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Medicaid Providers

Welcome!

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) created Healthy Blue, a new plan designed to service the millions of North Carolinians who participate in the state Medicaid program.

Focused on the health of each member

Blue Cross NC embraces the mission to improve the health and well-being of members and communities as well as the commitment to enhance the health of each member served.

On this site, you will find resources that help health care professionals do what they do best — care for our members.

Provider Manual

  • Provider Manual (coming soon)

Training & Tutorials

Find a doctor

We work with thousands of doctors, hospitals and specialists to make getting medical care easy. Use our search tool to find a plan provider. You can search by name, specialty, location and more.

Provider Directories

Region 1

Avery, Buncombe, Burke, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania and Yancey counties

Region 2

Alleghany, Ashe, Davidson, Davie, Forsyth, Guilford, Randolph, Rockingham, Stokes, Surry, Watauga, Wilkes and Yadkin counties

Region 3

Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly and Union counties

Region 4

Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren and Wilson counties

Region 5

Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson and Scotland counties

Region 6

Beaufort, Bertie, Camden, Carteret, Chowan, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Northampton, Onslow, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington and Wayne counties

We want you to join us

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.

For detailed information about specific requirements for each provider type, refer to the Provider Permission Matrix on the NCTracks website or the NCDHHS Provider Enrollment team at 1-800-688-6696.

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.

Contracting

For more information or to join the Healthy Blue network, contact our Network Development team at 1-844-415-2045 or via email at NCProviderQuestions@NCHealthyBlue.com

Availity Portal access

The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Register and log in for access to help and training materials. Registration is free.

Don't have an Availity account? Register for free now!

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.

Enclosed are the DHHS approved BCNC Healthy Blue Medicaid attachments and reimbursement language 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.

   

Please note, this is not an executable contract template. Contact 844-415-2045 or email NCProviderQuestions@nchealthyblue.com to speak to a Healthy Blue representative that can answer additional questions and assist with the process of becoming a Healthy Blue network provider.

Blue Cross NC is excited to expand our relationship with you to serve Medicaid members in North Carolina.