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Thepreferred method for submitting authorizationsis through the Secure Provider Portal atprovider.ambetterofnorthcarolina.com. Avalon Healthcare Solutions is an independent company that manages lab benefits on behalf of BlueCross BlueShield of South Carolina and BlueChoice HealthPlan. Learn more about our non-discrimination policy and no-cost services available to you. It's the widely accepted coverage and superior service from fellow North Dakotans at 10 offices across the state. Data driven insights, stories of inspired healthcare solutions and the interactive BCBS Health Index. Olvido su contrasea? Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Disponible nicamente en ingls. 2023 Blue Cross and Blue Shield of North Carolina. Blue Connect Access your benefits anytime, anywhere. View the list of procedure codes that require prior authorization through Avalon. Once Avalon receives your request, it will be reviewed by Avalon's clinical staff and they will notify you of their determination. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Blue Medicare HMO and PPO Limitations and Exclusions, Blue Medicare Rx (PDP) Limitations and Exclusions, Important Legal Information and Disclaimers, Non-Discrimination Policy and Accessibility Services, Billing and Payments for Blue Medicare Plans, Billing and Payments for Individual and Family Health or Dental Plans. We look forward to working with you to provide quality services to our members. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. This list is provided for member information only. Prior Approval Drugs requiring prior approval have detailed criteria that must be met before prior authorization can be granted. Accessibility Forgot Password? Always check benefits through the VoiceResponseUnit(VRU) or MyInsuranceManagerSM to determine if prior authorization is required. Technical Information 100%. . You may want to check with your health care provider to make sure that prior review was obtained before you have the service or procedure in question. Forgot User ID? High Tech Imaging services are handled by NIA. Is the member being admitted to an inpatient facility? Find everything you need in the member online account. Always check your Benefit Booklet for specific information about your plan. Type at least three letters and we will start finding suggestions for you. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, https://www.bluecrossnc.com/providers/blue-medicare-providers/healthy-blue-medicare. Privacy Policy Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-844-594-5072. Linked Apps. Please note, any services, durable medical equipment or medications listed on the Prior Review Code List require authorization for ALL places of service, including when performed during any inpatient admission, including both planned inpatient admissions and emergent inpatient admissions*. Coming soon, the following categories of services will require prior authorization through National Imaging Associates (NIA): On April 25, 2022, our Medicare Advantage plans began requiring prior authorization through Avalon Healthcare Solutions for certain services. Policies, Manuals and Guides Referrals Forms Training Academy Pharmacy information Your benefits cover the service in question, The service is medically necessary according to Blue Cross NC medical policy, The service is performed in the right health care setting, The provider is correctly identified as in- or out-of-network, Special medical circumstances are identified that require specific types of review and follow-up. Learn the basics from our FREE Medicare guide, Be WellcastA Podcast About Being Your Best Self. Box 35 Durham, NC 27702 Customer Service: 1-888-206-4697 Grace Periods and Claims Pending Policies During the Grace Period (Individual On-Exchange Only) A prior authorization is not a guarantee of payment. Not all PA requirements are listed here. Are services being performed or ordered by a non-participating provider? PDF The Prior Authorization List To access your member services, please visit your BCBS company. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. 1 - CoverMyMeds Provider Survey, 2019. Forms Library | Medicare - Blue Cross NC Find and enroll in a plan that's right for you. Doctors. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Please verify benefit coverage prior to rendering services. Prior Authorization. Pre-Auth Check Tool | Ambetter of North Carolina Blue Cross Blue Shield members can search for doctors, hospitals and dentists: The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Inpatient admissions (with the exception of maternity admissions) elective, planned in advance or not related to an emergency. Blue Cross and Blue Shield of North Carolina Senior Health, DBA Blue Cross and Blue Shield of North Carolina, is an HMO D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All Disponible nicamente en ingls. All other marks are the property of their respective owners. Medicaid North Carolina | Healthy Blue of North Carolina Please be advised that we are currently experiencing longer than normal hold times when calling our Medical Management Department at 1-833-863-1310. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (i.e., experimental procedures, cosmetic surgery, etc. The changes help address the state's opioid epidemic and make treatment options more accessible for those with opioid dependency.