New effective date for Blue Cross NC behavioral health medical policy changes

On April 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a Notification of Policy Revision announcing that prior authorization for all Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) would be required effective July 1, 2024.

The new effective date for this policy revision is August 1, 2024. Policies for the new effective date will be posted on the Blue Cross NC provider website by July 17. Authorization requests for dates of service on or after August 1, 2024, will be accepted beginning on July 17, 2024.

Note that services occurring on or after August 1 will require an authorization form and relevant medical records prior to rendering IOP and PHP treatment and applies to Individual, Fully Insured, Administrative Services Only (ASO), and State Health Plan (SHP) members.

IOP and PHP services are defined as treatment rendered on an outpatient basis, with patients returning to their home environments or a community-based setting outside of program hours. IOP and PHP programs do not include boarding/housing, treatment in a locked unit, or in restricted access settings.

This policy update was made to confirm that care is accessible, medically necessary, clinically appropriate, and contributes to the successful outcome of treatment prior to services being provided.  

For questions, please email behavioralhealth@bcbsnc.com.