BCBSNC Member Eligibility and Access Issues
As you are probably well aware, BCBSNC is experiencing some difficulties in various areas as a result of open enrollment and the transition of a large set of members to a new processing system. An emergency meeting was called last week by BCBS that included NCMGMA and NC Medical Society representatives.
Please note the communications listed below from BCBSNC in response to state wide issues regarding Patient Eligibility and New Enrollment information. While this is not the final solution please use this as appropriate until BCBS can correct any BLUE E issues. They would like to thank you in advance for your assistance in caring for all BCBS members and having patience with them while their systems are being corrected.
Current Process – future appointments, non-urgent appointments
- If you have a BCBSNC patient who is seeking care, but who has not yet received their new ID card, please check Blue eSM to confirm the member’s benefits and eligibility. If you are unable to confirm the member’s enrollment, please try again as we are continually processing enrollment applications.
- Most BCBSNC members already have ID cards; however some members waiting for their ID cards may present you with a Certificate of Coverage issued by BCBSNC. If a BCBSNC member shows you a Certificate of Coverage, please accept it as proof of their enrollment with us.
Escalated Process – for walk ins, immediate/urgent/emergent services and unable to verify on Blue E or via 800-214-4844 number in a timely manner
- MEMBER IN OFFICE OR NEEDS TO BE SEEN ASAP – Member is in the office and the provider is unable to verify eligibility for an immediate, urgent/emergent service/appt via Blue eSM or the toll-free provider line (800) 214-4844. Prior to turning the patient away, the provider may call (919) 765-4035 for assistance. If voicemail picks up on this line, please leave a contact name and a contact number for the office. Please Note: this will not include detailed benefit information only to verify ELIGIBLITY.
- FUTURE APPOINTMENTS – If the provider is verifying eligibility for future appointments, please attempt to utilize Blue eSM or the 800 eligibility line.
- AUTHORIZATIONS: If a member needs clinical services authorized, providers should call the dedicated 1-800-672-7897 authorization number. The authorization line is separate and distinct and does not currently have a backlog. Please use this line for authorizations to minimize clogging the provider line.
Please send this link to any colleagues or referring providers that may also be struggling with eligibility verification.