Blue Cross NC Behavioral Health Billing: Credentialing, Claims and Prompt Pay

Blue Cross NC behavioral health billing runs on its own rules. Blue Cross and Blue Shield of North Carolina is an independent Blue Cross licensee. It is not Anthem, and what you learned from another Blue plan will not carry over. This guide to Blue Cross NC behavioral health billing covers how North Carolina therapists and psychiatrists get credentialed, submit claims, bill telehealth, and use North Carolina’s prompt-pay law. It covers Blue Cross NC only. Sources were checked on October 9, 2026.

Blue Cross NC is its own plan

Our Blue Cross NC billing guide says Blue Cross NC is an independent licensee, not Anthem. Our Anthem Blue Cross guide covers different states and a different company. Keep them apart. Payer numbers for all North Carolina insurers are in the North Carolina insurance contact guide, and the full list of payers we cover is in our private insurance guides.

Blue Cross NC also brought behavioral health management in house. Provider news from 2021 said that starting January 1, 2022, Blue Cross NC would take over behavioral health intensive case management and utilization management from Beacon. Providers request prior plan authorization (PPA) from Blue Cross NC instead of Beacon. The article names Blue e as the authorization portal.

How do I get credentialed with Blue Cross NC?

Register with CAQH, keep your profile current, and email your CAQH ID to Blue Cross NC’s credentialing team. Then submit the Individual Practitioner Enrollment form. Blue Cross NC’s individual practitioners page describes the path:

1. Complete and attest your profile in the CAQH Provider Data Portal.
2. Email your CAQH ID to .
3. Submit the Individual Practitioner Enrollment form.
4. After credentialing is confirmed, register for the Blue e provider portal and sign up for electronic funds transfer.
5. Receive your Network Participation Agreement.

Recredentialing starts as your cycle nears its end. Keep your CAQH profile complete and your attestation current, and report changes in practice information. The page does not cover behavioral health credentialing separately. For a plain-English walk-through, read our CAQH profile setup post, the credentialing page and the credentialing and network status guide.

Submitting claims to Blue Cross NC

Blue Cross NC’s commercial claims page lists three ways to submit:

• Blue e digital forms. Complete the CMS-1500 online.
• Electronic data interchange (EDI). Submit as a trading partner or through a clearinghouse.
• Paper. Mail forms to PO Box 35, Durham, NC 27702, with the member’s Blue Cross NC ID on every claim and attachment.

Appeals go through Blue e and the Care Affiliate portal, or by mail or fax with the Provider Coding Dispute Form or the Provider Commercial Appeal Form. The page separates billing and coding disputes from medical necessity and administrative denials, with different fax numbers. The page does not list the payer ID, timely filing limit or appeal deadline, so confirm those in your contract. Our denied claims service page covers follow-up, and our authorization glossary defines the terms.

Telehealth in Blue Cross NC behavioral health billing

Blue Cross NC’s telehealth policy for 2023 took effect January 1, 2023. Key points:

• Use place of service (POS) 02 for telehealth outside the patient’s home and POS 10 for telehealth in the patient’s home.
• Telehealth must be billed on professional claims. Facilities cannot bill it.
• Non-facility rates apply. Audio-only services are reimbursed at 75% of the allowed amount.
• The policy applies to commercial fully insured and ASO plans, including the State Health Plan, but not to care by providers outside North Carolina at the time of care.
• Claims need the modifier that fits the type of telehealth. The page points to the corporate reimbursement policy for codes.

Our guide to telehealth modifiers 93 and 95 explains the difference between audio-only and video modifiers. Check the current policy before you rely on a 2023 page.

North Carolina’s prompt-pay law

North Carolina General Statute 58-3-225 sets the clock for insurers:

• Notice in 30 days. Within 30 calendar days of receiving a claim, the insurer must pay it, deny it with specific reasons, or ask for more information.
• Undisputed amounts. Pay the undisputed part of a contested claim within 30 days.
• Missing information. If requested information does not arrive within 90 days, the insurer must deny the claim. You can reopen it by sending the information within one year of the denial notice.
• Interest. Late payments accrue interest at 18% per year.
• Filing window. Insurers may require claims within 180 days after care, and cannot set a shorter period. A late claim stays valid if on-time filing was not reasonably possible and it is filed no later than one year after the normal deadline.
• Status reports. If a claim is not paid or denied within 60 days, the insurer must send a claim status report, repeated every 30 days.

Delays caused by the claimant or by events beyond the insurer’s control are excused. Keep a log of submission dates and confirmations so you can show when the clock started. See also the claim denial terms.

A Blue Cross NC behavioral health billing checklist

Use this list to keep Blue Cross NC behavioral health billing on track.

1. Update CAQH and re-attest.
2. Email your CAQH ID and submit the enrollment form.
3. Register for Blue e and set up EFT.
4. Use POS 02 or 10 and the right modifier on telehealth.
5. Request PPA through Blue e when a service needs it.
6. Log every claim and follow up at day 30.

Weighing whether to join? Read credentialed or noncredentialed with insurance. MCM South also bills out-of-network claims for clients.

Blue Cross NC behavioral health billing FAQ

Short answers on Blue Cross NC behavioral health billing follow.

Is Blue Cross NC the same as Anthem?

No. It is an independent licensee. Our Blue guides treat each licensee separately.

What do I email Blue Cross NC to start credentialing?

Your CAQH ID, sent to , per the individual practitioners page.

Is audio-only therapy paid at full rate?

Under the 2023 telehealth policy, audio-only services are reimbursed at 75% of the allowed amount. Confirm the current policy.

How long can an insurer take to respond in North Carolina?

Thirty calendar days to pay, deny with reasons, or request information, under G.S. 58-3-225.

Where MCM South Medical Billing Service Works

MCM South Medical Billing Service works with mental and behavioral health practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims. If you run a North Carolina practice and want help with Blue Cross NC billing, you can request a free consultation.