Review our guidelines for submitting a request to Blue Cross NC to remove an individual practitioner from a group’s practitioner roster, terminate a network participation agreement of a solo practitioner or group, or request for approval of a transfer or assignment related to a practice’s merger or acquisition.

These instructions are applicable to all submittals:

• Email requests to providerupdates@bcbsnc.com. You can also fax your requests to 919-765-4349. Processing time can vary between requests sent to Commercial or Blue Medicare. Average processing time is between 10 to 30 business days.
• Include complete provider details such as name, NPI, IRS number, locations and Medicare number. You must provide the effective date.

Incomplete requests will not be accepted for processing. Requests that are incomplete or are missing information will be returned to sender. You will need to resubmit the request with complete information to be processed.

If you have questions or need assistance, call 800-777-1643, and selection option six.

You must submit requests 30 days prior to the termination date and include:

• Request on letterhead (must be signed by the practitioner being removed if the group is not the requestor)
• Reason for removal (e.g., retired, left practice, moved out of state)
• Any necessary member moves for continuity of care

You must submit requests 90 days prior to the effective date and include:

• Request on letterhead
• Reason for termination (e.g., retired, closed practice, network status change)

• Request on letterhead
• The new Tax ID information and contact for acquiring party
• Any necessary member moves for continuity of care

The new group can't be formed without the completed enrollment application(s) and new W9 (see group and practitioner enrollment change information for instructions).