BCBSNC - Blue Cross Blue Shield North Carolina (Prime Partnership) - General Information

Landing Page:    www.vida.com/bluecrossnc

During enrollment please select BlueCross BlueShield of North Carolina

• How does an AOM transition member get to a Vida Medical Provider?
  • Submit Lab requirements
  • Submit Medical record requirements
  • Complete Contact Form
  • RD session is bypassed in group MWL 

• VP Card: Use this for administrative and operational checks. It covers Account Eligibility , program details,  and exclusions

• Devices: Use  Standard Device Criteria or Clinical Device FAQs Vendor Transition members DO NOT automatically receive a device form

• Prescribing Overview: Use this for clinical inquiries. It houses all Pharmacy Benefits information, including Drug Coverage , formularies, and specific GLP-1 details 

Use Case 3: Sole provider (TIER 3 MWL ONLY)

• Drug list
  • No Formulary
• Grandfathering: Yes, ask members to call Prime to figure out the expiration date.
• PA expiration date or 90-day transition, whichever is later
  • If someone is calling saying their PA is expiring, ensure that they enroll in Vida and see a VMP. 
  • Ask are they currently on a GLP-1.
    • If yes, they need to be enrolled in Vida to avoid gaps in scripts
      • Full reassessment, no guarantee.

    • When discussing options with members please refrain from saying grace period. You can say 
      
      "The plan reviewed all authorizations set to expire early this year and decided to extend the expiration dates. Yours has been updated to remain active until March 31st."

    • Key Reminder for Agents:
       
    • Don't Say: "You are in a grace period."
    • Do Say: "The plan extended the date."
• Gold-carded: Yes

Additional Info

• What segment is this org in?
  • Partnership through Prime
• Are there any Fees at risk (FAR) org?
  • Yes (No support related PGs)
• When did we launch with this org?
  • (varies by paying org)
• How is the service being paid for?
  • Vida is available at no cost to employees 
• How do members enroll?
  • Vida App, VSC outreach campaign.
• Where should non-eligible members be directed?
  • If attempting enrollment and member is not eligible, it's likely due to a health condition that falls under the exclusion criteria for the program. Apologize for the inconvenience and please let them know that they did not meet the clinical criteria for enrollment. They do not need to be directed to their benefits team.
• Who is eligible?
  • Vida is available at no additional cost to eligible Blue Cross NC members and their covered dependents who are at least 18 years or older. Some plan exclusions apply.
• Is the org on the eligibility file?
  • Yes
• How often will eligibility terminations take place?
  • Eligibility files will be sent daily
    • Will follow our standard termination process
• Do we offer Phone and/or Email support?
  • Phone + email
• Is VSC outreach involved?
  • Yes