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 Psychiatric

Clinical Criteria Substance Abuse

Online Services for BCBSNC Providers

(Online services available for contracted behavioral health providers serving members enrolled in the State PPO)

Medical Policies

The medical policies are located on the following link and are updated regularly.
http://www.shpnc.org/myMedicalBenefits/ppo/behavior-hlth-policies.aspx

State Health Plan PPO Benefits Booklet

http://www.shpnc.org/myMedicalBenefits/ppo/default.aspx

Prescription Drug Info

The PBM for the Plan is Express Scripts.

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

Deficit Reduction Act

Fraud and Abuse