 Blue cross and blue shield of north carolina (BCBSNC)
QUICK REFERENCE GUIDE #2
NOTE: BCBSNC Corporate Medical Policy for Chiropractic takes precedence over any information you receive from BCNSNC telephone representatives for BCBSNC members, NC State Employees, Federal Employees, and BCBSNC self funded groups. Always contact your CNC Provider Rep to determine if a particular service is consistent with BCBSNC corporate medical policy. (You may view BCBSNC Corporate Medical Policy under the provider section of their website: www.bcbsnc.com) 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 thier status as a Network Provider. (This includes any self-funded groups who utilize a CNC contracted payor as a third party administrator.)
REMEMBER THAT EFFECTIVE January 1, 2006, BCBS member ID numbers for ALL BCBS in-state plans:
1. must contain a 4 digit alpha prefix (ex: YPPW, not YPP)
2. no longer uses the member's social security number as part of the member
ID number.
For BCBS out of state plans that have no group number on the member ID card, always use the alpha prefix of the member ID number as the group number.
For BCBS claims, the vast majority of ID cards, list an employer. If there is an employer listed on the card, it must be included in box 11 on the HCFA. However, if there is no employer listed on the card, you may leave box 11 blank.
PLEASE REMEMBER: BCBSNC (IN-STATE ONLY) CARDS THAT CONTAIN THE SUITECASE LOGO
SHOULD BE SENT DIRECTLY TO CNC - REGARDLESS OF WHETHER "PPO" APPEARS IN THE SUITCASE.
BCBS OUT-OF-STATE CARDS THAT HAVE A SUITCASE WITH "PPO" IN THE SUITCASE SHOULD BE SENT TO CNC
BCBS OUT-OF-STATE CARDS THAT HAVE THE SUITCASE LOGO, BUT DO NOT CONTAIN "PPO" WITHIN THE SUITCASE, SHOULD BE SENT DIRECTLY TO BCBS IN DURHAM, NC
WHEN IN DOUBT, FAX US A COPY OF THE CARD. WE WILL GLADLY ASSIST YOU!
BCBSNC Quick Reference Guide #2 for:
BlueCross and BlueShield of North Carolina (BCBSNC)
Federal Employee Plan
Preferred Select PPO
Preferred Careâ Select co-pay PP
PPO BlueCard
â
Blue Advantageâ PPO
Do not send claims directly to BCBSNC! SEND ALL "CNC" CLAIMS TO CNC!
Ignore the claims billing address on the member ID card or given to you on the telephone when verifying benefits. You are under contract through CNC and our instructions for filing claims override information given to you by BCBSNC Representatives!
 Eligibility/Benefits
When calling BCBS to verify benefits, REMEMBER TO USE THE CNC PROVIDER NUMBER 0194L, rather than YOUR provider's individual BCBS number.
- To verify benefits call the Provider Blue LineSM:
1-800-214-4844. Provider Blue LineSM Representatives are available:
8:00 AM to 5:00 PM, Monday through Friday. Remember to use the CNC provider number, 0194L.
- Chiropractic benefits vary by employer group. Ask for specific information on Chiropractic benefits for each member.
Co-payment/Coinsurance Collection
IMPORTANT REMINDER:
CO-PAYMENTS FOR BLUE ADVANTAGE (ONLY) ARE THE PCP CO-PAYMENT, EFFECTIVE 01/01/2006
- No money is collected at the time of service, except the member co-payment, if applicable.
FOR NORTH CAROLINA PROVIDERS ONLY:
Co-payments for chiropractic visits will change from the SPECIALIST
CO-PAYMENT to the PRIMARY CARE
â (PCP) PROVIDER CO-PAYMENT between March 1, 2006 and March 1, 2007. The co-payments will change from the specialist to the PCP co-payment, AS EACH MEMBER’S PLAN RENEWS. By March 1, 2007, all plans will have renewed and the correct co-payment will be the “primary care co-payment.” Please remember that plans renew throughout the year, not just in January!
ALWAYS VERIFY CO-PAYMENT AMOUNT FOR EACH MEMBER THROUGHOUT THE YEAR!
Exception:
Effective January 1, 2006, BCBSNC Blue Advantageâ members’ co-payments changed from Specialist to Primary Care Provider. (PCP)
- Once you receive your Explanation of Payment, provider may bill for any deductible or co-insurance up to BCBSNC’s allowed amount.
- Provider may not bill the member for the discount amount on covered services.
- Non-covered services may be billed at the provider’s normal charges, if the member was advised in advance that the services would be non-covered.
Referrals
- Preferred Careâ Select PPO is a direct access plan and no referral from a PCP is needed.
- When necessary to refer to another health provider, referrals within the network are strongly recommended.
- No referral form is needed
- Member may see any physician or Specialist. Higher ‘in-network” benefits are paid for services rendered by participating providers. Members may see non-participating providers for lower “out-of-network” benefits.
Claims Submission
Submit all claims to:
CNC
PO Box 2368
Cornelius, NC 28031
Please ignore the address on the member ID card or any address given to you by phone when verifying benefits and send all claims to CNC.
REMEMBER THAT EFFECTIVE January 1, 2006, BCBS member ID numbers for ALL BCBS in-state plans:
1. must contain a 4 digit alpha prefix (ex: YPPW, not YPP)
2. no longer uses the member's social security number as part of the member
ID number.
Please refer to the CNC Billing Instructions for complete information on claims submission.
- The claim must be identified as a BCBS claim in the address section at the top of the HCFA form (CNC/BCBS is an acceptable format). Be sure that you put the CNC address here.)
Example:
CNC/BCBS
PO Box 2368
Cornelius, NC 28031
- Claims must include your individual BCBSNC provider ID number in box 24K of the HCFA form, and your BCBSNC group ID number in box 33, if applicable.
- Claims must be identified in box 11C as either “BCBS Options” or “BCBSNC Advantage” (CNC, Blue Cross Blue Shield of NC or Major Medical are not acceptable in this box)
- If filing BCBS as secondary, always attach copy of the primary EOB from the payor, and submit this, together with a new HCFA 1500 directly to CNC.
- (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)
Claims Inquiries
- You can NOW check the status of your claims online with the new Blue eSM product. If you have not signed up for Blue eSM, please click here for information on how to sign up! (If you have signed up for Blue eSM but have not received your user ID yet, please contact CNC right away and we will assist you with obtaining the necessary passwords and user id's.
- In the interim, for tracing overdue claims (after 30 days from your billing date), complete your 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 to have the patient’s ID, date of birth and date of service available.
- Resubmit corrected/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. or use your
CNC Fax Inquiry Form and fax to (704) 895-8664.
- Refer to your CNC/BCBSNC Select/Advantage fee schedule to confirm allowable amounts and CPT codes.
Provider Relations
Questions relating to your participation in BCBSNC products should be directed to CNC
at 704-895-8117, EXT. 2.
|
