Thanks to the efforts of the North Carolina Medical Society (NCMS) and the NC Medical Group Managers (NCMGM), the state’s largest insurer, Blue Cross and Blue Shield of North Carolina recently implemented a new process to help practices know up front whether patients covered by BCBSNC insurance exchange plans are not current in their premium payments and thus in the “grace period” for continued coverage.

In the past, BCBS would not disclose the uncertain status of the patient when a practice checked eligibility, but waited until after the medical services were rendered.  Usually the practice received a paper letter stating the claim was pended due to the patient’s grace period status. It would remain pended until the member got caught up with premium payments (and BCBSNC would pay the claim) or coverage lapsed (and BCBSNC would deny the claim).

Staff from the NCMS and the NCMGM have been working with BCBSNC since last spring to  design this new procedure  when a patient is in the “grace period,” which will disclose this status when a practice checks the eligibility.