Appeals and disputes: submission reminders and next steps for invalid status

As a reminder, providers can now submit post-service appeal requests directly via CareAffiliate through our Blue e^℠ Provider Portal. This updated process was introduced in our November 2024 Provider News, where we shared detailed information and guidance to help you get started.

Additionally, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind providers of important steps when receiving an invalid response after submitting appeals or disputes. Please follow the steps outlined below to understand the reason and justification for an invalid status. This process is designed to provide clarity and resolution without the need to contact Provider Customer Service.

Submissions via CareAffiliate through our Blue e Provider Portal

If a provider submits an appeal or dispute via CareAffiliate through our Blue e Provider Portal and receives an "invalid" status on their case or response, they should log into the Blue e portal to view the reason and justification.

Submissions via Fax or Mail

For appeals or disputes submitted by fax or mail, providers will be notified if their request is deemed invalid via:

• If a fax number was provided, the notification will be sent via fax.
• If no fax number was provided, the notification will be mailed to the provider.