Update: Changes in prior authorization for Blue Cross NC outpatient therapy requests effective December 1, 2024

On November 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced changes in prior authorization for outpatient therapy requests effective December 1, 2024: Update: Changes in prior authorization for Blue Cross NC outpatient therapy requests now effective December 1.

Blue Cross NC has identified incorrect messaging on the Blue e eligibility portal displaying that prior authorization is not required for rehabilitation services (physical, occupational, and speech therapies) for Fully Insured members.

This error impacted services rendered from December 1, 2024, to January 16, 2025. As of January 17, 2025, the issue was corrected, and authorization requirements are now displaying correctly in the Blue e eligibility portal.

As a result of this error, Blue Cross NC has identified the impacted claims denied for no prior plan approval and will be adjusting those claims to bypass the authorization requirement.

Key Information for Providers:

• Impacted claims will be adjusted automatically, with no action required from providers. Please do not re-file claims.
• Please allow 30 days from the date of this communication for claim adjustments to be finalized.
• Additional updates will be shared via Blue e in the “What’s New” section once adjustments are finalized.