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This Pricing Development and Maintenance Policy applies to the calculations of contractual allowances ("fees") for services billed on a CMS-1500, UB-04, or successor claim form to Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
In-network pricing policies
Commercial CMS-1500 pricing policies
Commercial UB-04 pricing policies
Medicare pricing policies
Out of network pricing policies
Fee schedules
Blue Cross NC provides fee schedule information electronically to participating physicians. Providers looking for past allowed fee schedule amounts should contact Network Management. Participating physicians who wish to view a special or supplemental fee schedule can contact Network Management to request a hard copy of the fee schedule.
Professional Commercial CMM, EPO, HMO, POS, and PPO fee schedules
Participating providers filing claims under CMM, EPO, HMO, POS, and PPO lines of business can view their fee schedule in Blue e.
Blue Medicare HMO and Blue Medicare PPO fee schedules
Contact Network Management
Phone: 800-777-1643
Fax: 919-765-4349
Email: ProviderUpdates@bcbsnc.com
Fee Schedules FAQ
If you are unable to determine which name to select, contact your Network Management service representative for assistance.
If you are unable to locate a specific code on your fee schedule, contact your Network Management service representative for assistance.
All BCBSNC participating physicians, physician groups, or physician organizations who are duly licensed by a state licensing board as a medical doctor or as a doctor of osteopathy with Blue e access can view the fee schedule transaction.
Fee schedules are available in Blue e for CMM, HMO, and PPO lines of business.
The fee schedule transaction only displays current fee schedules. If you need information about past allowed amounts please contact your Network Management service representative for assistance.
Contact your Network Management service representative for assistance.
The fee schedule transaction does not allow the user to key in a modifier. If any modifier is associated with any service code it is displayed in the modifier column. The user is not able to view any reduced fee schedule rate. The provider can access Clear Claims Connection for how modifiers effect payment and can also reference the modifier guidelines (PDF).
Yes. Select the option for viewing your full fee schedule. Once the full fee schedule is displayed, select the option to print the document.
If you need to request a special or supplemental fee schedule, contact your Network Management service representative to request a CD or hard copy.
Both fee schedules, facility and non-facility, will be displayed in separate columns. You will need to scroll down to view both fee schedules as one is displayed after the other.
Non-participating physicians do not have an agreed upon contracted fee schedule with BCBSNC at this time.
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.
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