Submission of Medical Records Required Within One Year of the Request Date

Blue Cross and Blue Shield of North Carolina (BCBSNC) is changing the process for claims previously denied and pending supporting medical records from providers. When services and procedures supplied to members require additional documentation to determine medical necessity, BCBSNC will have a one-year submission window, effective December 1, 2016. If medical records are received outside of this one-year submission window, any claims denied and pending receipt of supporting medical records will remain denied, in accordance with prompt pay regulations (G.S. 58-3-225) for the timely filing of supporting medical records.