{"reporting_entity_name":"Blue Cross Blue Shield of North Carolina","reporting_entity_type":"Health Insurance Issuer","plan_name":"Blue Home Silver Standard 5800 with Novant Health","plan_id_type":"HIOS","plan_id":"11512NC0400017","plan_market_type":"Individual","last_updated_on":"2026-08-17","version":"2.0.0","out_of_network":[{"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":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1083684385,1548473804,1659733186]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1083119275,1285332155,1306259700,1306860580,1346739927,1376079483,1417174616,1518202068,1518317056,1528403433,1548497381,1548765290,1578015871,1578857975,1669808234,1689056236,1760416150,1861013112,1881221349,1952722969]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1699157933]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1821231077]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1134558083,1528455888,1679129639,1932742855]}]}]}]},{"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":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1699157933]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1083119275,1285332155,1306259700,1306860580,1346739927,1376079483,1417174616,1518202068,1518317056,1528403433,1548497381,1548765290,1578015871,1578857975,1669808234,1689056236,1760416150,1861013112,1881221349,1952722969]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1083684385,1548473804,1659733186]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1821231077]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1134558083,1528455888,1679129639,1932742855]}]}]}]},{"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":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528455888,1679129639,1932742855]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1821231077]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1306259700,1306860580,1346739927,1376079483,1417174616,1518202068,1518317056,1528403433,1548765290,1578857975,1689056236,1861013112,1952722969]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1699157933]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1083684385,1659733186]}]}]}]}]}