If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Claims mailing addresses. This information will help you confirm that anything you paid to the health care provider at the time of service was the correct amount per your plan. Claim Number: Identifies specific services received during a health care visit through a uniquely assigned number. Blue Cross NC has a process for an enrollee, the enrollee's designee, or the enrollee's prescribing physician (or other prescriber) to request an expedited review based on exigent circumstances. Accessibility You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! Service: A summary description of the type of medical service provided. If Blue Cross NC denies a request for a standard exception or for an expedited exception, Blue Cross NC has a process for the enrollee, the enrollee's designee, or the enrollee's prescribing physician (or other prescriber) to request that the original exception request and subsequent denial of such request be reviewed by an independent review organization. Further, all of this information is pending regulatory approval. Disponible nicamente en ingls. Usage Agreement If you are billed by the provider, you will be responsible for paying the bill and filing a claim with Blue Cross NC. Customer Service: 1-888-206-4697. Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service. Contact Us | NC State Health Plan The Blue e User you identify for EFT access is designated as the Authorized Signatory of the Electronic Funds Transfer record.BCBSNC agrees to inform the Authorized Signatory by email, and to provide confirmation, by US postal service, of any creation of or change to the record. Read the latest Dental Provider news. This confirmation will be delivered to the physical address on . Claims Submission. If you need more information about a particular service, contact your health care provider to discuss the details of how they filed the claim with your plan. Copayments, coinsurance, noncovered services, or any charges in excess of any maximum or allowed amount are never applied to your deductible amount. Technical Information Ambetter PA Health & Wellness Member and Provider Services Phone Number: Ambetter from Peach State Health Plan Georgia, 1100 Circle 75 Parkway, Suite 1100, Atlanta, GA 30339. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Learn how to submit all of your claims and receive your payments electronically for faster processing and payment using electronic data interchange (EDI). Please review the terms of use and privacy policies of the new site you will be visiting. Heres everything you need to know about it. Best Practices to reduce the chance of retroactive denials: Enrollee recoupment of overpayments is the refund of a premium overpayment by the enrollee due to the over-billing by the issuer. Alternatively, you may call customer service at the number listed on your EOB or ID card. If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. Phone:(800) 824-8839, Blue Shield Life & Health Insurance Company All Excellus plans use this mailing address: Excellus BCBS Attn: Claims P.O. Phone: 1-844-594-5072. Download the Medicare Reimbursement Account (MRA) Pay Me Back claim form: Complete the form following the instructions on the front. Contact Us | BlueCross BlueShield of South Carolina A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month's premium during the benefit year. Raleigh NC 27699-2501, Questions: Medicaid.Transformation@dhhs.nc.gov, Jay LudlamPhone: 919-527-7000Fax: 919-832-0225, John E. ThompsonPhone: 919-855-4100Fax: 919-733-6608, Eva Fulcher, Deputy Director Learn more and enroll in EDI on our Manage electronic transactions page. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Necesita su ID de usuario? Other Liability: Out-of-network providers do not have contracts with us to agree to lower negotiated rates, thus, they can bill you for more than your plan's allowed amount. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. Submit a separate claim for each patient. However, you may be responsible for charges billed separately by the provider which are not eligible for additional reimbursement. Durham, NC 27702 Learn more about our non-discrimination policy and no-cost services available to you. Monday-Thursday 8 a.m. - 5 p.m. We can help with: Understanding your benefits This process is voluntary. Blue Cross NC will make a decision on your request for certification within a reasonable amount of time taking into account the medical circumstances. Register Now, Ancillary and Specialty Benefits for Employees. Ambetter Magnolia Health Member and Provider Services Phone Number: Ambetter from Managed Health Services Indiana, 550 N.Meridian St. Suite 101, Indianapolis, IN 46204, Ambetter from NH Health Families New Hampshire, 2 Executive Park Drive, Bedford, NH 03110. Tweet Loading. Copayments may count towards out-of-pocket maximum. Please note that some policies require that a specific number of family members must meet their individual deductibles first before the family deductible is met. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Mailing Address for BCBSNC MedicalClaims, send paper claims to a different mailing address. Allowed Amount: The discounted rate your plan has negotiated with in-network providers and facilities for covered services. You may have to pay the out-of-network provider in full and submit your own claim to Blue Cross NC. Blue e Provider Access - Blue Cross and Blue Shield of North Carolina Prior review is not required for an emergency or for an inpatient hospital stay for 48 hours after a vaginal delivery or 96 hours after a Cesarean section. Blue Cross NC will make its determination on the external exception request and notify the enrollee or the enrollee's designee and the prescribing physician (or other prescriber, as appropriate) of its coverage determination no later than 72 hours following its receipt of the request, if the original request was a standard exception request and no later than 24 hours following its receipt of the request, if the original request was an expedited exception request. Balance billing occurs when an out-of-network provider bills an enrollee for charges other than copayments, coinsurance, or any amounts that may remain on a deductible. Complete the form following the instructions on the back. Blue Cross NC will notify you and the provider of an adverse benefit determination electronically or in writing. Contact Us | Healthy Blue of North Carolina Copayment: The fixed dollar amount you pay up front to a health care provider for a covered service. Phone: 800-723-4337. Phone:(559) 734-1321 If you have any problems logging in to the Blue e network or Blue Premier, please call the eSolutions HelpDesk at 1-888-333-8594 Option 1 or your system administrator. Closed onState Holidays, NCTracks Contact Center -Provider information for claims and billing.Phone: 800-688-6696, 2501 Mail Service Center Fraud and Abuse The following contact information may also be helpful. These appeals include dissatisfaction with a claim denial for post-service issues that may be either provider or member liability. Family Deductible: Your family has a deductible for all covered members on your policy, if applicable. Enroll in EDI and submit claims for free using Office Ally. During the grace period, the QHP issuer must provide an explanation of the 90 day grace period for enrollees with premium tax credits pursuant to 45 CFR 156.270(d). Olvido su contrasea? These appeals may be submitted internally to Blue Cross NC without written consent from the member. However, if you are unable to use the Claims Routing Tool, use the current addresses listed below. Submit a separate claim for each member. Blue Cross and Blue Shield of North Carolina is now sending some Healthy Blue bulletins, policy change notifications, prior authorization update information, educational opportunities, and more to providers via email. Ambetter Sunflower Health Plan Member and Provider Services Phone Number: 1301 International Parkway, Suite 400, Sunrise, FL 33323. By continuing to use this website, you consent to these cookies. Ambetter Home State Health Member and Provider Services Phone Number: Ambetter from Illinicare Health Illinois, PO Box 92050, Elk Grove Village, IL 60009-2050. Site Map Box 35 Value Options (for members enrolled in SHP). Code Set; Paper Claim Filing; Dental Providers. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Attaching supporting medical information will expedite the handling of the provider appeal. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, https://www.bluecrossnc.com/providers/network-participation/become-blue-cross-nc-provider-or-recredential/apply-provider-number, https://www.bluecrossnc.com/providers/esolutions/electronic-solutions/submit-electronic-files, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. The protection of your privacy will be governed by the privacy policy of that site. Print and mail the form to the Blue Cross and Blue Shield company in the state that the services were rendered by December 31 of the year following the year you received service. Ambetter from Arkansas Health and Wellness Member and Provider Services Phone Number: Ambetter from Coordinated Care Washington, 1145 Broadway, Suite 300 Tacoma, WA 98402. Examples of reviews not eligible for the provider to appeal on their own behalf are: If at any time a member and/or their authorized representative request an appeal during the review of a provider appeal, the member appeal takes precedence. Does insurance cover breast pumps blue cross blue shield? Your plan is not notified by your provider when you have made any payments to them. Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. Check out the changes and updates to our plan in 2023. Linked Apps. Or mail a paper copy, along with proof that you paid a Medicare Part B premium, to: Complete the form following the instructions on the back. Filing Claims: In-Network In-network providers in North Carolina are responsible for filing claims directly with Blue Cross NC. Forms to add or remove a Blue e user or NPI. Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address. An enrollee, instead of the provider, submits a claim to the issuer, requesting payment for services that have been received. PDF Claims Filing Tips and Guidelines State Government websites value user privacy. For questions about your plan, bills or claims, call the Customer Service number on the back of your Blue Cross NC Member ID card. In-Network: Doctors, hospitals, clinics, and other health care providers who have a contract with your plan to provide services to you at a discount. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. P.O. Does cigna health insurance cover birth control? Allowed amount Blue Cross NC will make its determination on a standard exception and notify the enrollee or the enrollee's designee and the prescribing physician (or other prescriber, as appropriate) of its coverage determination no later than 72 hours following receipt of the request. Phone:(800) 541-6652, (Subscriber ID number begins with the letter "R.") 620 S. Dora St., Suite 201 Calls are recorded to improve customer satisfaction. Ambetter Arizona Provider Services Phone Number: Ambetter from Arkansas Health & Wellness Arkansas. (See Filing Claims below for additional information.). Log in to Blue Connect to view your plan info and contact information. Phone:(800) 622-0632, Blue Shield of California, CalPERS However, prior review is not required for an emergency or for an inpatient hospital stay for 48 hours after a vaginal delivery or 96 hours after a Cesarean section. Ambetter from Absolute Total Care Member and Provider Services Phone Number: Ambetter from Arizona Complete Health Arizona, 1870 W. Rio Salado Parkway Tempe, AZ 85281. Provider websites Public website: https://provider.healthybluenc.com Secure website: https://www.availity.com Prior authorizations/ notifications (medical/behavioral health) Phone:844-594-5072 Fax: Inpatient: Medical: 855-817-5788 All continued stay requests/discharge planning notifications/updates: 844-451-2694 Home Contacts Beneficiary and Provider Support Medicaid Policies and Procedures NC Medicaid Contact Center - Provider and beneficiary information on Medicaid policies and procedures. Please review the terms of use and privacy policies of the new site you will be visiting. Box 2924 Phoenix, AZ 85062-2924. Members (or their authorized representatives) may visit http://www.bcbsnc.com/content/services/formulary/rxnotes.htm for information about the ways to submit a request. Contact Us Live Chat: Availity Chat with Payer is available during normal business hours. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Connect - Blue Cross and Blue Shield of North Carolina Help Learn more about our non-discrimination policy and no-cost services available to you. Claims for non-capitated services provided to a Blue Shield HMO member that are erroneously submitted to the capitated IPA or Medical Group for processing are required to be forwarded by the capitated IPA or Medical Group to Blue Shield within 10 working days. Blue Cross and Blue Shield of North Carolina However, you will have to file a claim if you do not show your ID card when you obtain a prescription from an in-network pharmacy, or the in-network pharmacy's records do not show you as eligible for coverage, or you are in your three month grace period if you receive a federal subsidy. PDF Healthy Blue Provider Quick Reference Guide You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Deductible: The amount you pay for eligible services during a benefit period before your plan begins to pay. Necesita su ID de usuario? Reason Code: Indicates an explanation is available in the "What Our Codes Mean" section at the end of the EOB. If you still need to submit paper claims, use the Claims Routing Tool to determine the correct mailing address for each member. Send us a secure message If you're already a member, you can log in to your account to send us a secure message at any time. Issuers' exceptions processes allow enrollees to request and gain access to drugs not listed on the plan's formulary, pursuant to 45 CFR 156.122(c). P.O. If you have questions, please contact your local Blue Cross and Blue Shield company. For more efficient delivery of the request, this information may also be faxed to the Appeals Department using the appropriate fax number below. Claims/Customer Service Blue Cross Blue Shield of North Carolina P.O. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Claims Administrator Phone:(800) 541-6652 Linked Apps. P.O. Provider Services For provider questions and claims issues: Phone: 1-844-594-5072 Eligibility verification Prompt 1 Authorizations and precertification Prompt 2 Claims status Prompt 3 Provider relations Prompt 4 Pharmacy department Prompt 5 Care management Prompt 6 Inpatient coordination Prompt 7 Remember, copayments, if applicable are not applied to the deductible, coinsurance or out-of-pocket amounts. Then select Chat with Payer and complete the pre-chat form to start your chat. Once you reach your coinsurance maximum, your plan will pay 100% for covered services for the rest of the benefit period. Heres everything you need to know about it. Change). The BlueCross/BlueShield of North Carolina mailing address for medical claims is: BCBSNC MEDICAL CLAIMS PO BOX 35 DURHAM NC 27702-0035 If you found this helpful, please share! These claims won't be paid until your bill is paid in full. You may notice this amount is often higher than the allowed amount. Friday 8 a.m. - 4 p.m. https://www.bluecrossnc.com/providers/network-participation/apply-credentialing, Tools for managing specific health conditions such as asthma, diabetes, or cardiovascular disease, First time users: https://www.bluecrossnc.com/providers/esolutions/electronic-solutions/submit-electronic-files, Behavioral Health (mental health and substance use disorder), If you suspect healthcare fraud and abuse, please report the problem immediately to Blue Cross NC, https://www.bluecrossnc.com/about-us/policies-and-best-practices/fraud-and-abuse, Submitting Precertification/Admission Notification or Continued Stay Review. If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. Benefits are thus "coordinated" between the two health plans. Mail Applications and Correspondence to: Blue Cross Blue Shield of Arizona P.O Box 13466 Phoenix AZ 85002-3466. Access a wealth of healthcare resources and tools with MyBlue. Call us Healthy Blue Member Services 844-594-5070 (TTY 711) Monday through Saturday, 7 a.m. to 6 p.m. Eastern time. Chico, Ca 95927-2640 Include itemized bills for covered services or supplies. In-network providers in North Carolina are responsible for filing claims directly with Blue Cross NC. An EOB is a statement an issuer sends the enrollee to explain what medical treatments and/or services it paid for on an enrollee's behalf, the issuer's payment, and the enrollee's financial responsibility pursuant to the terms of the policy. Accessibility If you have any excluded services, (services your plan does not cover) they will appear in this column as well. The deductible may not apply to all services. The pre-service review process is not changing. Fraud and Abuse The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. BCBS of Western New York P. O. Privacy Policy It does not include your premium, charges over allowed amounts, or services that are non-covered. Box 2291 Electronic Solutions; What is Blue e? Claims must be received by Blue Cross NC within 18 months of the date the service was provided. Learn more about our non-discrimination policy and no-cost services available to you. Blue Cross and Blue Shield of North Carolina. Your member ID card is your key to using your medical plan benefits. North Carolina - Blue Cross and Blue Shield's Federal Employee Program P.O. You may be responsible for paying any charges over the allowed amount in addition to any applicable copayment, deductible, coinsurance, and non-covered expenses. They will be told they won't be paid unless you pay your bill before the end of the third month. Blue E Learn More Already a Member? 3. If Blue Cross NC needs more information to process your urgent review, Blue Cross NC will let you and your provider know of the information needed as soon as possible but no later than 24 hours after we receive your request. Include proof that you paid a Medicare Part B premium. Secure websites use HTTPS certificates. Ambetter NH Healthy Families Member and Provider Services Phone Number: Ambetter from PA Health & Wellness Pennsylvania, 300 Corporate Center Drive, Suite 600, Camp Hill, PA 17011. Any premium overpayments will normally be credited to your account and applied to future premiums due. Use this form to submit a claim to be reimbursed for paying Medicare Part B premiums. Go to Availity Portal and select Anthem from the payer spaces drop-down. in your benefit booklet for information on who to call for prior review and to obtain certification for mental health and substance abuse services and all other medical services. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. If we didn't receive your premium payment by that date, you started your three-month grace period. (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). If you still need to submit paper claims,use theClaimsRoutingTool to determine the correct mailing address for each member. Out-of-Network: Services from health care providers who don't have a contract with your plan will usually cost you more than those received from an in-network provider. Forgot username or password? Claims and Billing | NC Medicaid Services not eligible for separate reimbursement, No Authorization for Inpatient Hospital Stay. How to prescreen claims with C3 (PDF, 540KB), Intro to Clear Claim Connection - recorded webinar (34 minutes), Intro to Clear Claim Connection - presentation (PDF, 816 KB), Clean claims submission tips (PDF, 24 KB). Health Claims:803-264-2215 in Columbia, or toll-free 888-410-2227. Phone:(707) 462-7607. Technical Information , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For each step in this process, there are specified time frames for filing an appeal and for notification of the decision. Register Now, Ancillary and Specialty Benefits for Employees. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. NC MedicaidContact Center -Provider and beneficiary information on Medicaid policies and procedures.Phone: 888-245-0179Monday -Friday 8 a.m. - 5 p.m. Blue Cross NC may extend this period one time for up to 15 days if additional information is required and will notify you and your provider before the end of the initial 15-day period of the information needed and the date by which Blue Cross NC expects to make a decision. Your provider will be notified of the decision, and if the decision results in an adverse benefit determination, written notification will be given to you and your provider. Chico, CA 95927-2510 Instructions: 1. PDF Local Blue Cross and Blue Shield Mailing Addresses State/Alpha Prefix Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, Demographic and Contact Information (Job Aid), Individual Practitioner Enrollment Application, Tax Identification and Legal Names (Job Aid), Terminations of Practitioners and Groups (Job Aid), Applied Behavioral Analysis/Adaptive Behavioral Treatment for Autism Spectrum Disorder (ABA/ABT) Fax Form, Enrollment Pending Claims Filing Exception Form, FAQ for Electronic Credentialing and Enrollment Submission, FAQ for Enrollment Pending Claims Filing Process, Member Appeal Representation Authorization Form, Prime Therapeutics - Pharmacy Fax Order Form, Post Service - Dermatology Patch Allergy Testing Form, Post Service - Hemodialysis Treatment for ESRD Form, Post Service - Medical Records Fax Sign-up Form, Post Service - Intraoperative Neurophysiologic Monitoring Form, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire.
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