blue cross of nc medicare advantage hmo patient portal

Is Blue Cross and blue shield of North Carolina an HMO?

Blue Cross and Blue Shield of North Carolina is an HMO, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.

Does Blue Cross have dental insurance in North Carolina?

Oct 08, 2021 · Important Medicare Advantage Updates for 2022. Blue Cross® and Blue Shield® of North Carolina (Blue Cross NC) is working with Liberty Dental Plan and their large network of providers to provide dental benefits as part of your Blue Medicare Advantage plan. Members will have access to this new network of providers effective January 1, 2022.

How do I find a blue Medicare plan in NC?

Blue Cross and Blue Shield of North Carolina offers three drug formularies (drug lists) so Medicare beneficiaries can have options for their prescription needs. Blue Medicare HMO Enhanced, HMO Essential and Blue Medicare PPO Enhanced share the same Medicare prescription drug list. This list is based on a preferred list of FDA-approved ...

What mail order providers does Blue Cross NC use in Ma?

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

Is Blue Cross Blue Shield of NC PPO or HMO?

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.

What is NC Blue Connect?

Blue Connect gives you convenient access to all the things you need to feel confident in your health care decisions - like Find a Doctor, cost estimators, coverage details and our 24/7 nurse hotline.

Is Blue Shield an HMO?

Blue Shield offers a variety of HMO and PPO plans. Contact us if you have any questions or to find out more about our plans.

How do I activate my Healthyblue card in NC?

It just takes a few minutes to register. You'll need your member ID number (shown on your ID card), your birth date, and your ZIP code. If you need help, call us at 844-594-5070 (TTY 711). Connect with your benefits.

How do I file a claim with Blue Cross Blue Shield of NC?

Visit BlueCrossNC.com/Claims for prescription drug, dental and international claim forms, or call the toll-free number on your ID card. Important Notes When Completing the Claim Form: Type or use blue or black ink to complete. Complete a separate claim form for each covered family member.

Does NC BCBS cover Covid testing?

Your Guide to Getting Tested We're currently covering, with no cost-share to members, COVID-19 tests performed in labs or at-home when ordered by a provider, are consistent with current CDC guidance and have been cleared, approved or given emergency use authorization (EUA) by the FDA.

What is HMO insurance?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

Which is better a HMO or PPO?

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.Sep 19, 2017

What is Blue Shield trio HMO?

The Trio HMO plan is affordable and predictable – low copays, no deductibles and almost no claim forms. With the Trio HMO plan, you have access to a quality network of local doctors and hospitals. You need to select a primary care physician (PCP), who is responsible for the overall coordination of your care.

Is NC Health Choice the same as Medicaid?

Unlike Medicaid, the NC Health Choice for Children program is limited by the amount of funds that are available. Therefore, it is open only to children on a first come, first served basis.

How do I get a Medicaid card in NC?

If you don't receive your Medicaid card, or if you lose your card, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421)....Your Medicaid card will have:Your primary care provider's (PCP's) name and phone number.Your Medicaid identification number.Information on how you can contact us if you have any questions.

How do I change my primary Medicaid provider in NC?

But, if you want to change your PCP you may:Call the Medicaid Contact Center at 888-245-0179, or.Call your local DSS Office, or.Go to Find a provider to see who is taking new patients.

Resources and Forms

Get essential resources for Medicare providers, including Medicare payer sheets, online provider manual and newsletters.

Medical Management Programs and Services

Get information on the programs and services designed to help maintain high quality care for Blue Medicare PPO and Blue Medicare HMO members.

Policies and Responsibilities

Review Blue Cross NC's Blue Medicare PPO and Blue Medicare HMO policies and provider responsibilities to our Medicare members.

Prior Plan Approval

Find out which services need prior plan approval and how to request it.

Provider Appeals

Get details and instructions for filing a post-service provider appeal.

Electronic Commerce

Connect with other providers online to research claims, benefits and eligibility information.

Contact Us

Questions about providing care for Blue Medicare PPO and Blue Medicare HMO members? Contact us for answers.

What is blue Medicare Advantage?

This plan uses a prescription drug formulary. 1 Benefits are limited to the drugs on this formulary unless an exception is approved by the plan.

What is covered outpatient medicine?

Covered outpatient drugs which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee.

What is the coverage gap for 2019?

Standard coverage gap drug benefits - In the coverage gap, you pay 37% for 2019 coinsurance for all generics. Your coinsurance for approved brand-name drugs is 25% for 2019. Coverage is not available for refill medications before 75% of the time period for the supply has passed.

What are the uses of anorexia agents?

Agents when used for anorexia, weight loss , or weight gain (even if used for a non-cosmetic purpose such as morbid obesity) Agents when used to promote fertility . Agents when used for cosmetic purposes or hair growth. Agents when used for the symptomatic relief of cough and colds.

Do you have to use a network pharmacy to receive benefits?

Members must use network pharmacies to receive full benefits. Drug benefits or services not described in the plan formulary or the Evidence of Coverage, or not required by law or regulations, are not covered. Prescriptions filled by pharmacies outside the United States, even for a medical emergency are not covered.

Is step therapy covered by Medicare?

Certain drugs may require step therapy. Drugs covered by Medicare Part B are not payable as Part D benefits. (Refer to your Medicare Part B coverage documents for Part B drug coverage.) Compounded medications require an exception request to be approved.

Is prescription drug coverage gap?

Enhanced coverage gap drug benefits - In the coverage gap, you pay only a copayment for Tier 6 preferred generics and 37% for 2019 coinsurance for all other generics. Your coinsurance for approved brand-name drugs is 25% for 2019.

Availity 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.

Provider news

The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.

General Documents

Here are some forms and documents related to your Blue Advantage plan.

Member Newsletters

Read the "Blue Advantage Bulletin" member newsletter for tips and health information to help you make the most of your plan.