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 Forms and Documents 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
Enhancement to Current Claims Processing System Beginning June 1, 2022 March 29, 2022 Claims & Coding

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) remains committed to correct coding and reimbursement and maintains a suite of widely recognized and transparent payment policies. 

It’s estimated that up to 80% of medical claims contain errors.1  And whether those mistakes are the result of human error, or deliberate fraud, inaccurate billing can be a costly problem when combined with the increasing cost of health care.  

Starting on June 1, 2022, Blue Cross NC will implement an enhancement to our claims processing system that supports correct coding. The goals of this endeavor are to implement, to the extent possible, claim payment policies that are national in scope, simple to understand and that come from standard sources. Blue Cross NC believes that this will enable you and your billing staff to more readily understand our payment of claims given the widespread use of these policies.   

These enhancements take into consideration Blue Cross NC’s historical claims experience as well as policy guidelines from the following sources: 

  • CMS reimbursement guidelines, publications, and policies 
  • AMA CPT®, HCPCS, and ICD-10-CMcoding definitions and guidelines 

Blue Cross NC’s payment policies focus on areas such as: 

  • National bundling edits including the Correct Coding Initiative (CCI) 
  • Modifier usage 
  • Global Surgery  
  • Add On code usage 
  • Maximum units over time 
  • Age appropriateness 
  • CMS’ National Coverage Determinations 
  • National Uniform Billing Committee (NUBC) and Optum Uniform Billing Editor  

For dates of service June 1, 2022 and later, claims will be processed using this updated and industry standard claims adjudication logic. 

1. Gooch, Kelly. (2016). “Medical billing errors growing, says Medical Billing Advocates of America.” Retrieved from Becker’s Hospital Review. 

About Us Newsroom Blog Member Forms COVID-19 Transparency in Coverage Find Care Rights & Responsibilities Policies & Best Practices Privacy Policy Website User Agreement Fraud & Abuse Technical Information Contact Us Locations Careers

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

© 2025 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. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.