BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA (bcbsnc)

HSA/HRA

(INSTRUCTION GUIDE FOR

NORTH CAROLINA

CNC PROVIDERS)

BCBSNC introduced Health Savings Account (HSA’s) and the Health Reimbursement Arrangement (HRA’s) in January 1, 2005 as part of the Blue Options PPO product line.

To easily identify members with HRA’s or HSA’s,  member ID cards will clearly state:

BlueOptionsHSA

Or

BlueOptionsHRA

Higher in-network benefits are available to BlueOptionHRA and BlueOptionHSA members who seek care within the PPO provider network.

Each time one of these cards is presented, the provider should first carefully review the member’s card.  If the card indicates a co-payment amount, the provider should collect ONLY the co-payment from the member, as usual, and submit the claim to CNC

If the card indicates a deductible and co-insurance amount, the provider must verify both the deductible and coinsurance amounts.  To assure that you are receiving the most current information, you should obtain this information from Blue e.  (If you have yet registered for Blue e, please contact CNC directly and we will assist you with registering for this great service!)   Until you have registered for Blue e, contact BCBSNC Customer Service to verify deductibles and co-insurance.  Once these amounts have been verified, the provider may choose one of two options:

The provider may submit the claim to CNC, wait for the EOP, and then bill the member for the appropriate amount due the provider

                                            Or

The provider may collect up to the lesser of the member’s estimated out-of-pocket costs or $50.00, for services received in the provider’s office. The estimated amount must be based on the CNC allowable's, not the provider’s billed charges.  Providers must inform the member that the amount being collected is an estimate only.  If the member is unable to pay at the time of service, the provider should not refuse to provide necessary treatment to the member.  If they choose, (and if funds are available) the member can use funds from their HSA or HRA to pay for these services.   The provider should submit the claim to CNC as usual.

The final determination of what the member owes will be based on the claim that is submitted to BCBSNC and will be reflected on the EOP.  Any applicable refunds due to the member must be returned within 45 days.

For additional information regarding BCBSNC HSA/HRA’s, please refer to the 2006-2007 BCBSNC Blue Book, 3-39.