How to Submit Applicable Medical Records and Itemized Bills for Blue Cross NC Medicare Member High Dollar Review

Effective October 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will now consider all Medicare claims with total charges of $100,000 or greater on Blue Cross NC Members are High Dollar claims requiring Medical Review. This is a follow-up to our originally announced Itemized Bill Review (IBR) program announced November 1, 2023.  These claims will now require Itemized Bills and applicable medical records to be submitted with or prior to the claim submission. Claims received without the required documentation will have an electronic mail back of the claim for resubmission of a new claim to be processed when records are available.

Blue Cross NC can accept itemized bills and applicable medical records to support electronically submitted Medicare Advantage claims via the following methods:

1. The secure on-line message system ProviderLink
   a. Fax transmission via 844-340-5477 - Blue Cross Blue Shield of NC - Medicare Line of Business
2. Please use the following instructions for submitting itemized bills for Blue Cross NC member high dollar reviews via fax.
   • Create a fax cover sheet containing the following information:
     1. Patient’s name
     2. Patient’s member ID number (including the Prefix and Suffix)
     3. Patient’s date-of-birth
     4. Date(s) of service
     5. Total charge
     6. Sender’s name and direct phone number (Blue Cross NC will contact the individual listed if there are any questions about the received document)
     7. Subject:   Blue Cross NC Member High Dollar Medical records and Itemized Bill
        
   • Fax the cover sheet followed by the itemized bill to:
     844-340-5477 - Blue Cross Blue Shield of NC - Medicare Line of Business
     
3. To submit high-dollar claims via mail, please mail the claim, applicable medical records, and associated itemized bills using the appropriate coversheet to:

Blue Cross Blue Shield of North Carolina
PO Box 35
Durham, NC  27702