The North Carolina Medical Society (NCMS) has been closely monitoring the claims problems members have been having with Blue Cross and Blue Shield of North Carolina (BCBSNC), meeting with BCBSNC representatives to better understand the issues and how the insurer is working to resolve the issues. BCBSNC reports they are making progress in processing individual member claims that were delayed due to difficulties with their new technology platform.  As of June 2, claims for Affordable Care Act plans are processing normally, they said. They were hopeful that claims for their ‘grandfathered products’ would be released in early June.
Currently, more than 94 percent of all claims are processing normally, BCBSNC reports. Less than 6 percent of all claims are currently being held.
By mid-July, they expect to be current in processing new and first submission claims, as well as claims that normally suspend for additional review, manual intervention or may require medical records.
With the high volume of claims currently moving through the claims processing system, you may see an increase in claims activity during this month.
BCBSNC also advised that as you receive and reconcile claims payments, please check to see if you need to refund any advance payments you may have received from your BCBSNC patients as you waited for the claims to be processed.
Doctors facing financial hardship because of this delay should contact BCBSNC directly. They have a team in place to guide these requests for individual review and consideration. For more information about this process, please see the details and contact information.
If you need to check the status of a claim, please use Blue eSM to determine if they have received the claim in question.  Any status that shows the claim is in the system is a reliable means of confirming that they have received it.  If the claim has not yet been paid, that is an indicator that the claim is being held.  You may also call the Provider Blue LineSM at 1-800-214-4844 for claims assistance.
This issue affects claims related to services for individual (under age 65) members, which constitutes a limited percentage of all claims.  Please do not submit duplicate claims, as this will increase their inventory and potentially delay processing time.