State Health Plan Clear Pricing Project
Clear Pricing Project and the N.C. State Health Plan Network
The State Health Plan’s Clear Pricing Project (CPP) was developed to secure the Plan’s financial future and to promote quality, accessible health care. The goal is to ensure that members have this valuable benefit for years to come, while bringing transparency to health care expenses and addressing the rising health costs that you and your family face every day.
This effort resulted in more than 28,000 providers partnering with the Plan for transparent and affordable health care. These provider partners are included in the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan’s Clear Pricing Project, and Blue Cross NC’s Blue Options network.
- If you select a Clear Pricing Project provider as your Primary Care Provider listed on your ID card, your visits are free!
- If you visit a CPP behavioral health provider, your visits are free!
- If you visit a Clear Pricing Project specialist, Enhanced PPO Plan (80/20) members will pay only $40 for a CPP specialist ($80 for a non-CPP specialist), and Base PPO Plan (70/30) members will pay $47 for a CPP specialist ($94 for a non-CPP specialist).
Compare the difference and check out the savings!
CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART
Enhanced PPO Plan (80/20)
Base PPO Plan (70/30)
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
|Behavioral Health Provider||
$0 for CPP Provider;
$25 for other Providers
$0 for CPP Provider;
$45 for other Providers
$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
Please note the following:
- The Clear Pricing Project does not affect members on Medicare Advantage plans.
- The NC State Health Plan Network is composed of CPP providers and Blue Options providers. There is an indicator in the Find A Doctor tool that identifies CPP providers. That CPP designation DOES need to be noted in the Find a Doctor tool for the provider to be a CPP Primary Care Provider (PCP).
- Providers joined the CPP at the practice level, so members should be able to see any provider in that listed CPP practice. However, a lot of providers practice at multiple locations and different practices. If members see their CPP PCP at a NON-CPP practice, the member will not receive the $0 copay. Members are encouraged to check with their provider on their CPP status.
- 3/31/2021 – Treasurer Folwell Condemns Hospitals’ “Pattern of Deceit” on Price Transparency
- 3/25/2021 – Treasurer Folwell Thanks Sponsors for Supporting H169 – State Health Plan Data Transparency Bill
- 3/23/2021 – Treasurer Folwell Calls for Support of H169 – State Health Plan Data Transparency Bill
- 1/4/2021 – Treasurer Folwell Applauds U.S. Court Decision on Health-Cost Transparency
- 8/18/2020 – Treasurer Folwell Announces N.C. State Health Plan Network Reopens for New Providers to Join
In The News
- 4/26/2021 – Price Transparency’s Slow Burn
- 4/18/2021 – N.C. Senate passes SHP bill focused on contract limits, coverage extensions
- 4/16/2021 – ‘Scrutinize your medical bills': NC State Treasurer Dale Folwell calling for more billing transparency
- 4/14/2021 – Bill to make medical bill data accessible moves forward
- 4/8/2021 – Some NC hospitals are not complying with federal price transparency rules, state treasurer says
Frequently Asked Questions
As a State Health Plan member, you have access to the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan’s Clear Pricing Project (CPP), and Blue Cross NC’s Blue Options network. CPP providers have agreed to get rid of secret contracts, making health care more affordable and transparent. In an effort to lower health care costs for members and to support CPP providers, the Plan offers significant copay reductions for members who visit a CPP provider. The CPP is applicable to members on the Base PPO Plan (70/30) and Enhanced PPO Plan (80/20).
This does not impact members on the Medicare Advantage plans. This would only be applicable to Medicare-eligible members on the 70/30 Plan.
The CPP is only applicable to North Carolina providers, including Primary Care Provider (PCP) offices, specialist offices, participating hospitals and urgent care facilities. Outside of North Carolina, you would still have access to in-network providers in the Blue Options network.
You can go to any CPP Specialist, Chiropractor, Speech or Occupational Therapist to receive a copay reduction. To qualify for the $0 CPP PCP copay, you must have selected a CPP PCP which appears on your State Health Plan ID card and then see that PCP for your office visit. Here's how to select or update your Primary Care Provider!
You are able select a new provider any time during the year – CPP or non-CPP – by using eBenefits, the Plan’s enrollment system. Here's how to select or update your Primary Care Provider!
To locate a CPP Provider, follow the steps below:
- Visit www.shpnc.org. Click the Find a Doctor link at the top of the home page.
- Scroll down to select your health plan to access your Find a Doctor Tool.
- The Find a Doctor Tool opens. Select the plan type by clicking the Individuals, Families, & Groups button.
- Choose North Carolina State Health Plan in the drop-down box and click Submit.
- Click the Find a Doctor or Facility button.
- From there, you can search by Category or by Name.
- CPP providers will say “Clear Pricing Project Provider” next to their name. Note: You cannot specifically search for a CPP provider by that designation.
You can change your provider anytime throughout the benefit year, so you will be able to select another provider. You can also research a new provider by using the Find a Doctor tool or contacting the provider’s office to see if they are accepting new patients.
CPP providers and specialists within a practice joined the CPP via the practice level. This means you can see any provider within that practice and still have the copay reduction. Please note that the address is very important. When selecting your provider, make sure you intend to see the provider at the address reflected for that provider. Not all practices that your provider may be affiliated with joined the CPP.
This does not impact your pharmacy benefits with the State Health Plan.
No. There can only be one provider reflected on your ID card as your PCP.
No. As long as the provider is part of the Blue Options network, provider will not be considered out-of-network. You will have the normal copayment applied. For emergency situations, service at the nearest hospital would be processed at an in-network benefit.
If your provider didn’t sign on to the Clear Pricing Project, they are still considered in-network for the benefit year, if they are currently in the Blue Options network, but the CPP copay reductions would not apply.
Using a CPP provider will lower your out-of-pocket amount for your copayment, which is applied to your out-of-pocket maximum, but it does not impact your deductible.