Bcbsnc network management phone number. Updates February 2024 (PDF) Carelon Medical Benefits Management, Inc. Find resources for Blue Cross NC Providers in- and out-of-network to manage patient claims and appeals, eligibility, prior authorization and more. How to Manage your Visa card on My Benefits Center Out-of-Network Benefit Exceptions. 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. Learn More 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. Box 2291 Durham, NC 27702-2291. 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. notice updates to ProviderUpdates@bcbsnc. Usage: This code requires use of an Entity Code. Claims information and online EOBs; Up-to-date information about your deductible and coinsurance; Estimated out-of-pocket costs for specific providers and services 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. We provide health insurance in Michigan. What's New for 2024. - 9:00 p. 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. ) Q: What are your Customer Service hours? Linking your Blue Connect account helps you quickly access:. 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. 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. Don't have your member ID card? Please call: 888-206-4697 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. Mark Werner has over 15 years of experience in network management, including 10 years as Vice President, Network Management at BCBSNC. How to Shop Online . 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. ANC. 888 You can access these in-network health care providers in all 50 states, and Washington, D. EST. . 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. Work Biography for Mark Werner, Bcbsnc. Call for verification of benefits, confirmation of coverage, and claims issues. com or fax to Network Management Operations at 919-765-4349. Healthcare Management and Operations, Pharmacy Exception, P. 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. HIPAA affects almost the entire health care industry, including employers. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. You make your patients' lives better. nationsbenefits. BCBSNC is partnering with American Imaging Management (AIM) to perform reviews of these procedures. 11/12/2020. Fax: 919-765-4349. O. 800-777-1643. 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 BCBSNC will assist you in finding a network provider for any future services before the 90-day period expires. com. Episodic Case Management (acute inpatient rehab, DME, home health, etc. We have a diverse network of exceptional health care professionals who ensure our members have uninterrupted access to the health care they need. Mark Werner holds a 2019 - 2020 Certificate of Management Excellence @ Harvard Business School. Contact eSolutions Help Desk: 888-333-8594, option 1. Here's what you need to know about Blue Cross and Blue Shield of North Carolina's coverage. MED. at 1-888-333-8594. Contact Network Management to obtain information about credentialing, provider numbers, contracts and sample fee schedules. Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling. The member will 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. NEW OR REVISED. Utilization management/Medical Management/Case Management. Updates (PDF) Carelon Medical Benefits Management, Inc Updates November 2023 (PDF) Carelon Medical Benefits Management, Inc. May 26, 2021 · MEDICAL POLICY NUMBER. For questions regarding your contract, please call Blue Cross NC Network Management line at 800-214-4844, and select Option 6. Find out if your doctor, drug, or pharmacy is in-network, or explore other care options. GENE. Contact us for more details about our plans, coverage, costs and more. Check out the changes and updates to our plan in 2024. You can reach our Blue Cross NC team by chat, phone, secure message or visiting a store. 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. Members are still expected to select a primary care physician (PCP). You can access these in-network health care providers in all 50 states, and Washington, D. Wellness and clinical practice guidelines: Network Management Office 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. Providers Home Submitter Number does not meet format restrictions for this payer. 16, 2003, as well as Appointment/Patient Phone Number Fax Number . Phone: 1-844-594-5072. Phone: 1-877-258-3334 Fax: 1-919-765-1920. ©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. Blue Cross NC makes health insurance easy. Submit CMS1500 and UB04 claims electronically through Blue e. – “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 Carelon Medical Benefits Management, Inc. 00052. 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. Forms to add or remove a Blue e user or NPI. Mail: Blue Cross NC P. We'll do the same for you. 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. Fax: 1-713-663-1227 Email to submit provider inquiries: Ambulatory Surgery Centers (ASC) – Independent, Non-Hospital owned. 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. Revised. 535 - Claim Frequency Code; 24 - Entity not approved as an electronic submitter. Diagnostic Imaging Management. Call to get one-on-one counseling from a clinical pharmacist. For other Blue e issues, including concerns about security or privacy, call the eSolutions HelpDesk from Monday to Friday, 8:00 a. Physical address: Blue Cross NC 5901 Chapel Hill Road Durham, NC 27707 Find in-network doctors, facilities, prescriptions, and more. Gene Therapy for Spinal Muscular Atrophy. Choose option 6 to continue the enrollment process. If you're a provider looking for information about eligibility, claims status or other details, log in or register with Blue e. If you are in need of more information about your plan you should contact customer service Monday-Friday, 8:00 a. 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. Mark Werner, based in Durham, NC, US, is currently a Vice President, Network Management at BCBSNC. 634 - Remark Code; See more Provider NPI not registered with BCBSNC. Mark Werner brings experience from previous roles at BCBSNC and Blue Cross and Blue Shield of North Carolina. Don’t have your ID card? Call: 1-888-206-4697. Blue Cross NC may choose to pay non-contracted providers. 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. Blue Cross NC provides medication therapy management (MTM) to members with a Service Benefit Plan. Join the Blue Cross NC provider network, trusted by doctors, dentists, pharmacists and hospitals across North Carolina for more than 90 years. 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. com . Primary Care Medical Home (PCMH) Certification for Joint Commission Accredited ambulatory care organizations focuses on care coordination, access to care, and how effectively a primary care provider and interdisciplinary team work in partnership with the patient (and where applicable, their family). All other questions can be sent via email to SHPProviderNetwork@nctreasurer. Contact Information BCBSNC Customer Service. Use this instructional guide for help (PDF) completing the taxpayer W-9 Primary Care and OB/GYN practices may apply for The Joint Commission PCMH Certification. Better care starts here. Contact Network Management Phone: 800-777-1643 Fax: 919-765-4349 Email: providerupdates@BCBSNC. 00009. to 5:00 p. com – preferably in Chrome. The member will need their Healthy Blue + Medicare member ID number, demographic information, and the 2023 prepaid Mastercard benefit card number and security code to purchase approved items. . Blue Cross NC is made up of multiple networks, including FEP, Medicare and Medicaid. MEDICAL POLICY TITLE. Our Company About Us Providers. 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. 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 Some prescriptions may require prior authorization or prior plan approval. through BlueCard®. Cosmetic and Reconstructive Services of the Trunk and Groin. 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. Updates June 2024 (PDF) For questions about your plan, bills or claims, call the Customer Service number on the back of your Blue Cross NC member ID card. For help with Blue Premier registration or account management, please contact your account administrator. C. Access tools, policies and the latest information to help you care for our members. Fax: 1-713-663-1227 Blue e is the provider portal for Blue Cross NC. Explore care options, or log in to Blue Connect℠ to search existing coverage. Ambulance. Ask your employer if you're in a Select Network or check your ID Card for your network. ): 336-659-2945 Concurrent Review/Discharge Planning: 336-794-1555 Pre-certification: 336-794-1556 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. m. 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. 00129. Prior Review Info for Providers Welcome to the Blue Connect and Blue Cross of North Carolina Member Self-Service Portal. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is expanding the Blue High Performance Network ℠ (BlueHPN ℠). It must start with State Code WA followed by 5 or 6 numbers. You will need to contact Blue Cross NC Provider Service at 800-777-1643. Non-participating providers can also use Blue e after registering their NPI to sign up for EFT. For issues with your password or user profile, contact your local Blue e Administrator. How does the member access the website to place an order? The member should visit mybenefits. Mark Werner is a Vice President, Network Management at Bcbsnc based in Manchester, New Hampshire. Student Blue offers health insurance plans for students of North Carolina. Ancillary Network Management: Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Ancillary Network Management. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. Revised For all other inquiries, including member support questions, please contact Blue Cross NC at 800-214-4844 or PNC. SpecialtyPharmUpdates@bcbsnc. Providers looking to join can find out more about these networks. Apr 25, 2020 · BCBS Federal Phone Number - FEP List Statewise Customer Service Precertification Mental Health/Substance Abuse Case Management Hospital; Alabama (800) 248-2342 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 HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. O. The BCBSNC Fee Schedule transaction is available only for participating professional medical doctors. 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. Updates March 2024 (PDF) Carelon Medical Benefits Management, Inc. Email: ProviderUpdates@BCBSNC. 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. It's important to visit an in-network doctor or hospital to save the most money on your medical and wellness care. Previously, Mark was a Vice President, Network Management at Blue Cross & Blue Shield of North Carolina. This move is expected to better coordinate operations to provide a simpler health care experience for customers. Calling the phone number on the back of your member ID card provides the fastest and most direct service for questions. Box 2291, Durham, NC 27702 Claim Number: Identifies 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 Contact Customer Service at 1-877-258-3334; Log on to our Web site at bcbsnc. Independent primary care practices that meet BQPP criteria are eligible to receive a double-digit fee increase on their Evaluation and Management (E&M) and Preventive E&M codes. To request prior authorization (certification) for certain out-of-network or out-of-state services. uhbol gerowwz lhnoznpw puahcp qyok hucrz jyxps uwcw jnlhw qill