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Forms and Documentation
Find all of the forms you need in one convenient place, including appeals forms, enrollment applications and credentialing forms.
Manage Claims & Inquiries
Learn about programs that recognize doctors and facilities for excellence in care.
Medical Policies, Prior Review and Appeals
Learn about the medical record submission process and review the CPT, HCPCS, revenue and diagnosis codes that most often necessitate provider initiated medical record submissions.
Access the online reference eManuals - the guides include information on our products, services, claims billing, policies and much more.
Inter-Plan Programs (BlueCard)
Get resources for providers who service out-of-state Blue Cross/Blue Shield members.
News and Information
See current news and information that affects providers, as well as our newsletter archive.
See information specifically for Blue Medicare HMO and Blue Medicare PPO providers.
Find out how to become part of the BCBSNC network of providers. Effective January 1, 2016, Physical Therapy and Mental Health professional commercial networks will be closed to new providers in certain counties. The closure does not apply to licensed Psychologists (PhD) or Psychiatrists (MD) and does not apply to Mental Health/Substance Abuse facilities. See the list of closed counties. Effective May 1, 2016, optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC) in all counties. Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at firstname.lastname@example.org and by phone 888-254-4290. The Network Remains Open to providers rendering Autism Services and Applied Behavioral Analysis.
Access information specific to the Pharmacy Program.
Enter dental claims, create personalized fee schedules and more.
Update Your Demographic Information
Use this form to report demographic changes to your practice. (pdf)
Blue Book Dental eManual
View or download our online reference guide for dental providers.
Joining the Dental Network
See enrollment and credentialing guidelines specific for dental providers and apply today!
Policies and Responsibilities
See policies and responsibilities specifically for Medicare providers, including information on specialty networks, credentialing, and the responsibilities of primary care physicians.
Post-Service Provider Appeals
Medical Management Programs and Services
Get information on medical management policies and services, including case management, health care services and quality improvement.
Resources and Forms
Find essential forms and information for Medicare providers, including prior authorization, Medicare payer sheets and provider newsletters.
Medical Policy Updates
See the latest updates to BCBSNC medical policies.
Find out about fee schedules for participating BCBSNC physicians.
Practice Quality Standards
See the service standards BCBSNC and BCBSNC contracting physicians must meet to provide the best service possible.
National Committee for Quality Assurance (NCQA)
BCBSNC has received accreditation from the National Committee for Quality Assurance. See the quality standards managed care plans must meet for accreditation.
Continuous Quality Improvement
Find out what BCBSNC is doing to improve members' health, care and well-being with our Continuous Quality Improvement.