Plan members on January 1, 2020.

If you executed a NC State Health Plan Network signature page to Blue Cross NC, it will be processed, and final confirmation is expected to be sent before October 1, 2019. 

If you are a current Blue Options PPO Provider who did not execute a NC State Health Plan Network Signature page, your current PPO contract will be applicable for the NC State Health Plan Network.

If you are currently a Blue Options PPO provider, you will be considered in-network for State Health Plan members January 1, 2020 regardless of whether you have signed a signature page to participate in the State Health Plan network or not.

If you are not currently credentialed, or not a current in-network provider in good standing you will not be considered part of the State Health Plan Network. Get network participation and credentialing information here.

 

Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please email participation inquiries to Avalon at NetworkTeam@AvalonHCS.com.

 

Chiropractic care networks are managed by Health Network Solutions (HNS) for HMO and PPO products. Visit the HNS website for more information