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Updates to provider claims refund request form

Blue Cross and Blue Shield of North Carolina (BCBSNC) will be implementing a new provider claims refund request form - making it easier to read while laying the ground work for future automation. Updates to the form are part of an ongoing effort to offer our network of health care professionals the most efficient tools and resources. BCBSNC will begin utilizing the form for our commercial lines of business, effective April 16, 2011.

Want to know what has been updated?

  • Changes to format and wording
  • Existing content will remain. No data elements will be eliminated though the following has been added:
    • NPI number (applicable to majority of invoices)
    • Check box to allow for immediate voucher deduct (which will waive the existing notice periods). Note: This change impacts all lines of business except FEP.

Want to see a sample copy of the new form?
(Note: Data elements may vary based on line of business)

Updates to the refund request form will impact all lines of business - Individual, Group, ASO, State PPO and NCHC, IPP, FEP, and Senior Segment unless otherwise noted above.

Providers having difficulty understanding the new refund request form should contact their regional Network Management representative.