State Health Plan Third-Party Administrator Transition Information

The State Health Plan (SHP) is transitioning from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to a new third-party administrator (TPA) effective January 1, 2025.

Blue Cross NC will continue to support providers and members during this time, and we are working to make it as smooth a transition as possible.

The following is important information for our provider community to know regarding the upcoming transition:

• Blue Cross NC will continue to serve as the Plan’s TPA until December 31, 2024. Any claims that were incurred (with dates of service) prior to January 1, 2025 will be processed by Blue Cross NC.
• Blue Cross NC is sending information on any existing authorizations that will extend into 2025 to the new TPA.
  • Any provider questions on authorizations for 2025 should be directed to the new TPA at 888-623-6862.
  • Additionally, you can visit the North Carolina State Health Plan Transition webpage. 

Providers with questions should use the following resources:

• For questions on services incurred prior to January 1, 2025:
  • Continue to contact Blue Cross NC Provider Customer Service at 800-214-4844.
•  For questions on services January 1, 2025, or after:
  • Please contact the State Health Plan or the new TPA at 888-632-3862.

Additional questions:

• What number should my patients call with questions?
  • For questions related to dates of service prior to January 1, 2025, State Health Plan members can call Blue Cross NC customer service at 888-234-2416. 
  • For questions on services after January 1, 2025, members should call the new TPA at 833-690-1037.
• If a member is admitted as inpatient prior to January 1, 2025, how do I file my claim?
  • Blue Cross NC will pay any inpatient facility claims where the member was admitted prior to December 31, 2024, through the discharge from the facility. Facility claims that meet the above criteria should be submitted to Blue Cross NC for processing following the normal process.
  • All professional claims will be paid by the new TPA effective January 1, 2025.
• What will happen to claims submitted after the end of claims runout June 30, 2026? 
  • Blue Cross NC cannot pay any claims after the end of the runout period. This includes adjustments. Providers should plan accordingly and submit any claims prior to the last 60 days of the runout period to allow Blue Cross NC time to process these claims prior to June 30, 2026.