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News & Press: Updates for Members

State Health Plan: Clear Pricing Project

Wednesday, June 19, 2019   (0 Comments)
Posted by: Kay Castillo
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State Health Plan: Clear Pricing Project


The State Health Plan is changing how it pays providers for services. These changes are part of The Clear Pricing Project. These changes will take place beginning January 1, 2020, and will only affect members on the 80/20 Plan, the 70/30 Plan and the High Deductible Health Plan.

The goals of the project include reducing costs, increasing transparency, ensuring long term funding of retiree health benefits, and addressing concerns with the high cost of the family plan.

Providers who wish to participate have until July 1, 2019 to return the necessary documentation to be part of the State Health Plan Network. If you miss the July 1 deadline, providers in Blue Options will not have an opportunity to sign up again. If you are not a Blue Options provider and wish to be, you may credential with Blue Cross NC.

Under this project, the State Health Plan will move away from a commercial-based payment model to a reference-based, transparent government-pricing model tied to Medicare rates. Health care providers will be reimbursed for their services at Medicare rates plus a substantial profit. For outpatient behavioral health providers, this could mean an increase in reimbursement rates. Provider rates will be established and are not negotiable. As a result, this will provide consistency for providers across the network.

More information from Blue Cross NC was sent to Providers in May. Click here to view that communication.

You should also have received communication in the mail from the State Health Plan.

Additionally, you may wish to view more information about the Project with FAQs provided at the bottom of this link.

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