Providers
Network participation
Whether you’re joining the Blue Cross NC provider network for the first time, updating your practice details, or adding providers to your organization, we make it easy to get started.
Individual practitioners
Individual practitioners are licensed healthcare professionals who deliver care directly to patients and have a Type 1 National Provider Identifier (NPI). This includes physicians, advanced practice providers, nurses, therapists, and other licensed clinicians. Whether you’re new to Blue Cross NC or managing an existing relationship, we'll help you find the right path to get started.
header
Join the Blue Cross NC network
heading-level
h3
description
Learn how to apply for network participation and complete credentialing if you’re new to the area, practice in a neighboring state, or are not currently in our network.
analytics-id
tile-1-bdc1146239-961f9a8d9e-Join the Blue Cross NC network
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Join an already in-network group
heading-level
h3
description
Find out how to affiliate with an in-network group if you’re already credentialed with Blue Cross NC and are starting with a new practice.
analytics-id
tile-2-bdc1146239-f8652d27aa-Join an already in-network group
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Maintain your information and in-network status
heading-level
h3
description
Update your provider profile, credentials, and practice details to stay compliant and maintain your in-network status.
analytics-id
tile-3-bdc1146239-e8be47d60d-Maintain your information and in-network status
theme
white
layout
vertical-left
mobile-layout
vertical-left
Group practices
A group practice is an organization made up of multiple individual practitioners and identified by a Type 2 NPI. Group practices may include a range of specialties and locations, but they are separate from facilities, such as hospitals or surgery centers. Our tools can help ensure your practice stays active and accurately represented in our network.
header
Join the Blue Cross NC network
heading-level
h3
description
Explore how to enroll your group in the Blue Cross NC network, including contracting and credentialing requirements for new organizations.
analytics-id
tile-1-0940ddf9a0-a8667fe0f7-Join the Blue Cross NC network
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Add a new provider or location
heading-level
h3
description
Add providers or practice locations to your existing group contract to keep your network participation current and accurate.
analytics-id
tile-2-0940ddf9a0-1f83894e6b-Add a new provider or location
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Maintain your information and in-network status
heading-level
h3
description
Keep your group’s credentials, roster, and practice information up to date to maintain participation in the Blue Cross NC network.
analytics-id
tile-3-0940ddf9a0-d09408507c-Maintain your information and in-network status
theme
white
layout
vertical-left
mobile-layout
vertical-left
Facilities
A facility is a healthcare organization or site of care where medical services are provided, such as hospitals, ambulatory surgery centers, imaging centers, or skilled nursing facilities. Facilities are identified by a Type 2 NPI and are credentialed separately from group practices. Maintaining accurate facility details helps support claims processing, directory listings, and ongoing network participation.
header
Join the Blue Cross NC network
heading-level
h3
description
Learn how to request participation for your facility and complete the contracting process to join the Blue Cross NC network.
analytics-id
tile-1-9f171982a0-5d7c595ce5-Join the Blue Cross NC network
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Maintain your information and in-network status
heading-level
h3
description
Review and update your facility’s information to ensure continued participation and accurate directory listings.
analytics-id
tile-2-9f171982a0-7fcb5a1c79-Maintain your information and in-network status
theme
white
layout
vertical-left
mobile-layout
vertical-left
Working with us
Access requirements, policies, and programs that support our work with providers and facilities.
header
HIPAA
heading-level
h3
description
Access HIPAA agreements, connectivity request forms, testing resources, companion guides, sample documents, and electronic data interchange (EDI) requirements.
analytics-id
tile-1-72b789d310-2dd6a5b308-HIPAA
theme
white
layout
horizontal
mobile-layout
vertical-center
header
EFT and payments
heading-level
h3
description
Set up electronic funds transfer (EFT), review payment options, and find information about provider reimbursement and dental payment methods.
analytics-id
tile-2-72b789d310-158916f5ca-EFT and payments
theme
white
layout
horizontal
mobile-layout
vertical-center
header
Pricing policies and fee schedules
heading-level
h3
description
Review reimbursement policies, fee schedules, billing guidelines, and pricing information for participating and out-of-network providers.
analytics-id
tile-3-72b789d310-d98964d9ce-Pricing policies and fee schedules
theme
white
layout
horizontal
mobile-layout
vertical-center
header
Access to care
heading-level
h3
description
Check access-to-care requirements, provider standards, and member rights and responsibilities resources.
analytics-id
tile-4-72b789d310-2a8945f585-Access to care
theme
white
layout
horizontal
mobile-layout
vertical-center
header
Quality standards and guidelines
heading-level
h3
description
Learn about NCQA standards, accreditation requirements, quality improvement programs, utilization management, credentialing, and network management expectations.
analytics-id
tile-5-72b789d310-3b74196ff1-Quality standards and guidelines
theme
white
layout
horizontal
mobile-layout
vertical-center
header
Quality assurance programs
heading-level
h3
description
Find information about prior authorization, utilization review, continuity of care, case management, and other programs that support quality care.
analytics-id
tile-6-72b789d310-2a90cf12c2-Quality assurance programs
theme
white
layout
horizontal
mobile-layout
vertical-center
Additional information
Review regulatory and reference information related to coverage requirements and federal protections.
header
Preventive care services for non-grandfathered group plans (PDF)
heading-level
h3
description
View a PDF list of preventive services that are available with no cost-sharing when provided by an in-network provider for members of some non-grandfathered health plans.
analytics-id
tile-1-20ddee85a1-8e90bad961-Preventive care services for non-grandfathered group plans (PDF)
theme
white
layout
vertical-left
mobile-layout
vertical-left
header
Federal No Surprises Act
heading-level
h3
description
Find information on how the No Surprises Act protects patients from balance billing and disputing a Qualifying Payment Amount
analytics-id
tile-2-20ddee85a1-cee9010fa1-Federal No Surprises Act
theme
white
layout
vertical-left
mobile-layout
vertical-left