Update March 2024 Prior Authorizations: Issue Impacting Some Providers’ Participation Status in Our Medicare Advantage Network

UPDATE 3/29/24: The following is an additional update to the Update: Issue Impacting Some Providers’ Participation Status in Our Medicare Advantage Network provider news posted February 8, 2024.  

Blue Cross NC has resolved the provider configuration issue impacting some providers’ participation status in our Medicare Advantage network, which also includes our vendor Carelon℠. Prior authorizations for services reviewed by Carelon will resume for dates of service (DOS) on / after April 1, 2024. This includes all members with Blue Medicare HMO℠, Blue Medicare PPO℠, Blue Medicare Freedom+℠ PPO, and Experience Health members. 

UPDATE 2/8/24: The following is an update to the Issue Impacting Some Providers’ Participation Status in Our Medicare Advantage Network provider news posted January 5, 2024.

Blue Cross NC has extended the exception timeline for prior authorization and will not require prior authorizations for services reviewed by Carelon. The extension has been extended through March 31, 2024. This includes all members with Blue Medicare HMO℠, Blue Medicare PPO℠, Blue Medicare Freedom+℠ PPO and Experience Health members.

Blue Cross NC is currently working to rectify this issue as quickly as possible and will provide an update once it has been resolved. If you have any questions, please contact customer service at 888-296-9790.

A provider configuration issue is impacting some providers’ participation status in our Medicare Advantage network, which also includes our vendor Carelon℠. Currently, the issue is limited to facility type providers that may share a type 2 NPI within their health care system (i.e., hospitals, labs, and professional groups), which is displaying providers as out-of-network. As a result, Blue Cross NC will not require prior authorizations for Medicare through Carelon for Medicare claims for the month of January 2024.

This includes all patients with Blue Medicare HMO℠, Blue Medicare PPO℠, Blue Medicare Freedom+℠ PPO and Experience Health members.

Blue Cross NC is currently working to rectify this issue as quickly as possible and will provide an update once it has been resolved. We expect full resolution of this issue by the end of January, and providers should proceed with Medicare prior authorizations through Carelon beginning February 1, 2024.

If you have any questions, please contact customer service at 888-296-9790.