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Medicaid Providers

Provider resources

We are committed to supporting you in providing quality care and services to Healthy Blue members. Here you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to Healthy Blue members.

Provider forms

Provider forms are located in our online library for easy access.

Healthy Blue Training Academy

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers training and tutorials to support providers in continuing their education. Presentations, videos and other training documentation will be added as they become available.

Provider manuals and guides

The Healthy Blue provider manuals and guides provide key administrative information including the Quality Improvement program, the Utilization Management program, quality standards for participation, claims appeals, reimbursement and administration policies.

Learn about Availity

Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into your account on the Availity Portal.

Prior authorizations

Blue Cross NC makes determinations based on selected inpatient or outpatient medical services including surgeries, major diagnostic procedures and referrals to validate medical necessity.

Behavioral health

The behavioral health provider network for Healthy Blue members includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs, and intensive outpatient services and programs.

Additional information

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

Provider tools & resources

Interested in becoming a provider in the Healthy Blue network?

We look forward to working with you to provide quality services to our members.