BCBSNC Creates Escalation Process for Physicians to Verify Patient Eligibility

Blue Cross and Blue Shield of North Carolina (BCBSNC) continues to cope with huge customer service demands from individuals who are trying to straighten out their coverage and from physicians seeking to confirm coverage and provide services. Upon learning that physicians and other providers have been unable to access information from BCBSNC to verify eligibility, BCBSNC has coordinated with NCMS and NCMGMA to create a temporary, streamlined process to ensure patients with BCBSNC coverage receive timely care. Here is a description of the steps BCBSNC has created:

Normal Process

If a BCBSNC member is seeking services but has not yet received his/her ID card, please check Blue-e to confirm the member’s benefits and eligibility. If you are unable to confirm via Blue-e, please try again as BCBSNC is continually processing enrollment applications.

Most BCBSNC members already have ID cards; however, some members are still waiting for their ID cards and may instead present a Certificate of Coverage issued by BCBSNC. Please accept a Certificate of Coverage as proof of enrollment.

Escalated Process

If a BCBSNC member is in the office for an immediate appointment or to receive an urgent/emergent service, and you have been unable to verify eligibility via Blue-e or BCBSNC’s Provider Service Line (800-214-4844), please call (919) 765-4035 for assistance. If voicemail picks up on this line, please leave a contact name and a contact number for the office.

Again, if you are attempting to verify eligibility for future appointments, please attempt to use Blue-e or the Provider Service Line first.  If a patient needs clinical services authorized for a future appointment, please try our dedicated Authorization Line (800-672-7897).

BCBSNC emphasized to NCMS that their escalated process is not a permanent solution, and encouraged medical practices to use this process as appropriate until recent problems with Blue-e are corrected and call volumes reduce.

 
 

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