Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is sending this to remind providers that the No Surprises Act (NSA) applies to individual health plans and fully insured and self-insured group health plans, including grandfathered plans. However, there are certain plans that are exempt from the NSA requirements. These exempted plans include the following:
- Medicare
- Medicaid
- Ancillary products such as standalone vision and dental
- Retiree Only plans: These are group health plans in which there is 1 or less active employees enrolled in the plan as defined under ERISA
Blue Cross NC will include the required NSA and Qualified Payment Amount (QPA) disclosure on any explanation of payment for claims to which the NSA applies based on the plan classification and claim information. To the extent a provider disagrees with Blue Cross NC’s designation of a claim as not subject to the NSA, the appropriate venue within which to address such a disagreement is the appeal process, not the Independent Dispute Resolution (IDR) process.
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.
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