Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Submitting Claims and Eligibility Inquiries for State Health Plan Members that Span 2021 and 2022 December 22, 2021 Claims & Coding State Health Plan

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.