Individual Member Claim Processing Update as of May 5

After suspending claims in February, Blue Cross and Blue Shield of North Carolina (BCBSNC) began processing claims again for their individual members in the middle of April.  Claims for these members, which were suspended in Facets (their new technology platform) are being processed in waves, as system configuration challenges are addressed.  BCBSNC anticipate the large majority of these now-suspended claims will have paid or be scheduled for payment by May 27.  However, they also expect that a portion of these claims will require additional manual intervention for the review of information normally not determined during automated claims processing.  This includes determinations of medical necessity and, as normal, they will pend claims for subsidy-eligible members who are in their grace period, until their premium is paid or the grace period expires and coverage is terminated.  Any additional manual intervention of these suspended claims in Facets should be completed as of mid-July, by which time they expect to be current with their claims inventory and return to normalized processing for new submission claims.