Healthy Blue Provider Quick Reference Guide

1 BNCPEC-0698-21 Healthy blue Provider Quick Reference GuideImportant phone numbers/addresses/websites: Provider ServicesPhone:844-594-5072 Monday to Saturday, 7 to 6 ET; voice portal 24/7 Provider websitesPublic website: website: authorizations/notifications (medical/behavioral health)Phone:844-594-5072 Fax:Inpatient Medical: 855-817-5788 Behavioral health: 844-439-3574 Outpatient Medical: 844-445-6649 Behavioral health: 844-429-9636 Durable medical equipment/home health infusions: 844-451-2793 Forms: north-carolina- Provider /formsOnline:Auth orization requests can also be sent through Services/EligibilityPhone:844-594-5070 Monday to Saturday, 7 to 6 ETSecure website: phone numbers/addresses/websites: (cont.)Pharmacy ServicesPhone:844-594-5084 Monday to Saturday, 7 to 6 ET24/7 NurseLinePhone:844-545-1427 24/7, including state holidaysSpanish: 844-545-1428 Behavior Health Crisis LinePhone:844-594-5076 24/7 Interpreter Services/Translation (TTY Line)Phone:844-594-5072 Grievance/claim inquiry (research and review)Note: This is not :844-594-5072, select Claims promptFraud, Waste and Abuse Phone:866-847-824723 Claims/EDIC laims information Phone:844-594-5072, select Claims promptPaper claim submissionTimely filing is 180 calendar days from the date of : blue Cross NC | Healthy Box 61010 Virginia Beach, VA 23466 EDI Availity1 Portal Client ServicesPhone:800-282-4548 Electronic payment enrollmentPhone.

2 877-882-0384 Electronic payment services ERA/EFTO nline: appealsProvider medical necessity appealAddress: blue Cross NC | Healthy Box 62429 Virginia Beach, VA 23466-2429 AppealsProvider has 90 days from receipt of an adverse determination to file an level 1 appeal, and the PHP will acknowledge receipt within five calendar and non-emergent transportation appeals are managed by the : blue Cross NC | Healthy BluePayment Dispute Box 61599 Virginia Beach, VA 23466-1599 Online:Use the secure Provider Availity Payment Appeal Tool at Through Availity, providers can upload supporting documentation and will receive immediate acknowledgement of their submission. Claims Payment Appeal Form/Reconsideration Form found on: :1 Availity is an independent company providing a secure Provider web portal for Healthy blue providers on behalf of blue Cross and blue Shield of North Healthy blue is a Medicaid plan offered by blue Cross and blue Shield of North Carolina.

3 blue Cross and blue Shield of North Carolina is an independent licensee of the blue Cross and blue Shield Association. Marks of the blue Cross and blue Shield Association. 4 VendorsTransportation ModivCare1 non-emergent transportationPhone:Reservations and ride assistance: 855-397-3602 Vision blue member ID: Notes:1 ModivCare is an independent company providing nonemergency transportation services for Healthy blue members on behalf of blue Cross and blue Shield of North EyeMed is an independent company providing vision services for Healthy blue members on behalf of blue Cross and blue Shield of North PREVIEWM ember Name: JOHN Q SAMPLEE ffective Date:Primary Care Provider (PCP):Telephone #:Date of Birth:Address:RXBIN: 020107 Identification #:Member ID #: 123456789 RXPCN: NCRXGRP: 8473X177227394800001X177227394800001 Members: Please carry this card at all times.

4 Show thiscard before you get medical care (except emergencies).If you have an emergency, call 911 or go to the nearestemergency : Lleve esta tarjeta con usted en todomomento. Mu strela antes de recibir el cuidadode la salud (excepto en emergencias). Si tieneuna emergencia, llame al 911 o vaya a la sala deemergencias m s blue within 24 hours after : Submit claims usingRXBIN: 020107; RXPCN: NC; RXGRP: Services:844-594-5070 Provider Services:844-594-5072 Pharmacy Member Services:844-594-5084 Help for pharmacists :833-296-503724/7 NurseLine:844-545-142724/7 Behavioral Health Crisis:844-594-5076 TTY:Use of this card by any person other than themember is fraud. If you suspect a doctor, clinic,hospital, home health service or any other kind ofmedical Provider is committing Medicaid fraud, Healthy Box 27287, Richmond, VA 23261-7287 Certain services are covered directly by blue is a Medicaid plan offered by blue Cross andBlue Shield of North Carolina.

5 blue Cross and blue Shield ofNorth Carolina is an independent licensee of the blue Crossand blue Shield Association. Marks of the blue Crossand blue Shield 07/21 Submit medical claims orHealthy Box 61010 Providers/hospitals: For preapproval/billing information,call 844-594-5072. For emergency admissions, notifyVirginia Beach, VA 23466-1010report it. Call a list of carved-out services, see your NameDescriptionUpdated ByLast ModifiedNC01NC01 SMaxwell02/03/2021 10:11 AMCard FrontCard BackDESIGN PREVIEWM ember Name: JOHN Q SAMPLEE ffective Date:Primary Care Provider (PCP):Telephone #:Date of Birth:Address:RXBIN: 020107 Identification #:Member ID #: 123456789 RXPCN: NCRXGRP: 8473X177227394800001X177227394800001 Members: Please carry this card at all times.

6 Show thiscard before you get medical care (except emergencies).If you have an emergency, call 911 or go to the nearestemergency : Lleve esta tarjeta con usted en todomomento. Mu strela antes de recibir el cuidadode la salud (excepto en emergencias). Si tieneuna emergencia, llame al 911 o vaya a la sala deemergencias m s blue within 24 hours after : Submit claims usingRXBIN: 020107; RXPCN: NC; RXGRP: Services:844-594-5070 Provider Services:844-594-5072 Pharmacy Member Services:844-594-5084 Help for pharmacists :833-296-503724/7 NurseLine:844-545-142724/7 Behavioral Health Crisis:844-594-5076 TTY:Use of this card by any person other than themember is fraud. If you suspect a doctor, clinic,hospital, home health service or any other kind ofmedical Provider is committing Medicaid fraud, Healthy Box 27287, Richmond, VA 23261-7287 Certain services are covered directly by blue is a Medicaid plan offered by blue Cross andBlue Shield of North Carolina.

7 blue Cross and blue Shield ofNorth Carolina is an independent licensee of the blue Crossand blue Shield Association. Marks of the blue Crossand blue Shield 07/21 Submit medical claims orHealthy Box 61010 Providers/hospitals: For preapproval/billing information,call 844-594-5072. For emergency admissions, notifyVirginia Beach, VA 23466-1010report it. Call a list of carved-out services, see your NameDescriptionUpdated ByLast ModifiedNC01NC01 SMaxwell02/03/2021 10:11 AMCard FrontCard BackSAMPLESAMPLE