Important News

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Revised Blue Cross and Blue Shield of North Carolina ("BCBSNC") Pricing Policy for Procedure/Service Codes ("Pricing Policy") effective January 1, 2007.

Please be informed of two significant components:

1. Effective on or before January 1, 2007, BCBSNC's website will now include current pharmaceuticals available to you and your patients under the injectable drug network, as well as a listing of all additions or deletions, which will become effective at the beginning of the next quarter. BCBSNC is hopeful that this enhancement will allow you to better plan for the distribution and billing process associated with these specialty pharmaceuticals.
   
   
2. Due to the uncertainty of the final fees applicable under the Medicare program last January 1st, many professional practitioners contacted BCBSNC to request guidance for when to begin submitting the new CPT and HCPCS codes. Medicare's initial pricing, and subsequent retroactive pricing caused administrative challenges for all. In an effort to streamline this process on a going forward basis, BCBSNC will price all new CPT and HCPCS codes based upon North Carolina Medicare source pricing available on January 1st. Should Medicare implement revised pricing retroactive to January 1st, BCBSNC will revise your fees for the affected codes within 30 days of release of the revised pricing. Your BCBSNC revised fees will be effective only on a going forward basis. BCBSNC is hopeful that this clarification will allow better planning and management of the billing and reimbursement process associated with the introduction of new CPT/HCPC codes and pricing.

Please review the revised pricing policy and contact your local Network Management field office should you have any questions or desire additional information.