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Pricing Policy Updates Effective January 1, 2025 November 01, 2024 Physicians & Specialists

To provide better clarity around our pricing policies Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is making the following changes effective January 1, 2025. 

The following language has been updated throughout our policies regarding the timing of pricing updates annually and quarterly: 

  1. Such updates and new pricing will apply for all dates of services on or after the source pricing effective date, but only for claims received after the date of Blue Cross NC’s implementation of the update/new pricing. Blue Cross NC does not make retroactive pricing adjustments for claims received prior to Blue Cross NC’s implementation date.

New standalone pricing policies for Specialty Rx Outpatient and MA.

Additional provider types added to Out-of-Network (OON).

  • Reference Laboratory
  • Home Health
  • Home Infusion Therapy
  • Private Duty Nursing
  • Home Durable Medical Equipment
  • Hospice Service
  • Skilled Nursing Facility
  • Specialty Pharmacy Services
  • Birth Center Services
  • Licensed Dietitian Nutritionist Services
In network pricing policies Out of network pricing policies

If you have any questions related to these changes, please call the Provider Blue Line at 800-214-4844.