Join the NC State Health Plan Network

Clear Pricing Project Contract Request Form

Welcome. This contract request form is to be completed if you are a current Blue Options (Commercial PPO) Blue Cross NC provider and are interested in changing to a Clear Pricing Project (CPP) fee schedule for the North Carolina State Health Plan.

Please complete all required fields on the form and submit using the button below. Once the form has been completed, you will be redirected to a submission completion page. If your submission is incomplete, you will be redirected back to the top of this page. Please be sure to complete all required fields and submit again.

​To learn more about the Clear Pricing Project and to access additional documentation, please access www.shpnc.org/ncshpprovidernetwork

 

Submitter

Practice Information


Contract Level Entity (if different than group practice name) 


Tax ID must match the current information Blue Cross NC has on file in order for a contract request to be processed.   Please use the following format: ##-#######


 

The practice legal name and practitioner roster listed in the contract you receive will match the current PPO data that Blue Cross NC has on file as of 9/1/2020.

Once offered, contracts must be signed within 10 days of receipt or the offer will expire.

Contract effective date will be January 1, 2021.