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View Out-of-Area Blue Members' Medical Policy and Pre-certification Requirements Online

Blue Cross and Blue Shield of North Carolina (BCBSNC) is excited to tell you about a new online tool available via our website - Medical Policy and Precertification/Preauthorization Router. This new feature is designed to make it easier for our health care partners to find information when treating out-of-area Blue Plan members.

Effective October 1, 2010, you have the ability to view medical policies that apply specifically to your out-of-area Blue Plan patients. Additionally, health care providers will have the ability to access general precertification/preauthorization requirements, along with contact information to initiate precertification/preauthorization requests. Please note: The router is not applicable to patients enrolled in Medicare Advantage Plans or the Federal Employee Program.

Online Instructions:

Visit Next, in the center of the page under Provider Resources, select the link - Out of State Blue Plans: Medical Policy & Prior Approvals/Authorization.

You will then be routed to Medical Policy PreCertification/PreAuthorization Information for Out-of-State Members

To obtain the medical policy precertification/preauthorization information for out-of-state members:

  • Select the type of information requested
  • Enter the patient's three letter alpha prefix that precedes the ID number and click "GO"
  • You will then be routed to the Home Plan's medical policy and/or prior review requirements.
  • Once medical policy and prior review requirements are viewed, you will then be reconnected back to the BCBSNC website.

We hope this new Web functionality gives you easy access to the information you need and provides a valuable supplement to the information you currently receive when verifying patient's benefits and eligibility.

If you have questions regarding the Medical Policy and Precertification/Preauthorization Router, please contact your regional Network Management representative.