North Carolina State Health Plan PPO
Note: Topics to the right do not apply to State Health Plan. All links for additional State Health Plan information are identified below as you scroll down this page.
The ValueOptions North Carolina Service Center (NCSC) in Research Triangle Park has been part of the mental health and substance abuse services delivery system in North Carolina since 1992.
State Health Plan PPO
Beginning in October 2006, ValueOptions has responsibility to provide utilization review services for the State Health Plan PPO to determine if treatment is medically necessary. ValueOptions will authorize admission and concurrent stays for all mental health and substance abuse admissions for inpatient, substance abuse residential treatment centers, partial hospitalization, and intensive outpatient/structured outpatient treatment programs.
The fax numbers for the State PPO plan are as follows:
- (877) 320-9938 for ITR submissions
- (877) 320-0269 for ORF submissions
Clinical Criteria
- Adult (PDF)
- Child and Adolescent (PDF)
Inpatient
- Child and Adolescent (PDF)
Psychiatric Residential Treatment Centers (ages 18 and younger only)
Substance Abuse Residential Treatment Centers
Medical Necessity determinations are made in accordance with the American Society for Addiction Medicine Criteria.
- Adult (PDF)
- Child and Adolescent (PDF)
Partial Hospital Program
- Adult
- Child and Adolescent
Intensive Outpatient Program (Structured Outpatient)
- Initial Treatment Request Form
- Outpatient Review Form (ORF2)
Authorization Request Forms
Online Services for BCBSNC Providers
(Online services available for contracted behavioral health providers serving members enrolled in the State PPO)
Medical Policies
The Blue Cross Blue Shield of North Carolina medical policies are located on the following link and are updated regularly.
http://www.bcbsnc.com/services/medical-policy/
State Health Plan PPO Benefits Booklet
http://www.shpnc.org/myMedicalBenefits/ppo/default.aspx
Prescription Drug Info
Blue Cross Blue Shield of North Carolina has provided the following link for prescription drugs:
http://www.bcbsnc.com/providers/ppa/prescriptions.cfm
Provider Network Information
BCBS Blue Options Network
(in-state providers contracted with BCBS of NC)
To find NC Providers:
http://www.bcbsnc.com/apps/providers/search.do?searchType=Doctor
Blue Care Network
(out-of-state providers contracted with the national BCBS Association)
To find out of state/out of area providers (Blue Card):
http://www.bcbs.com/healthtravel/finder.html
