bcbs of nc provider claims mailing address

These reasons are used to explain how a service was processed and gives additional information to help you understand how the plan determined what it will pay for the services you received. Box 272540 The provision also designates the order in which the multiple health plans are to pay benefits. They will be told they won't be paid unless you pay your bill before the end of the third month. Forms to add or remove a Blue e user or NPI. Health Claims:803-264-2215 in Columbia, or toll-free 888-410-2227. Fraud and Abuse Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. (Check your policy for details). 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. California Physicians Service DBA Blue Shield of California 1999-2023. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Box 9000 Alternatively, you may call customer service at the number listed on your EOB or ID card. Save time and money when you submit your claims electronically using Electronic Data Interchange (EDI). Coordination of Benefits exists when an enrollee is also covered by another plan and determines which plan pays first. Your member ID card is your key to using your medical plan benefits. Disponible nicamente en ingls. Medical necessity is used to describe care that is reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Type at least three letters and we will start finding suggestions for you. Claims must be received by Blue Cross NC within 18 months of the date the service was provided. Encouraging stronger patient-doctor relationships, enhanced communication and team-based care. Include itemized bills for covered services or supplies. Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. Read the latest Dental Provider news. You will then be given a reasonable amount of time, but not less than 48 hours, to provide the requested information. 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. (LogOut/ You can view your personal EOBs through your MyBlue account. Remember, copayments, if applicable are not applied to the deductible, coinsurance or out-of-pocket amounts. Learn more about the BlueCard Program. P.O. Comment? An EOB is generated after a claim has been received and processed. Save my name, email, and website in this browser for the next time I comment. If you still need to submit paper claims, use the Claims Routing Tool to determine the correct mailing address for each member. Check subscriber ID for three-letter prefix before sending. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. In-network providers in North Carolina are responsible for filing claims directly with Blue Cross NC. The BlueCross/BlueShield of North Carolina mailing address for medical claims is: BCBSNC MEDICAL CLAIMS Check out the changes and updates to our plan in 2023. The grace period gives members who receive subsidies from the federal government more time to pay their bill. 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. Box 272510 Ambetter Arizona Provider Services Phone Number: Ambetter from Arkansas Health & Wellness Arkansas. Phone: 800-723-4337. Necesita su ID de usuario? Submit a separate claim for each patient. 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. Home Contacts Beneficiary and Provider Support Medicaid Policies and Procedures NC Medicaid Contact Center - Provider and beneficiary information on Medicaid policies and procedures. Chico, CA 95927-2510 Contact Us Live Chat: Availity Chat with Payer is available during normal business hours. Ambetter Silversummit Healthplan Nevada Member and Provider Services Phone Number: Ambetter from Sunflower Health Plan Kansas, 8325 Lenexa Drive, Suite 200 Lenexa, KS 66214. Allowed amount Mail Applications and Correspondence to: Blue Cross Blue Shield of Arizona P.O Box 13466 Phoenix AZ 85002-3466. Complete the form following the instructions on the back. Log in to Blue Connect to view your plan info and contact information. Claims not received within 18 months from the service date will not be covered, except in the absence of legal capacity of the member. Submit a separate claim for each patient. We can help with: Understanding your benefits If your doctors, hospital, or pharmacy send in claims for you while you're in the second and third months of your grace period, Blue Cross NC is required to tell them your bill is past due. Site Map Chico, CA 95926, Blue Shield of California 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. These appeals may be submitted internally to Blue Cross NC without written consent from the member. Fraud & Abuse. You will have 45 days to provide the requested information. You may notice this amount is often higher than the allowed amount. It's the quickest and safest way to connect with us. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Privacy & Security Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. 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. Ambetter Coordinated Care Member and Provider Services Phone Number: Ambetter from Home State Health Missouri. 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). Durham, NC 27702 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. 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. Go to Availity Portal and select Anthem from the payer spaces drop-down. Claims. Box 272640 Blue Cross NC will notify you and the provider of an adverse benefit determination electronically or in writing. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. Mail Premium Payments to: Individual Affordable Care Act (ACA) Member Premium Payment Blue Cross Blue Shield of Arizona P . If you are unable to return to the pharmacy within 14 days, mail claims in time to be received within 18 months of the date of the service in order to receive in-network benefits. If you have any excluded services, (services your plan does not cover) they will appear in this column as well. Your Provider Billed: The amount your health care provider submitted for the services you received. Site Map Copayment: The fixed dollar amount you pay up front to a health care provider for a covered service. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Phone:(800) 541-6652 Fax: (559) 734-3828, Foundation for Medical Care of Mendocino-Lake Counties We use cookies on this website to give you the best experience and measure website usage. Technical Information P.O. To come out of the grace period and not have your policy terminated, you must pay your account in full. Register Now, Ancillary and Specialty Benefits for Employees. Claims mailing addresses are also included in all online member eligibility results. Heres everything you need to know about it. We make it easy to manage your healthcare finances, claims and health information. The advantage of being a member of your plan is that the provider has agreed to accept a reduced amount (allowed amount) for the services you received and your liability is based on the allowed amount and not the billed amount. Listed below, by county, are the addresses of medical foundations with which Blue Shield is affiliated. For help with Blue Premier registration or account management, please contact your account administrator. Ambetter Superior HealthPlan Member and Provider Services Phone Number: 12515-8 Research Blvd, Suite 400 Austin, TX 78759. Forward all claims to that foundation for payment. Using advanced data and analytics to provide optimal care to patients with chronic health challenges. 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. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Phone: 888-245-0179 Monday - Friday 8 a.m. - 5 p.m. Closed on State Holidays Medicaid Claims and Billing NC MedicaidContact Center -Provider and beneficiary information on Medicaid policies and procedures.Phone: 888-245-0179Monday -Friday 8 a.m. - 5 p.m. Learn more about our non-discrimination policy and no-cost services available to you. 2. Forgot username or password? Electronic Solutions; What is Blue e? Technical Information Linked Apps. 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. English Espaol. Accessibility For more information, view our privacy policy. Further, all of this information is pending regulatory approval. Ambetter Superior HealthPlan Member and Provider Services Phone Number: 877-687-1196: 68069: Ambetter of North Carolina Inc: 12515-8 Research Blvd, Suite 400 Austin, TX 78759: Ambetter of North Carolina Member and Provider Services Phone Number: 833-863-1310: 68069: Ambetter of Tennessee: 12515-8 Research Blvd, Suite 400 Austin, TX 78759 About BCBSNC.com Providers may not appeal any issues that are considered member benefit or contractual issues. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Mailing Address for BCBSNC MedicalClaims, send paper claims to a different mailing address. Inscribirse ahora! For more efficient delivery of the request, this information may also be faxed to the Appeals Department using the appropriate fax number below. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. Claims Administrator Change). Technical Information 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 2023 Blue Cross and Blue Shield of North Carolina. Level I Provider Appeal reviews are completed within 45 calendar days of the receipt of all information. Ambetter Sunshine Health Member and Provider Services Phone Number: Ambetter from Superior HealthPlan Texas. Media Center 800-972-808 (IVR-Claims/Eligiblity) 877-860-2837 (Blue Cross Community Health Plans) 877-723-7702 (Blue Cross Community MMAI) 877-774-8592 (Blue Cross Medicare Advantage) 800-676-2583 (Eligiblity - Out of State BCBS) 800-972-8382 (Eligibility - FEP) Indiana: 888-802-2160 855-251-8827 (Health Maintenance Organization) P.O. Then select Chat with Payer and complete the pre-chat form to start your chat. Your ID card gives you access to participating providers outside the state of North Carolina through the Blue Card Program, and benefits are provided at the in-network benefit level. Service: A summary description of the type of medical service provided. Learn More Already a Member? A lock icon or https:// means youve safely connected to the official website. Contact Us View contact information for various State Health Plan vendors to address specific questions or concerns. Ambetter from Arkansas Health and Wellness Member and Provider Services Phone Number: Ambetter from Coordinated Care Washington, 1145 Broadway, Suite 300 Tacoma, WA 98402. Faxing is the preferred method for providers to submit Level I appeals to Blue Cross NC. Home Overseas members must file claim forms for any covered medical or pharmacy servicesreceived outside of the United States. Also see, Remain eligible for coverage in accordance with the Marketplace rules, By fax (visit the website above for fax form and numbers), By mail to Blue Cross and Blue Shield of North Carolina, Healthcare Management and Operations, Pharmacy Exception, P.O. Help Call us Healthy Blue Member Services 844-594-5070 (TTY 711) Monday through Saturday, 7 a.m. to 6 p.m. Eastern time. Heres everything you need to know about it. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Claims mailing addresses. These providers will also be able to check and see if you've paid your bill before they submit more claims for services. If you have already paid a copayment or any other upfront payment to the provider, it will not be reflected here. Phone:(707) 462-7607. Privacy Policy (LogOut/ For more information, view our privacy policy. Careers 2023 Blue Cross and Blue Shield of North Carolina. 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. For help with Blue Premier registration or account management, please contact your account administrator. Ambetter Home State Health Member and Provider Services Phone Number: Ambetter from Illinicare Health Illinois, PO Box 92050, Elk Grove Village, IL 60009-2050. Chico, CA 95927-2630 What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 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. 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. Voice Messaging System is available outside of regular business hours. However, you may be responsible for charges billed separately by the provider which are not eligible for additional reimbursement. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. In an emergency, in situations where in-network providers are not reasonably available as determined by Blue Cross NC's access to care standards, or in continuity of care situations, out-of-network benefits will be paid at the in-network benefit level. You may be responsible for paying any charges over the allowed amount in addition to any applicable copayment, deductible, coinsurance, and non-covered expenses. Note: If you have met the required amount, this field will simply show "Met" on the EOB. 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). 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! Need to submit a claim? Box 272630 We make it easy to manage your healthcare finances, claims and health information. The pre-service review process is not changing. Individual Deductible: If you have dependents on your policy, each person may have an individual deductible that is applied toward a total family deductible. Family Deductible: Your family has a deductible for all covered members on your policy, if applicable. - Leave a reply here! 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. 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. Reason Code: Indicates an explanation is available in the "What Our Codes Mean" section at the end of the EOB. 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. does united health care cover hearing aids? If you use a provider outside of our network, you'll need to complete and file a claim form to be reimbursed. https://bluee.bcbsnc.com/providers/web/login. P.O. Fax: 919-733-6608, This page was last modified on 04/03/2023, An official website of the State of North Carolina. 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. The protection of your privacy will be governed by the privacy policy of that site. Box 272660 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. 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. You can use Availity to submit and check the status of all your claims and much more. Financial Dashboard. Register Now, Ancillary and Specialty Benefits for Employees. Claims may be denied retroactively, even after the enrollee has obtained services from the provider based on retroactive changes to eligibility, which include, but are not limited to failure to pay premiums and instructions from the Marketplace. Monday-Thursday 8 a.m. - 5 p.m. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Learn more about our non-discrimination policy and no-cost services available to you. Ambetter from Buckeye Health Plan Member and Provider, Ambetter Indiana Member and Provider Services Phone, Medical Coder Salary -the Best Paying Jobs in Healthcare Industry (2023), Amerihealth Caritas provider Phone Number, Payer ID and Claims mailing address list (2023), Ambetter from Absolute Total Care South Carolina, 1441 Main Street, Suite 900, Columbia, SC 29201. Register Now. Physicians, physician groups, and facilities may file a Level I Provider Appeal of Blue Cross NC's application of coding and payment rules to an adjudicated claim or of Blue Cross NC's medical necessity determination related to an adjudicated claim. State Government websites value user privacy. This process is voluntary. Claims/Customer Service Blue Cross Blue Shield of North Carolina P.O. Use this form to submit a claim to be reimbursed for paying Medicare Part B premiums. Linked Apps. 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. This limit may include copayments and deductibles. Chico, CA 95927-2540 Value Options (for members enrolled in SHP). 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. When the sum of all family member payments satisfies the family deductible, each member begins to make payments at the coinsurance rate. Customer Service: 1-888-206-4697. 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 Phone:(866) 510-8778, Blue Shield Medicare Advantage Plan Please review the terms of use and privacy policies of the new site you will be visiting. Member-specific, dose-specific drugs delivered directly to your practice. Forgot username or password? 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. does united health care cover dental implants? 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. This is the only level of appeal that is available to providers. 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. For each step in this process, there are specified time frames for filing an appeal and for notification of the decision. Fax: (818) 228-5014, Blue Shield of California Promise Health Plan Durham, NC 27702-2291. All other marks are the property of their respective owners. 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. Closed onState Holidays, NCTracks Contact Center -Provider information for claims and billing.Phone: 800-688-6696, 2501 Mail Service Center 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.

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