Submitting Claims and Eligibility Inquiries for State Health Plan Members that Span 2021 and 2022

Effective 1/1/22,  State Health Plan members will be migrated from a legacy system to our Facets platform.  Below are the following instructions for submitting claims and submitting eligibility inquires that span the 2021 and 2022 years. 

If a provider does not have an ID Card for a State Health Plan member, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provides two methods of inquiry to obtain the information.  A HIPAA 270 inquiry transaction may be sent with a Name and DOB only as well as a plan year 2022 date of service, and Blue Cross NC will respond with a 271 response providing information for the 1/1/22 effective policy. The Blue Cross NC secure provider portal, Blue e, also allows providers to perform a similar search using only Name and DOB with a 2022 date of service and the response will provide the effective coverage response for the 2022 service date.    

The eligibility response will contain Member ID, policy and benefit information relative to the date of service used for that particular plan year whether it is either 2021, or the new 2022 plan year. 

For outpatient facility and all professional claims submissions, which span the 2021 and 2022 calendar year, Blue Cross NC recommends that providers split claims on the calendar year in order to streamline the claims adjudication process.  For example, claims for dates of service for 2021 use the 2021 Member ID and for claims for dates of service for 2022, use the new 2022 Member ID. Please note inpatient facility claims should not be split and should be filed under the Member ID in effect on the date of the admission.