BCBS AFFILIATENCPBM: CVS Caremark

Blue Cross Blue Shield of North Carolina Prior Authorization Guide

Submit prior authorization requests and appeal denials with BCBS North Carolina. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for NC providers.

Generate BCBS North Carolina LMN →

Prior Authorization Contacts

PA PHONE

1-800-672-7897

PA FAX

1-919-765-4409

TURNAROUND

30 days standard, 72h expedited

TIMELY FILING

180 days

APPEALS MAILING ADDRESS

BCBS NC, Attn: Appeals Department, PO Box 2291, Durham, NC 27702

Common Denial Reasons

⚠ BCBS NC Medical Policy criteria not met
⚠ Step therapy required
⚠ Non-preferred brand without exception
⚠ Site of care

Step Therapy Requirements & Override Rights

North Carolina Senate Bill 361 (2019) established step therapy override requirements. BCBS NC must respond within 72 hours urgent / 15 days standard. For biologics, typically requires 3-month DMARD trial.

Tips for BCBS North Carolina Submissions

1. NC SB 361 provides step therapy override rights
2. CVS Caremark handles pharmacy benefit
3. Submit via Blue e provider portal
4. Reference BCBS NC Medical Policy number

External Review Authority

If BCBS North Carolina denies your final internal appeal, you have the right to request an external review through: North Carolina Department of Insurance.

External review decisions are binding on the insurer.