For physicians and healthcare professionals
Provider Pathways is a 24/7 educational resource that offers a foundation for doing business with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). It is designed to be user friendly and gives you flexibility when scheduling Healthy Blue training for yourself and your staff. In order to launch the Provider Pathways eLearning, please complete NC Provider Pathways registration.
Trainings and tutorials
We offer training and tutorials to support Healthy Blue providers in continuing their education. Presentations, videos and other training documentation will be added as they become available.
- Carelon Rehabilitation Solution Presentation
- Carelon Supplemental Guide to the Rehabilitation Program
- Electronic Visit Verification Home Health Checklist
- Healthy Blue Provider Billing Guide
- Carelon - Provider Training for Rehabilitation Program
- Musculoskeletal Solution Provider Office Staff Training
- Carelon – Provider Training for Radiology/Cardiology Program
- Diagnosis Codes In The Provider Portal For Blue Cross And Blue Shield Of North Carolina
- Guidance for Authorization Requests Beyond Member Eligibility Date
- Outline of Personal Care Services Referral/Intake Process
- Quick Reference Guide
- Tobacco Cessation Provider Education
- Billing Guidance for Healthy Blue Providers
The provider manual provides key administrative information, including the quality improvement program, the Utilization Management program, quality standards for participation, claims appeals, and reimbursement and administration policies.
For Healthy Blue providers in NC serving Medicaid members.
Additional provider training resources
Healthy Opportunities Pilot Provider Training Resources
The Center for Medicare and Medicaid Services (CMS) approved up to $650 million in state and federal Medicaid funding to cover the cost of providing select pilot services that address non-medical drivers of health in four priority domains: housing, food, transportation, and interpersonal violence/toxic stress. Visit the Healthy Opportunities Pilots page to learn more.
North Carolina Integrated Care for Kids (NC InCK)
North Carolina Integrated Care for Kids (NC InCK) is a new government-funded model aimed at improving the way children and families receive care and support services. All children and youth from birth to age 21 who are enrolled in North Carolina Medicaid or CHIP (NC Health Choice) and who live in one of five North Carolina counties (Alamance, Durham, Granville, Orange, and Vance) will automatically be enrolled in NC InCK. Visit NC InCK to learn more.
Telehealth or telemedicine is the use of telecommunication technologies to extend care to patients virtually rather than in person. Telehealth allows health care providers to:
- Increase continuity of care
- Extend access to care beyond standard working hours
- Help overcome clinical shortages, especially among rural and other underserved populations
- Provide support for patients managing chronic health conditions
- Screening patients with symptoms of infectious diseases
- And more
Screening, brief intervention, and referral to treatment
SBIRT is a clinician’s tool for identifying unhealthy substance use behaviors and providing appropriate intervention for at risk patients.
Improving the patient experience
A series of online course for providers and office staff that conveys practical strategies for implementing patient care and applying best practices.
Our full library of provider materials
Having trouble finding the resource you are looking for? Check out our full library of provider materials to locate exactly what you are trying to find.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior authorization lookup tool
- Prior authorization requirements
- Claims overview
- Member eligibility and pharmacy overview