Issue Impacting Some Providers’ Participation Status in Our Medicare Advantage Network

A provider configuration issue is impacting some providers’ participation status in our Medicare Advantage network, which also includes our vendor Carelon^℠. Currently, the issue is limited to facility type providers that may share a type 2 NPI within their health care system (i.e., hospitals, labs, and professional groups), which is displaying providers as out-of-network. As a result, Blue Cross NC will not require prior authorizations for Medicare through Carelon for Medicare claims for the month of January 2024.

This includes all patients with Blue Medicare HMO^℠, Blue Medicare PPO^℠, Blue Medicare Freedom+^℠ PPO, and Experience Health^℠ members.

Blue Cross NC is currently working to rectify this issue as quickly as possible and will provide an update once it has been resolved. We expect full resolution of this issue by the end of January, and providers should proceed with Medicare prior authorizations through Carelon beginning February 1, 2024.

If you have any questions, please contact customer service at 888-296-9790.