We’re glad to hear that you are interested in joining the Healthy Blue network. We have a diverse network of exceptional health care professionals who ensure our members have uninterrupted access to the health care they need.
Our prior authorization, referrals, claims and payment processes are streamlined to help you focus on what you do best — care for your patients.
We support you with:
Enrollment qualifications vary, but all providers must complete an application with the North Carolina Department of Health and Human Services (NCDHHS). Providers are responsible for maintaining the required licensure, endorsement and accreditation specific to their provider type to remain qualified. They are required to notify NCDHHS immediately if a change in status occurs.
Providers who wish to contract with us must be enrolled with NCTracks. Information about enrollment in NCTracks can also be found at the NCTracks website.
All provider enrollment, data management, recredentialing and verification must be completed by the provider through NCTracks.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Healthy Blue embraces the mission to improve the health and well-being of members and communities as well as our commitment to enhancing the health of each member served.
The NCDHHS approved Blue Cross NC Healthy Blue Provider Medicaid attachments and reimbursement language is posted for providers’ review/inquiry.
For purposes of determining the Blue Cross NC Rate, the total reimbursement amount that provider and Blue Cross NC have agreed upon for the applicable provider type(s) for Covered Services provided under this Agreement shall be one hundred percent (100%) of the Blue Cross NC Medicaid Fee Schedule(s) in effect on the date of service. Notwithstanding the foregoing, Blue Cross NC shall reimburse all in-network primary and specialty care physicians as well as physician extenders (e.g. nurse practitioners and physician assistants) no less than one hundred percent (100%) of the Medicaid Fee-for-Service rate for the service or bundle (as permitted under 42 C.F.R. § 438.6(c)(1)(iii)(A)), unless Blue Cross NC and provider have mutually agreed to an alternative reimbursement arrangement.
The parties acknowledge and agree that the Blue Cross NC Medicaid Fee Schedule(s) are subject to modification by Blue Cross NC at any time during the term of this Agreement and will be applied on a prospective basis.