NC State Health Plan Network

The State Health Plan (Plan) would like to extend its sincere gratitude to the organizations that continue to support the Clear Pricing Project (CPP) by being a part of the NC State Health Plan Network. The main goal of the Clear Pricing Project is to provide a fair and transparent network for our members while preserving and protecting the Plan’s financial sustainability.

The Plan recently announced that it will be reopening the NC State Health Plan Network for new medical providers to join. Medical providers will have from September 15 to October 15, 2020, to sign up. Providers who join will be included in the network effective January 1, 2021.

If you are currently a CPP provider in the NC State Health Plan Network, you DO NOT need to take any action during this sign up period.

The Plan’s Board of Trustees approved 2021 benefit changes that highlight CPP providers as those who support transparency and affordable health care, while offering members major discounts when visiting a CPP provider. These discounts are likely to encourage members to visit CPP providers with increasing frequency. If you are a provider who has not yet joined the CPP team, now may be a perfect opportunity.

CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART

Provider

80/20 Plan

70/30 Plan

Primary Care Provider (PCP)

$0 for Clear Pricing Project (CPP) PCP on ID card;

$10 for non-CPP PCP on ID card;

$25 for any other PCP

$0 for Clear Pricing Project (CPP) PCP on ID card;  

$30 for non-CPP PCP on ID card;

$45 for any other PCP

Specialist

$40 for CPP Specialist;

$80 for other Specialists

$47 for CPP Specialist;

$94 for other Specialists

Speech, Occupational, Chiropractor and Physical Therapy

$26 for CPP Providers;

$52 for other Providers

$36 for CPP Providers;

$72 for other Providers

For questions regarding your contract, please call Blue Cross NC Provider Relations at 800-777-1643. All other questions can be sent via email to SHPProviderNetwork@nctreasurer.com.

Providers who currently do not participate in Blue Cross NC’s commercial PPO network (brand new providers) are able to join the NC State Health Plan Network by completing the necessary pre-requisite steps outlined here. After you complete the pre-requisites steps, you will receive the option to sign a CPP contract. These providers are not subject to the 10/15 deadline for consideration.

Provider FAQs

Who should complete the NC State Health Plan Network contract request form?

Who should complete the NC State Health Plan Network contract request form?

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 Sept. 15 – Oct. 15, 2020.

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

 

When should I complete the NC State Health Plan Network contract request form?

When should I complete the NC State Health Plan Network contract request form?

The contract request form should be completed between Sept. 15 – Oct. 15, 2020.

Will I be able to complete my NC State Health Plan Network contract request form after Oct. 15, 2020?

Will I be able to complete my NC State Health Plan Network contract request form after Oct. 15, 2020?

No, the window to join the NC State Health Plan Network is open for a limited time only - between Sept. 15 – Oct. 15, 2020 - for existing Blue Cross NC commercial PPO providers. We encourage all providers to submit the contract request form in September 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.

When will my NC State Health Plan Network contract be effective?

When will my NC State Health Plan Network contract be effective?

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, 2020. On January 1, 2021, 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, 2021, 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.

If I later decide I do not want to continue seeing State Health Plan members under the NC State Health Plan Network contract, how do I terminate it?

If I later decide I do not want to continue seeing State Health Plan members under the NC State Health Plan Network contract, how do I terminate it?

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.

Can I fax, email, or mail my contract interest form or my contract to Blue Cross NC?

Can I fax, email, or mail my contract interest form or my contract to Blue Cross NC?

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.

How does this impact my Blue Cross NC commercial PPO contract?

How does this impact my Blue Cross NC commercial PPO contract?

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. Pricing within the NC State Health Plan Network was effective January 1, 2020, for providers who joined during the last open window. 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, 2020. Providers who decide to participate in the NC State Health Plan Network in 2021 will be reimbursed for services rendered in 2021 and beyond according to the applicable provisions of the NC State Health Plan Network contract reimbursement exhibit and fee schedule.

If I have questions about the fee schedule or the reimbursement exhibit, who do I contact?

If I have questions about the fee schedule or the reimbursement exhibit, who do I contact?

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

Do I need to be credentialed with Blue Cross NC to participate in the NC State Health Plan Network?

Do I need to be credentialed with Blue Cross NC to participate in the NC State Health Plan Network?

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.

When will my North Carolina State Health Plan Network contract be fully executed?

When will my North Carolina State Health Plan Network contract be fully executed?

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.

Where do I find information about the methodology used for the reimbursement exhibit?

Where do I find information about the methodology used for the reimbursement exhibit?

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

How do I negotiate the reimbursement exhibit?

How do I negotiate the reimbursement exhibit?

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.

I am currently participating in Community Care Physicians Network (CCPN) or Carolina Medical Home Network (CMHN). How do I join the NC State Health Plan Network?

I am currently participating in Community Care Physicians Network (CCPN) or Carolina Medical Home Network (CMHN). How do I join 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.

I am currently an out-of-network Reference Laboratory. How do I join the NC State Health Plan Network?

I am currently an out-of-network Reference Laboratory. How do I join the NC State Health Plan Network?

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

I am currently an out-of-network Chiropractor. How do I join the NC State Health Plan Network?

I am currently an out-of-network Chiropractor. How do I join the NC State Health Plan Network?

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

Have there been any benefit changes for State Health Plan members regarding providers in the NC State Health Plan Network?

Have there been any benefit changes for State Health Plan members regarding providers in the NC State Health Plan Network?

The Plan’s Board of Trustees approved 2021 benefit changes that highlight CPP providers as those who support transparency and affordable health care, while offering members major discounts when visiting a CPP provider. These discounts are likely to encourage members to visit CPP providers with increasing frequency.

CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART

Changes Effective January 1, 2021

Provider

80/20 Plan

70/30 Plan

Primary Care Provider (PCP)

$0 for Clear Pricing Project (CPP) PCP on ID card;

$10 for non-CPP PCP on ID card;

$25 for any other PCP

$0 for Clear Pricing Project (CPP) PCP on ID card;  

$30 for non-CPP PCP on ID card;

$45 for any other PCP

Specialist

$40 for CPP Specialist;

$80 for other Specialists

$47 for CPP Specialist;

$94 for other Specialists

Speech, Occupational, Chiropractor and Physical Therapy

$26 for CPP Providers;

$52 for other Providers

$36 for CPP Providers;

$72 for other Providers

I am currently a CPP Provider participating in the NC State Health Plan Network, do I need to take any action?

I am currently a CPP Provider participating in the NC State Health Plan Network, do I need to take any action?

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 2021 unless you elect to terminate in accordance with the termination provisions included in the contract.