{"reporting_entity_name":"Blue Cross Blue Shield of North Carolina","reporting_entity_type":"Health Insurance Issuer","plan_name":"Blue Home Gold 1800 with Novant Health","plan_id_type":"HIOS","plan_id":"11512NC0400001","plan_market_type":"Individual","last_updated_on":"2026-06-17","version":"2.0.0","out_of_network":[{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"1160F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1801115878]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1215914080]}]}]}]},{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"1159F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073519385,1104263946,1215137831,1235158866,1558385062,1578067468,1598970840,1609836253,1639332182,1861806945]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104898170,1124048863,1265578074,1437566718,1467558924,1508395740]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104115682,1700507175]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1588056303]}]}]}]},{"name":"Lipid Panel Doc Rev","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3008F","description":"Lipid Panel Doc Rev","allowed_amounts":[{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104898170,1265578074,1437566718,1508395740]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1700460276]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104115682,1144245333,1700507175]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073519385,1104263946,1326228214,1407472699,1558385062,1578067468,1598970840,1609836253,1639359276]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1588056303]}]}]}]},{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"1160F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104115682,1700507175]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104898170,1124048863,1265578074,1437566718,1467558924,1508395740]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1588056303]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073519385,1104263946,1215137831,1235158866,1558385062,1578067468,1598970840,1609836253,1639332182,1861806945]}]}]}]},{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"1159F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1215914080]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1801115878]}]}]}]},{"name":"Lipid Panel Doc Rev","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"3008F","description":"Lipid Panel Doc Rev","allowed_amounts":[{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1801115878]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1215914080,1841782562]}]}]}]}]}