Bcbsnc network management phone number

Bcbsnc network management phone number. These services include claims processing, formulary management, mail service, pharmacy network management, manufacturer trade contracting and clinical programs. Mark Werner works as a Vice President, Network Management at Bcbsnc, which is a Consumer Services company with an estimated 86 employees; They are part of the Networking team within the Information Technology Department and their management level is VP-Level. Contact Customer Service at 1-877-258-3334; Log on to our Web site at bcbsnc. ) Q: What are your Customer Service hours? For Blue Medicare HMO/PPO: contact 800-266-6167; Certain durable medical equipment (DME) Blue Medicare HMO/PPO DME and Experience Health Medicare Advantage (HMO) DME: Prior approval codes for DME are available from Customer Service, Utilization Management or your Blue Cross NC Network Management representative. Calling the phone number on the back of your member ID card provides the fastest and most direct service for questions. ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Call for verification of benefits, confirmation of coverage, and claims issues. Providers. Providers Home Diagnostic Imaging Management. com or fax to Network Management Operations at 919-765-4349. Complete sections A and B. BCBSNC will assist you in finding a network provider for any future services before the 90-day period expires. We have a diverse network of exceptional health care professionals who ensure our members have uninterrupted access to the health care they need. Box 660712 Most out-of-network services require utilization management review. HelpDesk@bcbsnc. Linking your Blue Connect account helps you quickly access:. Blue Cross NC provides medication therapy management (MTM) to members with a Service Benefit Plan. Don't have your member ID card? Please call: 888-206-4697 Contact Information BCBSNC Customer Service. ALLOWED AMOUNT $4,250 $4,250 C. com . If you have EFTFULL, proceed to: Have questions? Call or write us! Member Services: 844-594-5070 (TTY 711) Already a member? Log in to your account and send us a message. Click Get medical care. Mark Werner, based in Durham, NC, US, is currently a Vice President, Network Management at BCBSNC. Join our network. Jan 11, 2013 · BCBSNC makes best efforts to keep information up to date; however, it may not always be possible. and has a long history of providing a full range of pharmacy benefit management services for its participating plans. Our employees bring energy and creativity to the workplace and it shows in our innovative approach to improving the health and well-being of North Carolinians. MED. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services If your doctor is part of the BCBSNC network, he or she should contact BCBSNC and request prior plan approval for your scans. Deductible Amount ( For IN-NETWORK and OUT-OF-NETWORK Services Combined) $1,000 $1,000 D. Submit CMS1500 and UB04 claims electronically through Blue e. You can reach our Blue Cross NC team by chat, phone, secure message or visiting a store. Non-participating providers can also use Blue e after registering their NPI to sign up for EFT. O. Ambulance. Amazon Pharmacy does not dispense controlled substances (Schedule 2 medications). Eastern time. If you are in need of more information about your plan you should contact customer service Monday-Friday, 8:00 a. Don't have a secured provider portal account yet? Providers who don't have an account can mail a claim to one of the following: Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan Work Biography for Mark Werner, Bcbsnc. Revised For issues with your password or user profile, contact your local Blue e Administrator. ALLOWED AMOUNT Minus Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. Thank you for your participation and for providing dental care to our Blue Cross NC members. Find A Doctor. BCBSNC is partnering with American Imaging Management (AIM) to perform reviews of these procedures. Contact Network Management Phone: 800-777-1643 Fax: 919-765-4349 Email: providerupdates@BCBSNC. By calling 800-672-7897, Care Management staff are available to assist with arranging care for services for our commercial and State Health Plan membe Utilization management/Medical Management/Case Management. Current as of 07/12/2024 | Y0079_12318_M CMS Accepted 08282024 | U36079, 6/24 About Mental Health (cdc. Mail to: If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us. Condition Management for Exchange Members: 855-462-1781. Get an Enrollment and Change Application from Customer Service (call the number on the back of your member ID card) or through your employer. In-network providers can request a prior review and authorization by calling Blue Cross NC Utilization Management at 800-672-7897, Monday through Friday, 8 AM to 5 PM ET. notice updates to ProviderUpdates@bcbsnc. We provide health insurance in Michigan. For help with Blue Premier registration or account management, please contact your account administrator. gov) Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. Or troubleshoot STATchat SM functionality. Email: NMSpecialist@bcbsnc. Box 660712 Dallas, TX 75266-0712. com – Patient ID number – Patient’s date of birth MemberClaimsSubmission@bcbsnc. We are currently not able to accept credit card payments by phone for Medicare and Senior Dental members. Our Company About Us Blue Cross NC has robust search tools to help you find in-network doctors, hospitals, specialty pharmacies and urgent care in your state or across the country. If your doctor is not part of the BCBSNC network or is located outside of North Carolina, you must tell your doctor to get prior plan approval for you. Box 3248 Omaha, NE 68180 402-390-1820 May 31, 2005 · Blue Cross and Blue Shield of North Carolina (BCBSNC) announced today that detailed plans are in place for transitioning members to alternative hospitals in preparation for the departure of North Carolina Baptist Hospital (NCBH) from BCBSNC networks on June 4. You make your patients' lives better. Better care starts here. Office Locations Omaha Headquarters. MEDICAL POLICY TITLE. Prior Review Info for Providers 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. Explore the health insurance options offered by Blue Cross and Blue Shield insurance agencies. Find information on how the No Surprises Act protects patients from balance billing and disputing a Qualifying Payment Amount. The Diagnostic Imaging Management (DIM) program is a prior-plan approval program that requires providers to obtain prior authorization for certain diagnostic imaging procedures, such as MRI's, MRA's, CT scans, etc. com and access Blue Connect (With Blue Connect you can request up to two new ID cards or update your policy's contact information when your address, phone number or e-mail address changes. You can call 1-800-333-7009 to pay by phone. Revised. HIPAA affects almost the entire health care industry, including employers. . C. Log in to find contact information specific to your area and plan. Signature: Date: Daytime. The scenario is a total outpatient HOSPITAL bill of $5,000. Blue Cross Blue Shield of New Mexico Medical Care Management P. With MTM, clinical pharmacists can help you identify, prevent and resolve any medication-related problems, from side effects and drug interactions to drug use for non-medical purposes. Contact Information BCBSNC Customer Service . Here's what you need to know about Blue Cross and Blue Shield of North Carolina's coverage. %PDF-1. Providers looking to join can find out more about these networks. If the provider or member does not get prior authorization for out-of-network services, the claim may be denied or will be subject to a post-service medical necessity review. Please contact the Customer Service number on the back of your ID card for assistance. – “Today Wayne Memorial Hospital became an out-of-network facility for Blue Cross and Blue Shield of North Carolina (BCBSNC) customers except those with Blue Medicare SM and those May 26, 2021 · MEDICAL POLICY NUMBER. SpecialtyPharmUpdates@bcbsnc. Fax: 505-816-3856. Phone: 1-844-594-5072. Please contact your bank if you are unsure whether or not your bank allows your savings account to be drafted. 634 - Remark Code; See more Provider NPI not registered with BCBSNC. You can also find the nearest hospital, clinic or urgent care center. 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. To request prior authorization (certification) for certain out-of-network or out-of-state services. Job aid available, see link below. Prime Therapeutics is an independent company that is solely responsible for providing pharmacy benefit management services. Hours: Monday – Friday, 8:00 am – 5:00 pm Contact us & track your inquiries with Secure Email (See Case Management feature icon) – Located on the Agent Portal click on the Case Management programs (PDF) are available at no additional cost, but copayment and coinsurance for covered services may apply. Ancillary Network Management: Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Ancillary Network Management. State Health Plan fee schedules State Visit the Blue Cross NC Raleigh location for help with insurance questions, health education, fitness classes and much more. Phone. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. Box 2291 Durham, NC 27702-2291. that insurer. You can also email the HelpDesk at Bluee. 11/12/2020. to 5:00 p. Number: Blue Cross NC makes health insurance easy. Total Bill $5,000 $5,000 B. If you feel like you’re in crisis, please call our Behavioral Health Crisis Line at 844-594- 5076 . You can also check your card balance, view your transaction history, and find participating retailers. Fax: 1-713-663-1227 For questions about your plan, bills or claims, call the Customer Service number on the back of your Blue Cross NC member ID card. Proof of prior dental coverage with less than 63 days lapse in coverage is required. GENE. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. 00129. Access to utilization management staff Continuity of care How we’re improving quality Highlights and accomplishments Contact information WHAT’S INSIDE As a member of Blue Cross and Blue Shield of North Carolina (BCBSNC), you should know your rights, how to track claims, how to appeal a You can access these in-network health care providers in all 50 states, and Washington, D. EST. Usage: This code requires use of an Entity Code. Provider Enrollment: Reset passwords for encrypted emails. You will need to contact Blue Cross NC Provider Service at 800-777-1643. Mark Werner holds a 2019 - 2020 Certificate of Management Excellence @ Harvard Business School. If the Blue e Administrator does not see EFTFULL to select as a role, contact the Electronic Solutions Help Desk at 1-888-333-8594 for assistance. PLEASE NOTE: If your other insurance or Medicare policy is primary, you must attach a copy of the Explanation of Benefits from . By Phone: Call the number on the back of the member’s ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative. 855-229-5720 Get help with technical issues on My Insurance Manager. The BQPP focuses on Primary Care Management and rewards independent practices committed to providing high-quality outcomes, and low-cost, patient-centered care for BCBSNC members. Phone: 877-783-1385 fepblue. Contact us for more details about our plans, coverage, costs and more. Physical address: Blue Cross NC 5901 Chapel Hill Road Durham, NC 27707 Find in-network doctors, facilities, prescriptions, and more. The Centers for Disease Control and Prevention recently announced that people with depression or mental health disorders are also at high risk for contracting severe COVID-19. Mark Werner brings experience from previous roles at BCBSNC and Blue Cross and Blue Shield of North Carolina. 800-672-7897 M-F 8AM to 6PM: State Health Plan c/o BCBSNC PO Box 30085 Durham, NC 27702: Base PPO Plan (70/30) & Enhanced PPO Plan (80/20) Members: Humana (Medicare Advantage Carrier) For questions regarding Humana Medicare Advantage Plans. How are members attributed to a practice? Attribution to BCBSNC Members is based on the following criteria and is used for cost and quality: For questions regarding your contract, please call Blue Cross NC Network Management line at 800-214-4844, and select Option 6. Some prescriptions may require prior authorization or prior plan approval. Phone: 1-877-275-9787. Learn More Jun 6, 2014 · BCBSNC will streamline operations by moving all operational functions, including the Healthcare Division and Network Management Department, under Chief Operating Officer and Executive Vice President Alan Hughes. Have questions? Call or write us! Member Services: 844-594-5070 (TTY 711) Already a member? Log in to your account and send us a message. Prime Therapeutics does not offer Blue Cross or Blue Shield products or services. 800. Q: How do I change my primary care provider? A: To change your primary care provider, you can either call Customer Service at 1-877-258-3334 or visit My MemberServices at bcbsnc. Contact Network Management Phone: 800-777-1643 Fax: 919-765-4349 Email: ProviderUpdates@bcbsnc. Pharmacies participating in BCBSNC’s specialty pharmacy network as of July 1, 2011:. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) proporciona asistencia gratuita a las personas con discapacidades, así como servicios lingüísticos gratuitos para las personas cuyo idioma principal no es el inglés. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Search for a doctor or other health care provider. Steps to make sure you're looking in the right network: Read your plan information carefully to know which network your health plan falls in. process should contact: BCBSNC Network Management . Fax: 919-765-4349. 7 %µµµµ 1 0 obj >/Metadata 291 0 R/ViewerPreferences 292 0 R>> endobj 2 0 obj > endobj 3 0 obj >/XObject >/Pattern >/Font >/ProcSet[/PDF/Text/ImageB/ImageC 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. Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling. 535 - Claim Frequency Code; 24 - Entity not approved as an electronic submitter. If you get health coverage through an employer: Contact your group administrator or HR department to make changes to your account. As a Corporate Director at BCBSNC,Mark Werner provided statewide strategic direction and oversight for BCBSNC’s contractual relationship with all providers, including healthcare systems, hospitals and physicians. Diagnostic & Preventive Services Covered at 100%. For questions regarding any of the content contained in this learning module, please contact Network Management at 1. My Benefits Center - otcnetwork. ): 336-659-2945 Concurrent Review/Discharge Planning: 336-794-1555 Pre-certification: 336-794-1556 Learn about Experience Health, a new and innovative insurance company owned by Blue Cross NC. 1643. 00052. Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. 855-229-5720 Verify network participation for Blue Plans nationwide. com. NEW OR REVISED. Condition Management: 866-874-0912. The Blue Cross NC Care Management Department works with physicians and members to facilitate the most medically appropriate, cost-effective, quality care for our members. 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 Find resources for Blue Cross NC Providers in- and out-of-network to manage patient claims and appeals, eligibility, prior authorization and more. See important dates, forms, resources, policies and more. Discover how to save money and time with your OTC card on My Nov 9, 2021 · The COVID-19 pandemic has caused an increase in the number of people reporting symptoms of depression and anxiety. All other questions can be sent via email to SHPProviderNetwork@nctreasurer. Get insurance delivered through your local BCBS agency. Q: Can I make my premium payment by phone? A: Yes. Omaha Headquarters 1919 Aksarben Drive Omaha, NE 68106 (Wheelchair accessible) P. Gene Therapy for Spinal Muscular Atrophy. Monday-Friday: 8:00 a. Submitter Number does not meet format restrictions for this payer. If you have questions about referrals and when you need one, contact Member Services at 844-594-5070 (TTY 711) Monday through Saturday, 7 a. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. If you are a participating provider other than a Blue Cross NC contracted medical doctor or doctor of osteopathy, you need to contact BCBSNC Network Management to obtain a current copy of your fee schedule. Blue e is the provider portal for Blue Cross NC. Mark Werner has over 15 years of experience in network management, including 10 years as Vice President, Network Management at BCBSNC. Referrals and inpatient prior authorizations 800-441-9188 Fax: 800-252-8815 or 800-462-3272 Case management 800-462-3275 Fax: 800-778-2279 Messages may be left in a confidential voice mailbox after business hours. BlueHPN is a national quality-based network that provides members with access to high-quality doctors, hospitals and specialists across the state and country - all while lowering costs. Appointment/Patient Phone Number Fax Number . Phone: 1-800-777-1643 . Cosmetic and Reconstructive Services of the Trunk and Groin. . to 6 p. It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Please Select Your State The resources on this page are specific to your state. Routine oral exams (once per Benefit Period) Adult & child cleaning (once per Benefit Period) Bitewing x-rays Blue Cross NC is made up of multiple networks, including FEP, Medicare and Medicaid. Contact us via the Live Chat icon - Located on Agent Portal click on the conversation icon. Mark Werner is a Vice President, Network Management at Bcbsnc based in Manchester, New Hampshire. This move is expected to better coordinate operations to provide a simpler health care experience for customers. Wellness and clinical practice guidelines: Network Management Office 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. Your claim cannot be processed without this information. Blue Cross NC may choose to pay non-contracted providers. Or check your network status. A Vast Network of Doctors and Hospitals. Dec 5, 2013 · Statement from BCBSNC Vice President of Network Management Lisa Cade on Wayne Memorial Hospital’s Rejection of BCBSNC’s Final Proposal CHAPEL HILL, N. org. Don’t have your ID card? Call: 1-888-206-4697. Check out the changes and updates to our plan in 2024. Forms to add or remove a Blue e user or NPI. Update your information. Then select a subcategory like Pediatrician. For all other inquiries, including member support questions, please contact Blue Cross NC at 800-214-4844 or PNC. Fax: 866-589-8254. S. For questions related to claims Episodic Case Management (acute inpatient rehab, DME, home health, etc. Contact eSolutions Help Desk: 888-333-8594, option 1. Use this instructional guide for help (PDF) completing the taxpayer W-9 Effective 1/1/2008, Blue Medicare HMO and Blue Medicare PPO members have the freedom to choose in-network providers and specialists without a referral. at 1-888-333-8594. ANC. Visit any of our locations for help understanding or purchasing a new health plan from Blue Cross NC. SECTION 5: Submitting Form Information. Phone: 1-877-258-3334 Fax: 1-919-765-1920. IN-NETWORK OUT-OF-NETWORK A. Find out if your doctor, drug, or pharmacy is in-network, or explore other care options. It's important to visit an in-network doctor or hospital to save the most money on your medical and wellness care. For additional contact information, please reference Chapter 2 of this e-manual. 00009. 888 Get help with all your health care needs at the Blue Cross NC Centers. If you have a health plan that offers an OTC benefit, you can register and activate your card on this webpage. 3 Call the BlueCard number on the back of your BCBSNC ID card or try our Find A Doctor search tool to find a provider near you. 16, 2003, as well as language is not English. Box 2291, Durham, NC 27702 Claim Number: Identifies Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). Fax: 1-713-663-1227 Email to submit provider inquiries: Ambulatory Surgery Centers (ASC) – Independent, Non-Hospital owned. Choose option 6 to continue the enrollment process. uploaded through Case Management. Select a category like Primary Care. Call to get one-on-one counseling from a clinical pharmacist. Explore care options, or log in to Blue Connect℠ to search existing coverage. What's New for 2024. - 9:00 p. through BlueCard®. Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina. 777. com is a webpage that allows you to use your OTC card to shop online for eligible items. • Network Management at 1-800-777-1643, option 6. O. 800-777-1643. For other Blue e issues, including concerns about security or privacy, call the eSolutions HelpDesk from Monday to Friday, 8:00 a. Healthcare Management and Operations, Pharmacy Exception, P. Access tools, policies and the latest information to help you care for our members. Members are still expected to select a primary care physician (PCP). Bradley “Brad” Wilson – a North Carolina native with extensive public service, community and business experience – has been named as Chief Executive Officer of Blue Cross and Blue Shield of North Carolina by the company’s Board of Trustees. Blue Cross NC data shows the top two most common Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of months of prior dental coverage. For health plans, providers and health care clearinghouses, the critical portions of the act are the Administrative Simplification provisions, which include new standards for electronic transactions that took effect Oct. to 9:00 p. m. If you buy your own health coverage: Log in to Blue Connect ℠ to update your contact information when your address, cell phone number, or email address changes. Out-of-Network Benefit Exceptions. Schedule an appointment today. Contact Network Management to obtain information about credentialing, provider numbers, contracts and sample fee schedules. We'll do the same for you. Email: ProviderUpdates@BCBSNC. Ask your employer if you're in a Select Network or check your ID Card for your network. Mail: Blue Cross NC P. The move, effective immediately, follows Wilson’s appointment as company President in November 2009. Here is an example of what your costs could be for IN-NETWORK or OUT-OF-NETWORK services. Contact Customer Support by phone or Live Chat. It must start with State Code WA followed by 5 or 6 numbers. Feb 11, 2010 · J. Case managers can help patients: Navigate the health care system; Identify, implement and monitor their health care needs Dec 1, 2011 · Prime Therapeutics serves nearly 19 million customers across the U. Jul 1, 2011 · For additional information, customers are asked to contact BCBSNC at the toll-free customer service number listed on their ID card or visit bcbsnc. Previously, Mark was a Vice President, Network Management at Blue Cross & Blue Shield of North Carolina. xjhjh zyalvixu wkbz ktgzxpx slpuo ldizyq drf evyv qrbwy rea