Usual, Customary and Reasonable reimbursement methodology: How benefits are paid
Due to differences in the health plans offered and administered by BCBSNC, reimbursement methodologies may vary. Under many of our plans, reimbursement is dictated by a specific fee schedule outlined in the terms of your provider contract. Under other plans, reimbursement is dictated by our “usual, customary and reasonable” (UCR) methodology, which is also outlined in the terms of your provider contract.
Our health plans subject to the UCR methodology are: State of North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan (State Health Plan), North Carolina Health Choice, Medicare Supplemental and some Blue Card plans.
If you have any questions regarding the reimbursement methodology for a specific health plan, please feel free to contact your local Network Management office.
Review the following to learn more about the UCR methodology.