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Medicaid Providers

Provider manual

The Healthy Blue provider manual provides key administrative information, including the quality improvement program, the utilization management program, quality standards, claims appeals, and reimbursement and administration policy information.

View or download the provider manual.

View or download the Quick Reference Guide

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SBIRT Toolkit

A clinicians' tool for identifying risky behaviors and providing appropriate intervention.

Screening, brief intervention, and referral to treatment, commonly referred to as SBIRT, is an evidence-based, comprehensive, integrated approach to the delivery of early intervention and treatment services to people with substance misuse and those at risk of developing disorders.

The goal of SBIRT is to reduce and prevent related health consequences, disease, accidents, and injuries. Risky substance use is a health issue that often goes undetected; providers can help by incorporating this evidence-based tool that is demonstrated to be valid and reliable in identifying individuals with problem use or at risk for a substance use disorder (SUD).

 

If you wish to print SBIRT educational materials, please review the links to obtain a downloadable flier and brochure. For any further discussions regarding SBIRT, please contact your Provider Experience or Provider Relations consultant.

SAMHSA

  • SBIRT Provider Training and Education (coming soon)
 

Learn about Availity

Many of the tools you need — eligibility and benefits inquiries, claims submission, claims status inquiries and authorizations — can be accessed through Availity. You can find instructions for locating and using these tools on the Learn about Availity page.

 
 

Electronic data interchange

 

Cultural competency resources

Patient panels are growing more diverse and needs are becoming more complex. It is important for providers to have the knowledge, resources, and tools to offer culturally competent care. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) wants to help Healthy Blue providers by offering the following comprehensive trainings and resources, as we all work together to achieve health equity.

My Diverse Patients

The My Diverse Patients website offers learning experiences and techniques and helps you provide the individualized care every patient deserves, regardless of their diverse backgrounds.

Improving patient experience

What Matters Most: Improving the Patient Experience is an online course for providers and office staff that addresses gaps in care and offers approaches to communication with patients. This course is available at no cost and is eligible for one continuing medical education (CME) credit by the American Academy of Family Physicians.

Cultural competency and patient engagement

Blue Cross NC has three versions of the Healthy Blue provider cultural competency training available, based on North Carolina’s geographic regions and the diverse tribal communities in those areas. See the flyer below for details on which version(s) you should take and how to confirm completion.

Caring for Diverse Populations Toolkit

A comprehensive resource to help providers and office staff increase effective communication by enhancing knowledge of the values, beliefs, and needs of diverse patients

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.