Enhanced claims review requirements beginning May 2026

Beginning May 2, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement enhanced review requirements for claims.

What’s changing

Blue Cross NC will conduct an Itemized Bill Review for all claims with total charges of $25,000 or greater submitted for Blue Cross NC members. Reviews may occur prepayment or post payment, depending on workflow routing.

Required documentation

For all claims that meet this threshold, providers must submit the following at or before the time of claim submission:

• A complete Itemized Bill, and
• All applicable medical records

Claims received without all required documentation will be denied and a medical records request will be sent.

How to submit

Blue Cross NC accepts Itemized Bills and supporting medical records for electronically submitted claims through the methods outlined in our established submission guidance.

For detailed instructions on submitting Itemized Bills and Medical Records, refer to the official guidance on our website.

This requirement will apply to all Commercial, Medicare, and IPP Host lines of business. This will not apply to the Federal Employee Program.