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Providers

Commercial appeals and inquiries

   

To ensure Blue Cross NC reviews your appeal or inquiry quickly, please review these instructions for a provider appeal form (PDF) and file appropriately. Submitting an inquiry as an appeal (or vice versa) will cause delays.

  • File an appeal when you are disputing the billing, coding or medical necessity of a claim.
  • File an inquiry when you have a contractual dispute that is not related to billing, coding or medical necessity.

How to file an appeal for commercial claims

Instructions

  1. Within 90 days of claim adjudication date, complete and submit the level I provider commercial appeal form. 
  2. Mail completed appeal form and any supporting documents to:

    Blue Cross NC
    Provider Appeal Department
    PO Box 2291
    Durham, NC 27702

    Or fax the completed form and supporting documents to:

    Billing/coding denials: 919-287-8708
    Medical necessity/administrative denials: 919-287-8709
Level I provider commercial appeal form (PDF)

Contact

Provider Blue Line
800-214-4844
Monday through Thursday 8 a.m. to 5 p.m. ET
Friday 8 a.m. to 4 p.m. ET

How to file an inquiry for commercial claims

Instructions

  1. Complete the provider inquiry form
  2. Mail the completed form to

    Blue Cross NC
    Provider Inquiry Department
    PO Box 2291
    Durham, NC 27702

    Or fax to 866-987-4167
General provider inquiry form (PDF)

Contact

Provider Blue Line
800-214-4844
Monday through Thursday 8 a.m. to 5 p.m. ET
Friday 8 a.m. to 4 p.m. ET