Post-Service Provider Appeals
Physicians, physician groups, and facilities may file a Level I Provider Appeal of BCBSNC's application of coding and payment rules to an adjudicated claim or of BCBSNC's medical necessity determination related to an adjudicated claim. These appeals include dissatisfaction with a claim denial for post-service issues that may be either provider or member liability.
Providers may not appeal any issues that are considered member benefit or contractual issues. These appeals are in addition to the non-contracting provider payment dispute process.
If at any time a member and/or their authorized representative request a post-service claim appeal during the review of a provider appeal, the member appeal takes precedence. At that time, the provider appeal will be closed.
Level I Post-Service Provider Appeal
Level II Post-Service Provider Appeal
Blue Medicare HMOSM and Blue Medicare PPOSM Provider Appeals FAQs