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We're excited to announce an upcoming refresh of our website that includes a cleaner design and easier navigation. 2023 Blue Cross and Blue Shield of North Carolina. Closer Look At IOP Billing For Behavioral Health Service Providers Provider (Individual/Group) Credentialing and Enrollment Process Change Effective November 1, 2022. Box 2291 Blue Cross NC partners with Mindoula1 to offer Blue Premier Behavioral Health Advanced (BPBHA), which addresses the complex health needs of members with serious mental illness, substance use disorder or both conditions. Trendwatch. We're here to help. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross NC is committed to telehealth coverage now and in the future. Thats why we feel confident that the new site will make it easier for you to find what you need so you can get back to helping your patients. Whether you have questions about picking a plan, finding care, using your benefits or seeing claim details, we can help. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The changes are among the first of their kind among health plans, which traditionally have treated behavioral health . In addition, it may be helpful to: Psychiatric or Behavioral/Mental Health Nurse Practitioner: To find a behavioral health practitioner, click on Find a Doctor at the top of the page and search under Behavioral/Mental Health.. Choose a therapist from your matches and book your first appointment right on Headway. Inpatient Psychiatry and Substance Use Disorder. Start the CAQH ProView Application Process. Mindoula is a next generation population health management company that scales the human connection through technology in addressing mind, body, and life challenges. Find information on specialty networks, credentialing, and the responsibilities of primary care physicians. More Details. If you need help, please dial 1-800-273-TALK (8255) or text "NAMI" to 741741. You should follow the steps below while you are waiting to ensure your application can be processed. When you see a therapist using your Blue Cross NC plan, you'll pay closer to $20-$50 per session rather than the standard $200-$300. Appeals forms, enrollment applications and credentialing forms. Inscribirse ahora! The changes are among the first of their kind among health plans, which traditionally have treated behavioral health separately from physical health. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Blue Cross NC Introduces New Payment Model to Reward Behavioral Health Credentialing & Recredentialing - Blue Cross Blue Shield of Massachusetts Now, as 53% of adults report that their mental health has been negatively affected by worry and stress over the coronavirus, it is more important than ever to find innovative solutions to the behavioral health issues facing our state. Disorders include: Substance Use Disorders: When a person uses substances or is dependent on a substance. This list is based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. Blue Cross NC wants to make sure you have the most accurate and up-to-date information. Marks of the Blue Cross and Blue Shield Association. Help reduce inquiries for your administrative information and save even more time by keeping your profile complete and up-to-date. Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. It affects how we think, feel, and act. Learn more about our non-discrimination policy and no-cost services available to you. Be aware your network provider might use an out-of-network provider for some services . 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. DURHAM, N.C. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is bringing value-based payments to its network of behavioral health providers, giving patients better access to high-quality, better-coordinated care for mental health and substance use disorders. TTY users call 711. If you need mental health, behavioral health, or substance abuse services . This program addresses the mental health crisis and health care shortage in North Carolina by providing tech-enabled support that expands outpatient behavioral health care to members in the greater Triangle area, as well as eligible members outside of North Carolina. For Providers: How to Get Credentialed | bcbsm.com Blue Cross and Blue Shield of North Carolina provides fee schedule information to participating physicians electronically. Review information sent to support credentialing application, Ask for information about credentialing and/or recredentialing application status, Licensed Clinical Social Worker Associate, Licensed Marriage and Family Therapist Associates, Licensed Professional Counselor Associate, Durable Medical Equipment (Diabetic Supplies Only), Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only), You can submit your information online easily, You can change your information yourself to make sure it's up-to-date, We can access your information whenever you've given us approval, We can verify and review your credentials to make sure they meet Blue Cross NC requirements, Your information is stored securely and you can access it whenever you want on your schedule, Apply for credentialing/recredentialing using the button below, Make sure your application status show the "Completed" stage before emailing us. To encourage the appropriate use of prescription drugs, some quantities are limited and some drugs must be approved before they will be covered. Here's what you need to know about credentialing for each section. Olvido su contrasea? Blue Cross NC - Find a Therapist | Headway Each facilitys cost of care is evaluated using data from its Local Blue Plan. Disponible nicamente en ingls. Risk Adjustment Coding and Documentation Tips 46% get a follow up visit within 7 days of leaving the emergency department for a mental health condition. American Hospital Association (AHA). Headquartered in Silver Spring, Maryland, Mindoula is currently operating in Maryland, Virginia, the District of Columbia, North Carolina, Nevada, Louisiana, West Virginia, California, Texas, Kentucky, Tennessee, Washington, Arkansas, Colorado, Missouri, New Jersey, Michigan, Pennsylvania, Delaware, South Carolina, Georgia, Mississippi, Minnesota, and Florida, with continued national expansion plans to meet the growing need for integrated whole person care. You must complete the credentialing and contracting processes to become a Blue Cross provider. See the standards Blue Cross NC and our contracting physicians must meet to provide the best service possible. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. All providers available via Headway are Clear Pricing Project Providers resulting in a $0 copay. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. Knowing what to look for can be hard, so were here to make it as simple as possible. Privacy Policy You have three options to manually supply Blue Cross NC with your application - email, fax, or mail. Hi. Olvido su contrasea? Olvido su contrasea? Disponible nicamente en ingls. Forgot username or password? Verifide will contact you if they need additional or updated information for primary source verification. Privacy Policy Fee Schedules | Blue Cross NC , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Site Map For instructions on how to request a transition supply or an exception to the formulary and instructions on how to appeal a decision about an exception or to file a grievance if you are dissatisfied for any reason, please review the following documents: If you discover incorrect information in our Find a Doctor Tool, please call Customer Service at 1-877-258-3334. Through Quartet, doctors can easily recommend patients for care with mental health providers who best meet their needs. The contract process takes 30 days from the date you register your NPI number. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Call us if you are experiencing emotional or mental pain or distress. For information and details regarding behavioral health, behavioral health, and substance use disorder benefits and services, please visit the Employee Benefits page and refer to your plans Benefits Booklet for the Base PPO Plan (70/30) or Enhanced PPO Plan (80/20) as appropriate. To verify whether a drug is covered, you may call Customer Service seven days a week from 8 am - 8 pm. All providers in the Blue Cross NC network need to be recredentialed every three years. Forgot username or password? Find brief education documents to describe proper documentation and coding of risk adjustment diagnoses. Accessibility Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. These tools are offered for your convenience and should only be used as reference tools. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Get information including case management, health care services and quality improvement. Mood Disorders/Affective Disorders: When a person feels constantly sad, has a loss of interest in key parts of life, or fluctuates between extreme lows of sadness and extreme highs of happiness. Yes. Blue Cross NC and Quartet Launch Innovative Mental Health Collaboration Technical Information Learn more about our non-discrimination policy and no-cost services available to you. Necesita su ID de usuario? Encouraging stronger patient-doctor relationships, enhanced communication and team-based care. To find Headway providers who offer pediatric support and accept your Blue Cross NC plan, you can filter results by your childs age under More Filters on the search page. Inpatient Psychiatry and Substance Use Disorder, Psychological and Neuropsychological Testing. Outpatient services $25 copayment / office visit; 50% after deductible . Please check members'benefits to determine if coverage is available. They can be reached at (800) 755-0798. Call our customer service number on the back of your member ID card to report information that is wrong. See the quality standards Blue Cross NC managed care plans has met for accreditation. IMPORTANT NOTE: An authorization letter from each provider, on the provider letterhead, must be received with this application in order to verify you have permission to perform business functions on their behalf. At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), our mission is to improve whole-person care for North Carolinians. Im Karah Manning with Blue Cross and Blue Shield of North Carolina, and Im part of the team working on some exciting changes to our website. Learn about the process for Level I, Level II and Non-Contract providers. Sign in on the right to update your existing profile information or, if you are a new user, register to . Practice Quality Standards 2021 Blue Cross and Blue Shield of North Carolina, Medical Policies and Clinical UM Guidelines, Guide to Drug Coverage Under Medical Benefit, Screening, Brief Intervention, and Referral to Treatment, Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment, Vanderbilt Assessment Scales ADHD Screening, Mood Disorder Questionnaire Bipolar Disorder Screening, Early Childhood Service Intensity Instrument (ECSII), Level of Care Utilization System (LOCUS)/ Children and Adolescent Level of Care Utilization System (CALOCUS), The Child and Adolescent Needs and Strengths (CANS), Supports Intensity Scale: Child and Adult, American Society of Addiction Medicine (ASAM) Criteria, Submit and inquire about behavioral health authorizations presentation, Benefits of Electronic Authorization Submission Brochure, Screening for alcohol use disorder in high-prevalence demographics. 1-800-952-8462. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Anxiety Disorder: When a person responds to certain objects or situations with fear or dread that can be both psychological and physical. Technical Information CPT and HCPCS Code List Before we can process your contract application, you should: Billing Services:Signing Up for Blueefor BILLING SERVICES. The NCDOI is the regulatory body for the state of North Carolina for managed care organizations. It comprehensive reference guide for our products, value-added programs, services. Serving Medicaid members in North Carolina Each provider applying for credentialing and/or recredentialing with Blue Cross NC has the right to: You don't need to be credentialed to register your NPI number. Claims/Customer Service. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. 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. Compare the difference and check out the savings! Find a Therapist, Psychologist, Counselor - Psychology Today Effective and high quality mental health care from providers who are in-network with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Headways mission is to make mental healthcare affordable and accessible. Please contact the Provider Blue Line at 1-800-214-4844. Register Now, Ancillary and Specialty Benefits for Employees. All other marks are the property of their respective owners. This includes joining our network, medical policy search, and other important daily tasks such as claims and appeals management. Thank you for your assistance. Learn more about our non-discrimination policy and no-cost services available to you. We want to clarify which mental health and substance use services require prior authorization from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) for commercial (excluding the State Health Plan), Federal Employee Program (FEP), and Blue Medicare members. Medical Record Submission Process Advance Medical Home . The No Surprises Act ensures price consistency and protects patients against surprise medical billing, including limitations on provider balance billing. Please ensure it's in the correct status. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. Higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity. Changes needed to fix NC's mental health crisis | NC Health News HIPAA Version 5010 Certain vaccinations, insulin and insulin injection supplies are also covered on all formularies. 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. Milliman, a health care consulting firm, has found that its becoming more difficult for patients to find access to affordable mental health and substance use disorder treatment.1 Reasons include lack of participation in health plan networks by behavioral health providers as well as a shortage of behavioral health providers. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience. Learn more about the process for submitting FEP medical records. Prior Authorization - Healthy Blue North Carolina Providers Decisions regarding your care should be made with the advice of a doctor. 2023 Blue Cross and Blue Shield of North Carolina. The first factor is the "Bill class," which refers to the type of service being billed. We credential all providers who want to enroll in our networks, except hospital-based physicians. Behavioral or mental health includes our emotional, psychological, and social well-being. Get information and a compliance timeline. A lock icon or https:// means youve safely connected to the official website. Psychiatrist and psychiatric nurse practitioners are able to prescribe medication to support mental health treatment. Technical Information Participating physicians who wish to view a special or supplemental fee schedule may contact their Network Management service representative to request either a CD or hard copy of . As of January 1, 2020, some services no longer require prior authorization. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, contact their Network Management service representative, contact your Network Management Service Representative, Contact your network management service representative, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. We'd like to provide our members with the best information possible. Accessibility As a part of this effort, we introduced Blue Premier Behavioral Health, a value-based care program that rewards providers for delivering high-quality behavioral health care. DURHAM, NC and NEW YORK, NY - Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Quartet today announced a new statewide initiative that will work to integrate mental health into primary care. Durham, NC 27702-2291. Learn more about our non-discrimination policy and no-cost services available to you. Find out which behavioral health services we offer. Drug Information Blue Cross NC last year began offering Quartets services to primary care and mental health providers free of charge. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.9 million members, including approximately 1.1 million served on behalf of other Blue Plans. Site Map Check with your benefits administrator or Blue Cross NC Customer Service to determine your eligibility. To learn more, view our full privacy policy. If you can't find your drug, your drug may not be covered. Headway does not offer Blue Cross or Blue Shield products or services. Choose your concerns and/or preferences for therapy to filter results to find the best provider match for you. Learn more about the process for submitting Blue Medicare medical records. Blue Cross NC Expands Mental Health Care for Children, Underserved Together, we can help the whole personthrive by bringing physical and behavioral health together. You can book an appointment with a provider directly from their profile page. The new approach to payment builds on efforts Blue Cross NC began in 2019 to better integrate behavioral health with physical health and to transform health care through value-based payments. Usage Agreement D-SNP resources, training and contact information. Increasing Access to Behavioral Health Care Advances Value for Patients, Providers and Communities. Heres what this means for you: If you have questions, contact Provider Services at 1-800-777-1643 option 6. Dental Plan LoginMedical Plan Login (Blue e). Review the CPT, HCPCS, revenue and diagnosis codes that most often necessitate provider initiated medical record submissions. Learn more about our non-discrimination policy and no-cost services available to you. Register Now, Ancillary and Specialty Benefits for Employees. Value-based payments are one way Blue Cross NC is addressing challenges in behavioral health. Blue Cross and Blue Shield of North Carolina. These include, but are not limited to intensive outpatient, methadone treatment, outpatient detoxification, outpatient therapy, and partial hospitalization. Member Services: 844-594-5070 Please remember that only medical professionals can diagnose an individual for a behavioral or behavioral health issue. Our technology will help people get the best mental health care for their needs and allow mental health providers to be recognized and rewarded for improving patients health. The Care Navigator will also reach out to the member to helpschedule their appointment and follow up to see if the appointment was held. The drugs listed below have been removed from the specified formularies (drug lists). Healthy Blue North Carolina Providers Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Inscribirse ahora! This program is available to members with Commercial, Federal Employee Plan (FEP), IPP Host and Home, and Medicare Advantage plans. Ensure that the healthcare organizations you authorize have instant access to accurate, timely information. Choose "Participation Contract Request" at the top of the enrollment forms to become a contracted provider. 24 hours a day, seven days a week. Become a Blue Cross NC Provider Recredential Now. Like most insurance coverage, our Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx plans have some limitations and exclusions. Use these forms to register your NPI number and Tax ID with Blue Cross NC. Healthy Blue is the Medicaid plan offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to serve North Carolinians who participate in the state Medicaid program. Blue e Provider Access - Blue Cross and Blue Shield of North Carolina We'll use information you give us (like your location, your preference for in-person or virtual appointments and what issue you might want help with) to match you to a provider. Disponible nicamente en ingls. Note that requirements vary by state, May help with understanding and coping with thoughts, feelings, and behaviors, May be able to diagnosis and assess mental health conditions, Has a doctoral degree and is licensed by the boards in the provider's state, May make diagnoses, provide individual and group therapy, May use CBT (cognitive behavioral therapy) and dialectical behavior therapy (DBT) or other methods, Has a doctoral degree and residency training, Licensed by the provider's state and may be board certified as well, May have licenses: National Council Licensure Examination or Board Certification, May assess or diagnosis mental health conditions or disorders, In some states, may be allowed to prescribe and monitor medication, Has a doctoral degree and can prescribe some medication but is not specialized, Licensed in the state in which the provider practices, Works with mental health professionals as a team, May also have National Council Licensure Examination or Board Certified, May prescribe medication but is not specialized, Works along with mental health professional, National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255), National Suicide Prevention Lifeline Online Chat, Substance Abuse and Mental Health Services Administration (SAMHSA) - SAMHSA National Helpline: 1-800-662-HELP (4357), HOPE4NC: A Crisis Counseling Program tailored for COVID-19. Suicide rates were on the rise, drug overdose deaths were dramatically increasing, and life expectancies for people with serious mental illness were lower before the pandemic began to impact our lives and well-being. Mental Health Care | Behavioral Health | Blue Cross NC Headway is an independent company providing behavioral health services on behalf of Blue Cross NC. Providing Behavioral Health Care | Providers | Blue Cross NC Learn more about our non-discrimination policy and no-cost services available to you.