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

On January 27, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced that messaging on the Blue e eligibility portal was incorrectly displaying that prior authorization is not required for rehabilitation services (physical, occupational, and speech therapies) for Fully Insured members: Update: Changes in prior authorization for Blue Cross NC outpatient therapy requests effective December 1, 2024 | Blue Cross NC.

As of January 17, 2025, this issue was corrected for most members, and authorization requirements are now displaying correctly in the Blue e eligibility portal. Blue Cross NC has identified the impacted claims for dates of service between December 1, 2024, and January 16, 2025, that were denied for no prior plan approval. We will be adjusting those claims to bypass the authorization requirement and there is no action required from providers.

 Claims for members under active 2024 policies into 2025

There are some members with coverage effective dates other than January 1, i.e., July 1, August 30, and for these members, we will have those claims completed for adjustments by February 17, 2025. The Blue e eligibility portal is currently being updated with correct authorization requirements. Claims for dates of service between December 1, 2024, and February 17, 2025, that were denied due to no prior plan approval will also be adjusted to bypass the authorization requirements.

Key Information for Providers:

Impacted claims will be adjusted, 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 all adjustments are finalized.