Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, Prior Review (Prior Plan Approval) Code List, Medical Oncology Program Prior Review Code List - Blue Medicare, Carelon (formerly known as AIM) Prior Review Code List, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. This list is provided for member information only. Disponible nicamente en ingls. Shop Plans; Members; Providers; Employers; Agents; Linked Apps. Inpatient maternity stays longer than 48 hours after vaginal delivery or 96 hours after a C-section. Technical Information Prior authorization requirements will be added for the following code(s): Blue Shield Association. Inpatient admissions, services and procedures received on an outpatient basis, such as in a doctor's office, and prescription medications may be subject to prior review. Many of our plans require prior authorization for certain procedures and durable medical equipment. You may submit requests for prior authorization to Avalon by fax (888-791-2181), by phone (844-227-5769), or online using Avalon's Prior Authorization System, 8 a.m. - 8 p.m., Eastern Time. Since 1933, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has helped millions of North Carolinians get and stay healthy. Join Our Network. No, Blue Cross NC does not require prior approval for drugs in the Physician Drug Program when administered in a provider clinic or outpatient setting. Learn more about our non-discrimination policy and no-cost services available to you. Once you submit your Prior Authorization request, thequickest method to check authorization statusis through the Secure Provider Portal. Not all PA requirements are listed here. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. A library of the forms most frequently used by health care professionals. Please be advised that we are currently experiencing longer than normal hold times when calling our Medical Management Department at 1-833-863-1310. Prior Authorization Lookup Tool - Healthy Blue SC No hold times. Blue Cross Blue Shield Prior Authorization | BlueCross BlueShield of South Carolina Your benefits cover the service in question, The service is medically necessary according to Blue Cross NC medical policy, The service is performed in the right health care setting, The provider is correctly identified as in- or out-of-network, Special medical circumstances are identified that require specific types of review and follow-up. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. on the Resources tab or for contracted providers by accessing availity.com. Surgery and/or outpatient procedures How can my provider request prior review and certification? Blue Shield of North Carolina (Blue Cross NC) is an independent licensee of the Blue Cross Blue Shield Association. Necesita su ID de usuario? For. Usage Agreement Accessibility BLUE CROSS, BLUE SHIELDand the Cross and Shield Symbols are registered marks of the Blue Cross Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Use the PA tool within the Availity Portal. Privacy Policy To request authorizations: From the Availity home page, select Patient Registration from the top navigation. NOTE: Services related to an authorization denial will result in denial of all associated claims. Accessibility Medicare Advantage: View the prior authorization requirements exclusively for our Medicare Advantage plans here. In many cases, approval is instant. Disponible nicamente en ingls. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. PA-TOOL-6032-V02-20170124-Prior Authorization List 1 About Prior Authorization BlueCross Blue Shield of South Carolina and BlueChoice HealthPlan have delegated prior authorization (PA) for outpatient lab services to Avalon Healthcare Solutions . 2023 Blue Cross and Blue Shield of North Carolina. When its not, well review your request, taking into account: Some requests may require additional documentation.