NC State Health Plan Network

Clear Pricing Project Update

The North Carolina State Health Plan (Plan) would like to extend its sincere gratitude to the organizations that were supportive of the Clear Pricing Project by joining the new NC State Health Plan Network. The Clear Pricing Project’s main goal was to create a fair and transparent network for our members while preserving and protecting the Plan’s financial sustainability.

The Plan is looking forward to working with the organizations that signed on to the Clear Pricing Project regarding future opportunities in alternative payment arrangements as well as other outcome and evidence-based programs.

In order to provide members with access to an adequate number of in-network hospitals, the Plan has decided to offer members a network that includes a combination of both the NC State Health Plan Network and Blue Cross NC’s Blue Options PPO Network.

If you agreed to join the NC State Health Plan Network and submitted your signature page for processing, you will be reimbursed at the rates outlined in that contract beginning with services provided on January 1, 2020 and after.

Since this approach is different than what was anticipated at the time that you signed the contract for the NC State Health Plan Network, the Plan would like to give your organization the opportunity to withdraw your signature page and go back to the rates that your organization negotiated with Blue Cross NC as part of their Blue Options PPO Network. It will be up to your organization to decide which option is best for you.

If you decide to stay in the Clear Pricing Project structure, Blue Cross NC will execute the signature page, at which point the contract will become binding for the period January 1, 2020, to December 31, 2020. After this initial one-year period, you may choose to leave the NC State Health Plan Network with 180 days’ notice.

If your organization would like to rescind its signature page and move back to the Blue Options PPO Network rates that you negotiated with Blue Cross NC, please send an email indicating you would like to rescind your participation and attach the signature page you previously submitted to by August 15, 2019 at midnight.

If you would like to stay in the NC State Health Plan Network at the rates outlined in this contract you do not need to take any action.

If your email indicating your decision to rescind the signature page is not received by August 15, 2019 at midnight, you will remain in the NC State Health Plan Network, effective January 1, 2020.

All reimbursement rates and contract information for the NC State Health Plan Network is available at:

HIE Update

  • House Bill 70 has passed and has been signed by the Governor.
  • NC HIEA will be working to process all agreements received and notify all providers of their status, then the NC HIEA will begin notifying Blue Cross NC of providers who are non-compliant. Blue Cross NC will then reject claims from non-compliant providers for services provided to State Health Plan members.
  • The State Health Plan values the providers who serve North Carolina Teachers, State Employees and Retirees and wants to support providers in their effort to connect to the HIE. We look forward to working with you in the coming months as we implement the requirements of the law.
  • HIE Provider FAQs