Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is insourcing utilization management (UM) and intensive care management (CM) behavioral health services previously provided by Beacon Health Options in two phases.
- Phase 1: Level 1 Appeals will take effect on June 1, 2021
- Phase 2: All other CM and UM services will be effective January 1, 2022
UM and CM Process Changes for Providers
Prior to June 1, 2021, providers should send Level 1 Appeals to Beacon Health Options at their current address:
Beacon Health Options
PO Box 12438
Research Triangle Park, NC 27709-2438
Starting June 1, 2021, providers will need to send Level 1 Appeals for behavioral health services to Blue Cross NC instead of Beacon Health Options using this new address:
Blue Cross and Blue Shield of North Carolina
PO Box 30055
Durham, NC 27702-3055
Fax: 919-765-2322
Level I Provider Appeals for billing/coding disputes and medical necessity determinations should be submitted by sending a written request for appeal using the Level I Provider Appeal Form. With the form, the provider may attach supporting medical information and mail to the appropriate address within the required time frame.
For more efficient delivery of the request, this information may also be faxed to the Appeals department at 919-765-2322. The Level I Provider Appeal Form includes fax numbers and mailing addresses for submitting different types of appeals. Faxing is the preferred method for providers to submit Level I appeals to Blue Cross NC. Attaching supporting medical information is not required, however, it will expedite the handling of the provider appeal. This is the only level of appeal that is available to providers.
For questions or concerns about the BHO behavioral health insourcing process, providers can email our Behavioral Health team.
