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Prior Authorization Requirements May Differ for Blue Medicare HMO and PPO Members

We’d like to remind participating providers that services listed on the Blue Cross and Blue Shield of North Carolina (BCBSNC) prior authorizations or prior approval list require that primary care physician, authorized specialist, or other provider of service, must contact BCBSNC Care Management & Operations—Medicare C/D at 1-888-296-9790, Monday through- Friday, 8 a.m. - 5 p.m. EST to obtain prior authorization for Blue MedicareSM members.

The prior authorization list and related guidelines for Blue Medicare HMO and Blue Medicare PPO are available online for your convenience. This includes prior authorization information for admissions and private duty nursing, diagnostic imaging services, prescription drugs, and other services or procedures (i.e., home health care, durable medical equipment, or mental health services) are on www.bcbsnc.com for your reference and convenience.

 BCBSNC should be notified within 24 hours or the first business day after an admission is required following an urgent/emergency admission.  Home health or durable medical equipment services arranged on a weekend or after business hours will be authorized the next business day, if appropriate medical justification is met and participating vendors are used for the services in question.

 If you have any questions, please call the Provider Blue LineSM at 1.800.214.4844.