The database can by accessed via the internet at caqh.org. The provider will use a personal ID and password to directly access the database over the internet. Providers may transmit the completed application electronically, or if they do not have Internet access, may call the CAQH Help Desk at 888-599-1771 and request an application to be sent by mail. The provider simply completes the paper copy and faxes it back to a toll-free number.

In the near future, score cards will be created and discussed with providers.

Generally, the percentage of claims requiring additional medical notes for processing is small. When such claims appear, providers are contacted, via letter, when that information is needed. Providers who want to send additional medical notes information should use the NTE Segment of the 2300 Loop in the 837 electronic claim. Providers should NOT send unsolicited medical notes on paper as they cannot be attached to the electronic claim.

The member appeal will take precedence and the provider appeal will be closed. The provider will receive a letter notifying the provider that their case has been closed because the member has filed an appeal.

Direct Senders of electronic transactions will need to do the following:

• Complete a copy of the Blue Cross NC Trading Partner Agreement (TPA), available on the HIPAA information page. You need to complete a TPA even if you do not need to test.
• Return an original copy of the TPA, signed by authorized personnel, to Blue Cross NC EDI Services (see Trading Partner Agreement Instructions online for more details).
• Complete an Electronic Connectivity Request (ECR) form for each type of transaction you want to transmit. These ECR forms are available on the HIPAA information page.

Indirect Senders who transmit electronic transactions to Blue Cross NC via another party (billing service, clearinghouse, or service bureau) will need to do the following:

Complete ECR forms for each type of transaction you want to submit or receive. These ECR forms are available on the HIPAA information page and may be completed and submitted on your behalf by your clearinghouse or service bureau.

The Council for Affordable Quality Healthcare is a not-for-profit collaborative alliance of the nation's leading health plans and networks, including Blue Cross NC. CAQH's mission is the improvement of healthcare access and quality for patients and the reduction of the administrative burden for healthcare providers and their office staff members.

An appeal form is available for most member plan types. Go to the Claims, appeals and inquiries page, find the member's plan type and then select File Appeal. You can find the corresponding appeal form on the plan type Appeals and Inquiries page. 

Yes, both claim status and eligibility information for out-of-state claims and members are available. Blue e transmits your inquiries to the Blue Cross and Blue Shield home plan of your patient and returns their response.