New provider coding dispute form for Medicare Advantage and Commercial lines of business

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is introducing a new form for our providers to submit coding disputes. The Commercial and Medicare Provider Coding Dispute form is available on our provider claims, appeals and inquires page. This new coding dispute form (PDF) is for use by both Medicare Advantage (MA) and Commercial providers.

Previously, Commercial providers submitted coding disputes using the Level One Provider Appeal form. Going forward, the Level One Provider Appeal form will be used exclusively for medical necessity reviews.

Currently, only Commercial providers are required to submit this form when submitting via fax or mail for coding dispute requests to be considered valid. However, beginning January 1, 2026, this requirement will also apply to MA providers. We encourage all MA providers to begin using the new form for submissions via fax or mail ahead of the effective date to ensure a smooth transition.

This change ensures consistency across both lines of business and applies to coding dispute requests submitted via fax or mail. This update does not impact member appeals or provider medical necessity reviews submitted with the Level One Provider Appeal form.

Our Commercial and Medicare providers can continue to submit post-service provider appeals through Care Affiliate, accessed through the provider portal. Providers do not need to use the updated coding dispute form for submissions through our provider portal. For more information about submitting via Care Affiliate please view this provider news.