We have noticed an increase in rejected Healthy Blue + Medicare^℠ Dual Special Needs Plans (D-SNP) claims since becoming the plan administrator. As a reminder to our providers, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) became the plan administrator for Healthy Blue + Medicare (D-SNP) starting January 1, 2026. This update applies to eligible members throughout all 100 counties in North Carolina, and providers should follow the claims process guidelines below to ensure claims are submitted to the correct administrator for processing.

As a reminder for the claims filing process:

• Starting January 1, 2026, providers will file D-SNP claims for members with the HME Prefix using Blue Cross NC’s Blue e portal. Beginning January 1, 2026, providers can use Blue e not only for claim entry, but also for eligibility and benefits inquiries, authorization requests, remittance/Explanation of Payment (EOP) inquiries, and claim status inquiries.
• For claims with dates of service and members with the L7H Prefix prior to January 1, 2026, continue filing through the Elevance provider portal (Availity). 
• If you submit directly or use a clearinghouse, please notify them to route D-SNP claims to Blue Cross NC for dates of service on or after January 1, 2026, using the DSNP member ID with prefix HME found on their ID card.
• If you or your clearinghouse received rejections, please resubmit any rejected claims to the correct administrator.
• For more information on setting up both processes, please refer to the additional article on plan administration changes.
• This change does not affect Medicaid claims. Continue submitting eligible services to Medicaid Direct.