bcbs of nc provider claims mailing address

Blue Cross NC will make its coverage determination on an expedited review request based on exigent circumstances 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 24 hours following receipt of the request. Further, all of this information is pending regulatory approval. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Change), You are commenting using your Facebook account. 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. Member Savings: The amount you saved by visiting an in-network provider or facility and being a member of your plan, entitling you to receive these negotiated discounts. Fax: 919-733-6608, This page was last modified on 04/03/2023, An official website of the State of North Carolina. You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! 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. Copayments may count towards out-of-pocket maximum. Defining a "Corrected Claim" The corrected claims process begins when you receive a notification of payment (NOP) or explanation of payment (EOP) from BCBSNC detailing the claims processing results. Blue Cross NC will make a decision on your request within a reasonable time but no later than 48 hours after receipt of requested information or the end of the time period given to the provider to submit necessary clinical information, whichever comes first. Learn more and enroll in EDI on our Manage electronic transactions page. These providers will also be able to check and see if you've paid your bill before they submit more claims for services. Fraud & Abuse. P.O. This means you may be able to pay a copayment rather than the full amount. Total: The amount you owe the provider, including any applicable copayment, deductible, coinsurance or other liability. London, KY 40742 The following contact information may also be helpful. Save my name, email, and website in this browser for the next time I comment. See "Who to Contact?" Use our Claims-Routing Tool to find out where to send your claims by mail. Prior authorization (prior review) is a process through which an issuer approves a request to access a covered benefit before the insured accesses the benefit. Forgot username or password? Foundation for Medical Care of Tulare & Kings Counties Ambetter Claims mailing address and provider Phone Number list (2023) Learn more about the BlueCard Program. With the form, the provider may attach supporting medical information and mail to the following address within the required time frame. Filing Claims: In-Network In-network providers in North Carolina are responsible for filing claims directly with Blue Cross NC. The information provided below applies to 2018 Individual On-Exchange plans unless otherwise noted. Print and complete the form according to instructions on the front. Coordination of Benefits applies when an enrollee is covered by two health plans at the same time. The provision is designed so that the payments of both plans do not exceed 100% of the covered charges. Ambetter Sunflower Health Plan Member and Provider Services Phone Number: 1301 International Parkway, Suite 400, Sunrise, FL 33323. 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. Electronic Solutions; What is Blue e? 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. Allowed Amount: The discounted rate your plan has negotiated with in-network providers and facilities for covered services. They will be told they won't be paid unless you pay your bill before the end of the third month. Your Plan Paid: The amount your plan paid for the services you received. Ambetter Arizona Provider Services Phone Number: Ambetter from Arkansas Health & Wellness Arkansas. You will have 45 days to provide the requested information. Careers NCTracks Contact Center. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Include itemized bills for covered services or supplies. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Submit a separate claim for each patient. English, Download the overseas retail prescription drugclaim form: Instructions: 1. 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. Financial Dashboard. For help with Blue Premier registration or account management, please contact your account administrator. 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. Access a wealth of healthcare resources and tools with MyBlue. Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. The protection of your privacy will be governed by the privacy policy of that site. In-network providers outside of North Carolina, except for Veterans' Affairs (VA) and military providers, are responsible for requesting prior review for inpatient facility services. Provider Appeals | Level I Provider Appeals | Blue - Blue Cross NC Call us Healthy Blue Member Services 844-594-5070 (TTY 711) Monday through Saturday, 7 a.m. to 6 p.m. Eastern time. 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 Please review the terms of use and privacy policies of the new site you will be visiting. Learn more about our non-discrimination policy and no-cost services available to you. Claims for capitated services provided to a Blue Shield HMO member that are erroneously sent to Blue Shield for processing/payment will be forwarded to the appropriate capitated provider within 10 working days of the receipt. English Espaol. (LogOut/ Box 2291, Durham, NC 27702. Ambetter Peach State Health Plan Member and Provider Services Phone Number: Ambetter from Silversummit Healthplan Nevada, 2500 N. Buffalo Drive, Ste 250, Las Vegas, NV 89128. 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. Member-specific, dose-specific drugs delivered directly to your practice. Privacy Policy 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. It does not include your premium, charges over allowed amounts, or services that are non-covered. Visalia, CA 93277 Forms to add or remove a Blue e user or NPI. (LogOut/ Prescription Drugs. Home Contacts Beneficiary and Provider Support Medicaid Policies and Procedures NC Medicaid Contact Center - Provider and beneficiary information on Medicaid policies and procedures. 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. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. Technical Information Learn more about our non-discrimination policy and no-cost services available to you. Claims mailing addresses are also included in all online member eligibility results. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Contacts | NC Medicaid 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. Level I post-service provider appeals for billing/coding disputes and medical necessity determinations are available to physicians, physician groups, physician organizations and facilities and are handled by Blue Cross NC. PO BOX 35 We make it easy to manage your healthcare finances, claims and health information. Providers have 90 calendar days from the claim adjudication date to submit a Level I Post Service Provider Appeal for billing/coding disputes and medical necessity determinations. Enrollee Claims Submission An enrollee, instead of the provider, submits a claim to the issuer, requesting payment for services that have been received. Box 272540 An enrollee, instead of the provider, submits a claim to the issuer, requesting payment for services that have been received. You pay coinsurance plus any deductibles you owe. Inscribirse ahora! 3. Learn more about our non-discrimination policy and no-cost services available to you. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 2023 Blue Cross and Blue Shield of North Carolina. Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. 2021 Blue Cross and Blue Shield of North Carolina, Medical Policies and Clinical UM Guidelines, Guide to Drug Coverage Under Medical Benefit, Screening, Brief Intervention, and Referral to Treatment, Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment, Authorizations and precertification Prompt 2. The protection of your privacy will be governed by the privacy policy of that site. Box 272540 P.O. For more efficient delivery of the request, this information may also be faxed to the Appeals Department using the appropriate fax number below. We make it easy to manage your healthcare finances, claims and health information. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Olvido su contrasea? Chico, CA 95927-2630 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. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Claims not received within 18 months from the service date will not be covered, except in the absence of legal capacity of the member. Technical Information Box 14053 Available for commercial, Shared Advantage, and BlueCard. If a pre-service request is denied, providers may contact Healthcare Management and Operations (HCM & O) at 1-800-672-7897 for a pre-service Provider Courtesy Review (PCR). Blue Shield of California, FEP benefit booklet, application, Summary of Benefits and Coverage). Claims/Customer Service Blue Cross Blue Shield of North Carolina P.O. Claims Administrator Then select Chat with Payer and complete the pre-chat form to start your chat. Comment? Forms and Documentation | Providers | Blue Cross NC 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 you use a provider outside of our network, you'll need to complete and file a claim form to be reimbursed. Usage Agreement Your member ID card is your key to using your medical plan benefits. 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. Deductible: The amount you pay for eligible services during a benefit period before your plan begins to pay. Provider Blue Book; Dental Provider Blue Book; Network Participation Mail Applications and Correspondence to: Blue Cross Blue Shield of Arizona P.O Box 13466 Phoenix AZ 85002-3466. Additionally, this information does not modify any of the terms of your health insurance policy/plan. does united health care cover dental implants? 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Box 35 Durham, NC 27702 Customer Service 1-800-222-4739 Precertification 1-800-672-7897 Case Management 1-888-234-2415 1-919-765-2081 Fax Care Management Programs Asthma Chronic Obstructive Pulmonary Disease Congestive Heart Failure Coronary Artery Disease Diabetes 1-800-222-4739 Ambetter Illinicare Health Member and Provider Services Phone Number: Ambetter from Magnolia Health Mississippi, 111 East Capitol, Suite 500, Jackson, MS 39201. Phone:(707) 462-7607. Blue Cross and Blue Shield of North Carolina. For a complete listing of vendors and their contact information: https://www.bluecrossnc.com/providers/pharmacy-program/specialty-pharmacy-network, Blue Cross NC offers a Spanish speaking customer service line for your patients, Questions regarding policies, procedures or guidelines (non-claims related). This does not include copayments or non-covered services. Fax: (818) 228-5014, Blue Shield of California Promise Health Plan Provider Appeals Department Calls are recorded to improve customer satisfaction. These appeals may be submitted internally to Blue Cross NC without written consent from the member. Alternatively, you may call customer service at the number listed on your EOB or ID card. Home How to Submit a Claim - Blue Cross and Blue Shield's Federal Employee Disponible nicamente en ingls. Use this form to submit a claim to be reimbursed for services that are covered under Service Benefit Plan dental benefits. You will then be given a reasonable amount of time, but not less than 48 hours, to provide the requested information. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Fraud and Abuse Register Now, Ancillary and Specialty Benefits for Employees. Learn more about our non-discrimination policy and no-cost services available to you. Services not eligible for separate reimbursement, No Authorization for Inpatient Hospital Stay. 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. NCTracks AVRS. BCBS of Western New York P. O. Submit a separate claim for each patient. 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. contact your local Blue Cross and Blue Shield company. To come out of the grace period and not have your policy terminated, you must pay your account in full. We use cookies on this website to give you the best experience and measure website usage. Note: If you have met the required amount, this field will simply show "Met" on the EOB. Question? Manage Claims & Records. Download the overseas medical claim form: Failure to request prior review and obtain certification will result in a full denial of benefits. Learn more about our non-discrimination policy and no-cost services available to you. Inscribirse ahora! Durham, NC 27702 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 Your payment is due on the first of the month. Blue Connect - Blue Cross and Blue Shield of North Carolina By continuing to use this website, you consent to these cookies. P.O. Suggestion? For provider questions and claims issues: Contact Us | NC State Health Plan Contact Us | Healthy Blue of North Carolina They do not count towards the deductible. 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. 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. It's the quickest and safest way to connect with us. Listed below, by county, are the addresses of medical foundations with which Blue Shield is affiliated. Privacy Policy Filing your claims should be simple. An EOB is an outline of what services you received from a provider and how your benefits were applied to cover those services. For all other covered services received outside of North Carolina, you are responsible for ensuring that you or your provider requests prior review by Blue Cross NC or its designee even if you see an in-network provider. 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. For each step in this process, there are specified time frames for filing an appeal and for notification of the decision. All rights reserved. Box 80 Buffalo, NY 14240- 0080 North Carolina BCBS of North Carolina ATTN: BlueCard 1965 Ivy Creek Blvd P.O. 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. Box 2291 Please review the terms of use and privacy policies of the new site you will be visiting. Learn more about Healthcare Fraud. If you are billed by the provider, you will be responsible for paying the bill and filing a claim with Blue Cross NC. Make sure your documents include the five following pieces of information as required by the IRS: Provider name (which is Medicare in this case), You can fax the form, along with proof that you paid a Medicare Part B premium, to, You can upload the form through the EZ Receipts mobile app, available at the. Contact Us View contact information for various State Health Plan vendors to address specific questions or concerns. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The decision will be made and communicated to you and your provider within three business days after Blue Cross NC receives all necessary information but no later than 15 calendar days from the date Blue Cross NC received the request. Contact Us - Healthy Blue North Carolina Providers PDF State Mail to Mailing Address City, State Zip P.O. 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. Linked Apps. This limit may include copayments and deductibles. Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. If you have any excluded services, (services your plan does not cover) they will appear in this column as well. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. These appeals include dissatisfaction with a claim denial for post-service issues that may be either provider or member liability. Box 35 Need to submit a claim? (You can fill the form in electronically or complete it by hand.). Ambetter of North Carolina Member and Provider Services Phone Number: Ambetter of Tennessee Member and Provider Services Phone Number. You only pay any applicable copayment, deductible, coinsurance, and non-covered expenses. Benefits are thus "coordinated" between the two health plans. Blue Cross and Blue Shield of North Carolina 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. Forgot username or password? Phone:(800) 622-0632, Blue Shield of California, CalPERS Usage Agreement As soon as Blue Cross NC receives all the requested information, or at the end of the 45 days, whichever is earlier, Blue Cross NC will make a decision within three business days. Blue e Provider Access - Blue Cross and Blue Shield of North Carolina Phone: 800-723-4337. Site Map Don't have your ID card? Closed onState Holidays, NCTracks Contact Center -Provider information for claims and billing.Phone: 800-688-6696, 2501 Mail Service Center Encouraging stronger patient-doctor relationships, enhanced communication and team-based care. For inpatient or certain outpatient mental health and substance abuse services, either in or outside of North Carolina, use the information on the back of your ID card to request prior review and receive certification. Box 2924 Phoenix, AZ 85062-2924. PDF Healthy Blue Provider Quick Reference Guide Help Privacy Policy That's why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. NC MedicaidContact Center -Provider and beneficiary information on Medicaid policies and procedures.Phone: 888-245-0179Monday -Friday 8 a.m. - 5 p.m. Marks of the Blue Cross and Blue Shield Association. Claim Number: Identifies specific services received during a health care visit through a uniquely assigned number. Overseas members must file claim forms for any covered medical or pharmacy servicesreceived outside of the United States. These claims won't be paid until your bill is paid in full. At this time, the provider appeal will be closed. Phone:(800) 541-6652, (Subscriber ID number begins with the letter "R.") Allowed amount Register Now, Ancillary and Specialty Benefits for Employees. You may notice this amount is often higher than the allowed amount. Learn more and enroll in EDI on our Manage electronic transactions page. Contact. Mail Premium Payments to: Individual Affordable Care Act (ACA) Member Premium Payment Blue Cross Blue Shield of Arizona P . Dental Claims:803-264-3879 in Columbia, or toll-free 800-222-7156. Learn more about our non-discrimination policy and no-cost services available to you. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Exigent circumstances exist when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a non-formulary drug. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Your Provider Billed: The amount your health care provider submitted for the services you received. If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. Phone: 888-245-0179 Monday - Friday 8 a.m. - 5 p.m. Closed on State Holidays Medicaid Claims and Billing For more information, view our privacy policy. P.O. Site Map Site Map Once you reach your coinsurance maximum, your plan will pay 100% for covered services for the rest of the benefit period. The pre-service review process is not changing. Once you log in, you also can send us a secure message if you still have questions. 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. Privacy & Security Box 272510 Necesita su ID de usuario? Phone:(800) 662-5502 Additionally, Blue Shield will send an Explanation of Benefits (EOB) to the billing provider as notification that the claim was forwarded to the appropriate capitated provider. Go to Availity Portal and select Anthem from the payer spaces drop-down. Any premium overpayments will normally be credited to your account and applied to future premiums due. Ambetter Superior HealthPlan Member and Provider Services Phone Number: 12515-8 Research Blvd, Suite 400 Austin, TX 78759. Register Now. Value Options (for members enrolled in SHP). About BCBSNC.com Blue e https://bluee.bcbsnc.com/providers/web/login 800.676.BLUE (2583) Chiropractic Services Health Network Solutions, Inc. (Blue Cross NC HMO & Blue Cross NC PPO) 704.895.8117 Contractual Updates Updates to Notice Contract Address Demographic Change Form 800.777.1643 919.765.4349 NetworkManagementProviderNot@bcbsnc.com Heres everything you need to know about it. 2023 Blue Cross and Blue Shield of North Carolina. 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). Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Fraud and Abuse The provision also designates the order in which the multiple health plans are to pay benefits. Claims must be received by Blue Cross NC within 18 months of the date the service was provided. If you receive a call that appears to originate from this number, the call is likely fraudulent or malicious and you should not answer it, or hang up immediately after receiving it if you do answer the call initially. Submit a separate claim for each patient. Service: A summary description of the type of medical service provided. https://bluee.bcbsnc.com/providers/web/login. Forgot username or password? Rev 3/2007 When the sum of all family member payments satisfies the family deductible, each member begins to make payments at the coinsurance rate. 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). Talk to a Customer Service representative with questions about your benefits, claims, ID cards, bills or other questions, call the Customer Service number on the back of your Member ID card Monday to Friday between 8 a.m. and 6 p.m.. Out-of-network liability and balance billing, Medical necessity and prior authorization timeframes and enrollee responsibilities, Drug exception timeframes and enrollee responsibilities, Information on Explanation of Benefits (EOBs), https://www.bcbsnc.com/members/public/forms/index.htm, http://www.bcbsnc.com/content/services/formulary/rxnotes.htm.

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