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Physicians and Other Providers
Access the most up-to-date provider information with our Find a Doctor search tool. Here, you can locate providers by name, specialty, county or zip code The Provider Search information is updated weekly.
You can also contact Customer Service at 1-877-258-3334 for assistance locating a provider or to obtain a paper copy of a directory. Additionally, many employers stock directories in their Benefits Department.
Blue Cross NC believes in the value of maintaining a relationship with a primary care provider. These providers are general practice, family practice, internal medicine and pediatric doctors who deal with a broad range of health care issues. They also help members manage their health and make decisions about their health care needs.
In addition, participating primary care providers participate in cost-saving quality assurance and utilization management programs. They also coordinate patient care, allowing the patient to easily navigate the health care system. These activities serve to enhance the physician-patient relationship, as well as increase the practice of cost-effective, high-quality medicine.
The following is a list of licensed medical and behavioral health professionals whose services are eligible for Plan benefits:
- Doctor of Medicine (MD)
- Doctor of Osteopathy (DO)
- Doctor of Dentistry (DDS) (DMD)
- Doctor of Podiatry (DPM)
- Doctor of Optometry (OD)
- Doctor of Chiropractic (DC)
- Doctor of Psychology (PhD)
- Physical Therapists (PT)
- Occupational Therapists (OT)
- Respiratory Therapists
- Nurse Midwives (CNM)
- Audiologists (MA)
- Physician's Assistants (PA)
- Pastoral Counselors (PC)
- Licensed Certified Social Worker (LCSW)
- Certified Nurse Specialist (CNS)
- Speech and Language Pathologists (SLP)
- Family Nurse Practitioner (FNP)
- Certified Substance Abuse Counselor (CSAC) with appropriate licensure
- Licensed Marriage and Family Therapist
- Licensed Professional Counselors (LPC)
- Licensed Psychological Associate
- Licensed Dietician Nutritionist (LDN)
- Licensed Clinical Addiction Specialist (LCAS)
- Psychiatric Registered Nurses
- Pharmacists (Immunizations only)
The following is a list of some ineligible providers:
- Individual who is not licensed and/or credentialed by the appropriate state/governing professional organization.
- Doctor of Holistic/Naturopathic medicine
- Doctor of Chinese/Oriental medicine
- Massage therapist
The following providers would not be eligible to contract directly with Blue Cross NC. These types of providers generally provide services under a Home Health Agency contract.
- Home Care Aides
- Certified Clinical Social Workers
- Registered Nurse
- Registered Nurse – Certified
Network providers agree to:
- Provide medical care at cost saving rates
- File claims for you
- Coordinate prior plan approvals, order records, verify benefits
- Require no out-of-pocket payment for covered services provided to you, except where copayments or coinsurance may apply
- Adhere to proven, cost-saving medical management practices such as certification for hospital admissions, concurrent review, case management and discharge planning
- Accept Blue Cross NC's reimbursement as payment in full
- Participate in Blue Cross NC's quality assurance program
If your current physician is not a Blue Cross NC network provider and you are just joining a Blue Cross NC health plan or changing health plans, we will assist you in finding a new provider. The continuity of care process will apply to Blue Care, Blue Choice and Blue Options plans if you are being seen regularly for an ongoing special condition or if you are in the second or third trimester of pregnancy or completing post-partum care.
If you are changing health plans, you can obtain information on how to request continuity of care from your employer or benefit administrator or by contacting Blue Cross NC Customer Service at 1-877-258-3334.
Continuity of care requests will be reviewed by a medical professional based on the information provided about specific medical conditions. Notification about eligibility for continuity of care will be sent after a decision is made. If a continuity of care request is approved, you may continue to see your current specialist for up to 90 days. Blue Cross NC will assist you in finding a network provider for any future services before the 90-day period expires.
To change your primary care provider, call Customer Service at 1-877-258-3334 or log in to Blue Connect.
Yes. You may designate a new primary care provider at any time.