Blue cross and blue shield of North carolina (BCBSNC)
QUICK REFERENCE GUIDE for chiropractic
The BlueCross BlueShield of North Carolina (BCBSNC) Quick Reference Guide provides information specific to BCBSNC concerning BCBS members, BCBS claims, and BCBS policies. The information in this section is in addition to the CNC/Payor Policies, CNC Documentation and CNC Billing Guidelines.
IMPORTANT NOTE:
BCBSNC Corporate Medical Policy for Chiropractic takes precedence over any information you receive from BCBS telephone representatives for BCBS members. Always contact your CNC Provider Rep to determine if a particular service is consistent with BCBSNC Corporate Medical Policy. CLICK HERE for the BlueCross and BlueShield Corporate Medical Policy for Chiropractic.
If you have any questions about any BCBS related topic, please contact your CNC Provider Rep at
(877) 426-2411.
The BCBSNC Quick Reference Guide contains the following information specific to BCBS and provides you with helpful information regarding your BCBS patients.
General Information
Eligibility/Benefits
Referral System
BCBS ID Cards
Claims Submission
Claims Inquiries
Provider Relations
gENERAL INFORMATION
PLEASE REMEMBER: Do not send claims directly to BCBSNC!
Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying benefits. You are under contract as a participating BCBS provider through CNC and our instructions for filing claims supersede information given to you by BCBS Representatives!
All claims for COVERED SERVICES provided to a beneficiary of a CNC contracted payor MUST be submitted to CNC. Participating providers who fail to submit all such claims to CNC may lose their status as an In-Network Provider. (This includes any self-funded groups who utilize a CNC contracted payor as a third party administrator.)
Blue Cross Blue Shield of North Carolina (BCBSNC) offers many different plans and chiropractic benefits vary based on your member's plan. Always verify specific chiropractic benefits for each member.
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Eligibility/Benefits
Please remember that the BCBSNC Corporate Medical Policy for Chiropractic must be strictly adhered to by CNC providers for all BCBS members except BCBS out-of-state members. The BCBSNC Corporate Medical Policy for Chiropractic supersedes ANY information that you are given when verifying eligibility and benefits.
Always verify eligibility and chiropractic benefits prior to providing any treatment. Benefits do vary by employer group. Ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Insurance Form.
Use the CNC/Blue esm web based service to verify eligibility for BCBS members. (If you are not contracted with Blue eSM , please CLICK HERE for information and instructions on how to sign up.)
BCBS in-state members - To verify eligibility and benefits for in-state policies, call the Provider Blue Line at (800) 214-4844. Provider Blue Line Representatives are available
8:00 AM to 5:00 PM, Monday through Friday.
State Health Plan members - To verify eligibility and benefits for BCBS State Health Plan (SHP) members, please call the Provider Blue Line at (888) 234-2416.
Federal Employee Plan members - To verify eligibility and benefits for Federal Employee Program (FEP) members, please call (800) 222-4739. (Please note: DME is not covered for chiropractic under the Federal Employees Plan. This includes orthotics, TENS units, etc. ALL DME should be treated as a non-covered service for FEP members so be sure to have your patients sign a waiver, agreeing to pay for any non-covered services, prior to rendering the service.)
Blue Medicare Supplement members - To verify eligibility and benefits for BCBS Medicare Supplement plans, please call (800) 672-6584.
BCBS out-of-state members - To verify eligibility and benefits for out-of-state, Inter-Plan Programs, please call (800) 676-2583, and choose option four.
Please remember that the BCBSNC Corporate Medical Policy does not apply to BCBS out-of-state members. Please contact the home plan to verify eligibility and benefits for BCBS out-of-state members.
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Referral system
- No referral from a PCP is needed.
- When necessary to refer to another health provider, referrals within the network are strongly recommended.
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BCbs id cards
All BCBS ID cards have an alpha prefix. The BCBS alpha prefix is a vital part of the member's ID number. The prefix helps identify the specific plan (or state) in which the member is enrolled. For your claims to process correctly, the entire BCBS ID number, including prefix and suffix, must be included on your claim. Please remember that if there are multiple members on a plan (such as family members), you must include the appropriate numeric suffix specific to each plan member.
The BCBS subscriber ID number should appear in box 1a on the CMS 1500 claim form without spaces or hyphens like the example below:
Please note:
The only BCBS HMP/PPO plans that are NOT filed through CNC are the BCBSNC Blue Medicare plans. All others, including the Blue Medicare Supplement plans (YPZ) and out-of-state Blue Medicare plans are filed through CNC.
If you are uncertain about any BCBS ID card, please use your CNC Fax Inquiry Form and fax a clear, legible copy of the member ID card to CNC and we will respond within 24 hours.
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CLAIMS SUBMISSION
All claims for BCBS contracted plans must be submitted to CNC through the ChiroTrack® system, except for secondary claims, corrected claims, or any claim with an attachment.
CLICK HERE for information on filing secondary claims.
CLICK HERE for information on filing corrected claims.
Please ignore any instructions regarding where to submit claims by payor phone representatives. CNC instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying benefits.
In order for BCBS claims to adjudicate quickly and accurately, please remember:
- When filing claims electronically, the claim must be identified as a BCBS claim in the address section at the top of the CMS 1500 claim form (CNC/BCBS is an acceptable format) using the example address listed below:
Example: CNC/BCBS
PO Box 2368
Cornelius, NC 28031
- Claims must be identified in box 11c as BCBS
- BCBSNC reserves the right to deny payment if a claim is submitted after 180 days. As a participating provider, you may not bill the member for claims submitted after 180 days.
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Claims Inquiries
You can now check the status of your claims on Blue eSM
- You can now check the status of your claims on Blue eSM. If you have not signed up for Blue eSM, please CLICK HERE for more details.
- For tracing outstanding claims (after 30 days from your billing date), complete the CNC Fax Inquiry Form and fax this form, together with the requested information, to CNC. We will gladly trace the claim for you!
- When using the automated system, you will need CNC's NPI number (1093773392), the patient’s ID number, patient date of birth, the date of service and the total amount billed from the claim submitted.
- Resubmit lost/missing claims through CNC.
- For questions relating to payment of a claim, please do not contact BCBSNC. Please use your Blue eSM online service, your
CNC Fax Inquiry Form, or call your CNC Provider Rep for assistance.
- Refer to your CNC/BCBSNC Fee Schedule to confirm allowable amounts and CPT codes.
- Please remember that the BCBSNC Corporate Medical Policy for Chiropractic must be strictly adhered to by CNC providers, for all BCBS members. This includes in-state plan members, State Health plan members, Federal Employee plan members, all self-funded plans and all HSA and HRA plan members. NOTE: For out-of-state members, please contact the home plan to verify benefits. If you have questions about BCBSNC Corporate Medical Policies, please contact your CNC Provider Rep.
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Questions relating to your participation with BCBSNC should be directed to your CNC Provider Representative at (877) 426-2411.
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