Before you start
If your practice uses Thrizer for out-of-network BCBS claims, an incomplete provider registration can delay claim processing. Use this guide when Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is a required Local / Host Plan for your practice or claim-service location. You are creating a non-participating provider record, not joining the network. Not sure which plan you need? First identify your required Local / Host Plan. The plan on your client’s insurance card is not necessarily the plan where your practice registers. The practice coordinates registration and links its clinicians. Blue Cross NC also requires individual enrollment for clinicians who have never enrolled with it. Adding their NPIs to a group roster alone is not enough. This is a Blue Cross NC requirement, not an instruction for each clinician to establish a separate practice. See its official enrollment FAQ, questions 12–13 and 20–22. Have your practice’s TIN, applicable billing NPI, each clinician’s individual NPI, service-location information, and the documents requested by the application ready. The group form requires a completed W-9 and gives delivery instructions before you can continue.Choose your starting point
The application introductions say Join our network, but the forms also offer out-of-network enrollment. Choose the non-participating options below. Blue Cross NC’s FAQ says non-participating applicants do not need CAQH credentialing just to enroll.
Individual enrollment
1
Open the individual application
Open the Individual Practitioner Enrollment Application and select Get Started.
2
Choose non-participating enrollment
Select Non-participating enrollment request status, then Continue. Do not choose Participating contract request if you intend to remain out of network.
3
Choose solo or group
Under Tax Information, select Solo practitioner not part of a group or Practitioner enrolling with a group. Enter the clinician’s individual NPI in Type I - Practitioner.
- Solo: complete and email the W-9 as directed before checking the W-9 confirmation box.
- Group clinician: check Group already enrolled or group enrollment form has already been submitted only if that statement is true. A submitted group application is not yet an approved enrollment.
4
Complete the application and confirm enrollment
Complete the remaining required fields and document requests using your actual practice information. Review before submitting and keep Blue Cross NC’s confirmation.If the clinician is joining a group, confirm individual enrollment before adding them through the group form. If the group is also new, its enrollment must be in place before the clinician’s enrollment with that group can be processed.
Group enrollment and clinician affiliation
1
Open the group form
Open the Provider Group Enrollment Form and select Get Started. Use this for a new group or to associate already-enrolled clinicians with a group.
2
Follow the W-9 instructions
Read the Tax Information section and send the completed W-9 exactly as the current form directs. Check the confirmation box only after you have actually sent it.
3
Choose out-of-network status
For the group’s contract status, select I want to remain out-of-network. Complete the required practice information and document requests.
4
Associate enrolled clinicians
Include the applicable clinicians and their individual NPIs. Only add clinicians whose individual Blue Cross NC enrollment is confirmed. A list or roster does not replace enrollment for someone new to Blue Cross NC.Review the information before submitting and keep the confirmation. If both the group and its clinicians are new and the form does not let you complete the required sequence, ask Blue Cross NC how to establish the group record first. Do not invent an existing enrollment or submit duplicate applications.