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Claims Escalation Process for Aged Claims 60 Days or Older

In mid-April, Blue Cross and Blue Shield of North Carolina (BCBCNC) implemented an escalation process within BCBSNC Customer Service for providers who need to escalate open claims 60 days or older, or if a corrected claim was submitted 60 or more days ago and still not reflected as received in our claims system. 

Prior to calling BCBSNC Customer Service or resubmitting a claim, please check claims status on Blue eSM (Health Trio link for Blue MedicareSM claims). When checking claims status on Blue eSM, please note the “Pended Status,” as that will indicate if the claim is fully processed or not at this time. If you have outstanding claims older than 60 days, and you've not already spoken to one of our provider specialists, please call the Provider Blue LineSM at 1-800-214-4844 for assistance.

Once you’ve contacted us with your request to research aged claims that meet the above criteria, we will send you a spreadsheet via secure mail to complete that will aid us in conducting the necessary research on your behalf. Please be sure to complete all required data fields of the spreadsheet, as that will expedite our research of the claim(s) in question. Here are some important tips to keep in mind while completing the spreadsheet:

  • Indicate the full member ID number on the spreadsheet, including the alpha prefix and appropriate dependent number as shown on the member ID card.
  • You can include multiple members and aged claims on the same spreadsheet.
  • Please reply to BCBSNC via with the spreadsheet attached, and be sure to send it to us from a secure or encrypted email address.
  • BCBSNC will send you an email response within 3 to 5 business days of receipt of your escalated claims request/spreadsheet to indicate the status of the claim(s) in question.

As BCBSNC continues to move forward in improving its claims processing cycle times, here are some ways you can help:

  • Please do not submit duplicate claims, as they increase our inventory and impact our timeliness in processing your claims.
  • Make sure claims are complete and accurately coded before submitting them for processing.
  • Include NPI numbers, Medicare number as appropriate, and your tax ID on the claim.
  • Keep your contact information, including address and phone number, up-to-date with us.
  • Submit any requested or required information in a timely manner.
  • Do not send medical records with claims unless we have specifically requested them.