Join the North Carolina
State Health Plan Network



Note: Read the professional pricing policy here (pdf). All other pricing policies will be posted as soon as they're available.


Blue Cross Blue Shield of NC (Blue Cross NC) is contracting a new State Health Plan-specific provider network called the North Carolina State Health Plan Network, effective January 1, 2020. The network is designed to help the State Health Plan reduce medical costs and increase transparency for its members.

Members enrolled in the State Health Plan administered by Blue Cross NC will have access to this new provider network. The North Carolina State Health Plan Network replaces the Blue Options network available to State Health Plan members today. Providers currently participating in Blue Options, and other non-network providers who meet our credentialing and requirements, are invited to participate.

Why Join the Network

Providers not contracted for the North Carolina State Health Plan Network by January 1, 2020, will be considered out-of-network. Out-of-network services will be subject to lower reimbursements and paid directly to the member. State Health Plan members will receive their lowest out-of-pocket costs when services are obtained in-network.

How to Join the Network

All providers interested in participating must complete a signature page and submit it to Blue Cross NC no later than July 1, 2019.

  • Providers already participating in Blue Cross NC Commercial PPO (Blue Options) and servicing State Health Plan members need only submit a contract signature page to NCSHPNetworkContracts@bcbsnc.com
  • Non-network providers must:
    1. Complete all required contracting steps with Blue Cross NC (including credentialing), and
    2. Submit a signature page following instructions separately provided by Blue Cross NC as part of that process. 

 

Frequently Asked Questions

The North Carolina State Health Plan Network is a unique network that does not impact the commercial lines of business or other benefits within your Commercial PPO contract (e.g., Blue Options PPO). Pricing within the North Carolina State Health Plan Network is effective January 1, 2020. 

Providers currently participating in the Blue Options PPO network will continue to see State Health Plan members as in-network until December 31, 2019. Those who decide to be part of the North Carolina State Health Plan Network in 2020 will be considered in-network for State Health Plan members. On January 1, 2020, those who decide not to accept this contract by not completing the signature page will be considered out-of-network for State Health Plan members. 

Out-of-network reimbursements for 2020 will be set at rates lower than in-network reimbursement, this includes hidden providers. Please note: Out-of-network payments will be made directly to members.

To become part of the network, you will need to be credentialed with Blue Cross NC. If you are not currently credentialed, you can get network participation and credentialing information here.

Yes, providers must be credentialed to participate in the North Carolina State Health Plan Network. However, if you are already a credentialed provider in good standing with Blue Cross NC, then you only need to download the signature page from our website, complete it, and email it to  NCSHPNetworkContracts@bcbsnc.com.

If you are not contracted with Blue Cross NC, or are in the process of terminating, you will need to be credentialed to join the North Carolina State Health Plan network. 

Get network participation and credentialing information here.

If you are already a contracted and credentialed provider in good standing with Blue Cross NC, then you only need to download the signature page from our website, complete it and email it to NCSHPNetworkContracts@bcbsnc.com. Please Note: Due to the volume of contracts expected and the timing of network implementation, we are unable to accept contract signature pages in any other format.

If you are not contracted and credentialed with Blue Cross NC, or you are in the process of terminating, you need to be credentialed to join the North Carolina State Health Plan Network. Get network participation and credentialing information here.

The signature page should be completed by the authorized representative for the entity or practice that is contracted with Blue Cross NC for Commercial PPO contracts.  All provider entities, rosters and locations associated with your existing Commercial PPO contracts with Blue Cross NC will be duplicated for the purpose of participation in the North Carolina State Health Plan Network. In most cases, each entity or practice would only have one contract and signature page with Blue Cross NC. All applicable NPI and Tax ID numbers should be included on the signature page to ensure accuracy.

If you are a provider who is currently part of the Blue Cross NC network as part of an agreement with Avalon, you do not need to complete a signature page.

If you are a provider who is not currently contracted with Blue Cross NC, get network participation and credentialing information here.

 

When you send your completed signature page to NCSHPNetworkContracts@bcbsnc.com you will receive an auto-reply email confirmation. Keep the email as your receipt, along with your completed signature page.

Blue Cross NC will process submitted signature pages and send final confirmation to you before October 1, 2019.

Unfortunately, due to the volume of contracts expected and the timing of network implementation, we are unable to accept contract signature pages in any format other than email to NCSHPNetworkContracts@bcbsnc.com.

If you are currently contracted with Blue Cross NC, the only action you need to take is to complete the signature page. Blue Cross NC will then ensure you are currently a provider in good standing and not a provider in an intermediary relationship (e.g., Avalon, HNS). Blue Cross NC will process submitted contracts and will send final confirmation prior to October 1, 2019.

If you are not currently credentialed, or not a current in-network provider in good standing, get network participation and credentialing information here.

We anticipate that you should receive your executed signature page and confirmation by October 1, 2019.

 

You will be considered out-of-network for the North Carolina State Health Plan Network. Out-of-network reimbursements will be set at reimbursement rates lower than in-network reimbursement.

Please note: Out-of-network payments will be made directly to members. 

The State Health Plan has determined that contract terms and reimbursement rates are not negotiable. Therefore, Blue Cross NC will not negotiate terms of the contract or reimbursement rates with providers.

Providers must agree to the contract terms and reimbursement rates to participate in the North Carolina State Health Plan Network.

Unfortunately, due to timing and the volume of contracts expected, we are unable to perform modeling for provider practices and health care systems. Please review the reimbursement exhibit (pdf).

You can choose to join the North Carolina State Health Plan Network and be considered in-network. To become part of the North Carolina State Health Plan Network, you must be credentialed. Get network participation and credentialing information here.

If you choose not to participate in the North Carolina State Health Plan Network, you will be considered out-of-network for State Health Plan members. Out-of-network reimbursements for 2020 will be will be set at reimbursement lower than in-network reimbursement rates.

Please note: Out-of-network payments will be made directly to members.

Yes, you must complete a signature page and email it to NCSHPNetworkContracts@bcbsnc.com to participate, even if you completed the interest form on the State Health Plan website.

Providers must be credentialed to participate in the North Carolina State Health Plan Network. If you are not contracted with Blue Cross NC, or are in the process of terminating, you will need to be credentialed to join the North Carolina State Health Plan network. Get network participation and credentialing information here.

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

Blue Cross NC subcontracts provider network services for chiropractic care to Health Network Solutions (HNS) for HMO and PPO products. Visit the HNS website for more information

Get the professional pricing policy here (pdf). All other pricing policies will be posted as soon as they're available.