In balance billing, an out-of-network provider charges for the leftover amount after the health plan pays its share. An unexpected balance bill is called a surprise bill.
Providers can initiate the open negotiation process by completing the Qualifying Payment Amount (QPA) Dispute Form.
Email - Send a completed Federal Open Negotiation Template to QPA@bcbsnc.com.
Mail - Send a completed Federal Open Negotiation Template to:
Network Management - Surprise Billing
PO Box 2291
Durham NC 27707
If you need additional assistance, please call 888-302-0530.
The No Surprises Act now holds members harmless from surprise bills when receiving:
On the first page of your EOP there is a remarks box that lists codes. Code X00 means “This claim is subject to Surprise Billing Legislation Protections.” Additional disclosure information is provided. Throughout the following pages, if the ‘Remark Code’ column states X00, it is a Surprise Billing claim.
The QPA is listed in the Contracted Charges column of your EOP.
Email QPA@bcbsnc.com to learn more about the QPA Methodology.
If we cannot come to an agreement after 30 business days, you may pursue the independent dispute resolution (IDR) process designed by the Centers for Medicare & Medicaid Services (CMS) as outlined in the No Surprises Act and regulations pursuant to the Act.
The appeals team will follow their normal appeals process. However, appeals will not review the following in terms of Surprise Billing:
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.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.