N.C. State Health Plan Network

Any current Blue Cross NC commercial PPO provider who is interested in supporting the Clear Pricing Project (CPP) by participating in the NC State Health Plan Network should complete the contract request form between June 1 and June 30, 2021. 

The contract request form should be completed by the authorized representative for the entity or practice that is contracted with Blue Cross NC for its commercial PPO network.  All provider entities, rosters, and locations associated with your existing Blue Cross NC commercial PPO contracts will be duplicated for participation in the NC State Health Plan Network. In most cases, each entity or practice will only need one contract and signature page.

If you are a provider who is currently participating in the Blue Cross NC commercial PPO network as part of an agreement with Avalon or Health Network Solutions (HNS), Community Care Physicians Network (CCPN), or Carolina Medical Home Network (CMHN), please check with those entities to discuss contracting details.

If you are a provider who is not currently contracted with Blue Cross NC, please read the network and credentialing information available here: https://www.bluecrossnc.com/providers/network-participation/become-blue-cross-nc-provider-recredential.
 

The contract request form should be completed between June 1 and June 30, 2021. 

No, the window to join the NC State Health Plan Network is open for a limited time only – between June 1 and June 30, 2021 – for existing Blue Cross NC commercial PPO providers. We encourage all providers to submit the contract request form in June and complete the contract within 10 days upon receipt. Please be mindful of the deadline and understand that if clarification is needed to process your request, it will take additional time. If clarification is needed, please be prompt with the additional information requested. 

As an existing Blue Cross NC commercial PPO provider, your existing Blue Cross NC commercial PPO contract will remain in place for State Health Plan members until December 31, 2021. On January 1, 2022, your NC State Health Plan Network contract, including the applicable provisions of the reimbursement exhibit and fee schedule, will take effect for State Health Plan members.   As of January 1, 2022, your Blue Cross NC commercial PPO contract will no longer apply for State Health Plan members. However, your current Blue Cross NC commercial PPO contract will continue to apply to all other Blue Cross NC commercial PPO members not covered under the State Health Plan. 

A termination clause is included in the contract which can be found here.

Should you choose to terminate your contract, you will need to provide adequate notice, as stated in the contract. Providers who terminate their NC State Health Plan Network contract are not eligible to re-enroll into the network under their Blue Cross NC commercial PPO contract.

No, Blue Cross NC has streamlined this process and will intake contract requests and issue contracts for signature online only. For this reason, Blue Cross NC is unable to accept contracts or contract requests in any format other than the electronic contract request submission. For more details please visit: https://www.shpnc.org/ncshpprovidernetwork.

The NC State Health Plan Network is a unique network for the State Health Plan only. It does not impact any other Blue Cross NC commercial lines of business or other benefits.  Providers currently participating in the Blue Cross NC commercial PPO network who choose to move to a NC State Health Plan Network contract will continue to see State Health Plan members as in-network under their current Blue Cross NC commercial PPO contracts until December 31, 2021. Providers who decide to participate in the NC State Health Plan Network in 2022 will be reimbursed for services rendered in 2022 and beyond according to the applicable provisions of the NC State Health Plan Network contract reimbursement exhibit and fee schedule.

Questions regarding these items can be submitted via email to: SHPProviderNetwork@nctreasurer.com.

Yes, providers must be credentialed with Blue Cross NC to participate in the NC State Health Plan Network. However, if you are already a credentialed provider in good standing with Blue Cross NC, and are interested in moving to the NC State Health Plan Network contract, please complete a contract request form which can be found here: www.shpnc.org/state-health-plan-clear-pricing-project

If you are not contracted with Blue Cross NC, or are in the process of terminating, you will need to be credentialed to join the North Carolina State Health Plan Network. You can find network participation and credentialing information here: https://www.bluecrossnc.com/providers/network-participation/become-blue-cross-nc-provider-recredential.

We anticipate your contract request will be processed within 1-10 days after submission. Once verified, you will receive an electronic copy of the contract for signature. You must sign the contract within 10 days of receipt in order to receive an executed contract. You can expect to receive a fully executed contract approximately 5 days after signing the NC State Health Plan Network contract via Adobesign.

Please refer to the State Health Plan’s Provider website at: https://www.shpnc.org/ncshpprovidernetwork.

The State Health Plan has determined that contract terms and reimbursement rates are not negotiable. Therefore, neither Blue Cross NC nor the State Health Plan will negotiate terms of the contract, including the reimbursement exhibit and fee schedule, with providers. Providers must agree to the contract terms, including the reimbursement exhibit and fee schedule, as written in order to participate as CPP provider in the NC State Health Plan Network.

If you currently participate in CCPN or CMHN, you do not need to complete the electronic contract request form. Please contact your network administrator to discuss the process to participate in the NC State Health Plan Network under their third-party network contract.

Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com 

Blue Cross NC subcontracts provider network services for chiropractic care to Health Network Solutions (HNS).  Please visit the HNS website at: http://healthnetworksolutions.net for contact information.

The State Health Plan’s current benefit design continues to highlight CPP providers as those who support transparency and affordable health care, while offering members major discounts when visiting a CPP provider. A recent change that was implemented in 2021, includes a $0 copay for a CPP PCP or Behavioral Health Provider office visit. These discounts are likely to encourage members to visit CPP providers with increasing frequency. 

As a current CPP provider, you do not need to take any action during this time.  Your NC State Health Plan Network contract will remain effective for 2022, unless you elect to terminate in accordance with the termination provisions included in the contract.