Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has for many years made available to our in-network providers, forms that allow them to submit inquiries regarding claims questions, submit additional documentation and appeal claims. Submitting appropriate forms ensures all inquiries are reviewed by the appropriate areas and prevents delays in responding to providers. Blue Cross NC receives a large volume of correspondence daily without the appropriate forms attached and without clear explanation as to why an inquiry has been submitted. This impacts our response time to the provider, and the potential for additional phone calls and documentation.  

Effective August 8, 2023, Blue Cross NC will require appropriate forms to be submitted with inquiries such as the Doctor Claim Inquiry.   

CMS 1500 and CMS-1450 (professional and facility/institutional claims respectively) red and white paper claim forms

Using the correct claim to report your services and charges prevents delays in processing your claim. We strongly encourage all providers to file their claims electronically either through their software vendor or through our Blue e portal. Blue e is quick and easy to use, it is free to our in-network providers, and it provides a variety of helpful information.  If it is necessary for you to file a paper claim, all professional claims must be submitted on the nationally accepted standard red and white CMS 1500 claim form (version 2/12) and for facility/institutional claims, the CMS-1450 claim form. Blue Cross NC will not accept photo or scanned copies of the HCFA 1500 or CMS-1450. We ask that you refrain from submitting handwritten claims because of the difficulty in reading some handwritten claims. Any claims that are handwritten must be legible. If the appropriate claim form is not submitted, and/or is not legible, the provider will receive a mail back letter to the address referenced on the claim. Helpful websites that will provide information regarding the CMS-1500 claim form is www.NUCC.org and for CMS-1450 claim forms www.NUBC.org. 

Doctor Claim Inquiry form   

If providers choose to submit their claims question(s) in writing, the revised Doctor Claim Inquiry form will be required and when appropriate, supporting documentation will also be required. The form is available to help you receive the answers to questions pertaining to topics such as an overpayment, a request about a denial or submitting additional documentation. If the form is not completed in its entirety and/or documentation is not attached to support the review, you will receive a mail back letter to the address provided on the form in the provider information section, advising the inquiry cannot be reviewed. It is very important that you provide all necessary provider information on the Doctor Claim Inquiry Form. The form and any supporting documentation should be mailed to BCBSNC, PO Box 2291, Durham, NC 27702-2291. Please visit the Provider Portal to access the revised Doctor Claim Inquiry form (PDF).  

Following these guidelines will allow us to be able to assist our participating providers in a timely manner and prevent your correspondence from being delayed. If you have any questions, please call 800-214-4844.