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Provider Level 1 Appeals Timeframe

In response to concerns and confusion in the physician community, Blue Cross and Blue Shield of North Carolina (BCBSNC) has updated the process and agreed to follow the 180 day timeframe on provider Level I appeals for those claims that have an adjudication date prior to 08/21/08 for Billing Disputes and 09/15/08 for medical necessity. BCBSNC will apply a 90 day timeframe for those claims that are adjudicated on or after the above dates. BCBSNC decided to reduce the number of days from 180 days to 90 days for administrative efficiency and because they had seen few appeals exceeding 90 days. This decision was not as a result of the Thomas settlement agreement. For more information contact your BCBSNC network management representative.