{"reporting_entity_name":"Blue Cross Blue Shield of North Carolina","reporting_entity_type":"Health Insurance Issuer","plan_name":"Blue Home Bronze 7000 with Novant Health","plan_id_type":"HIOS","plan_id":"11512NC0400021","plan_market_type":"Individual","last_updated_on":"2026-10-17","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":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1063088326,1063731453,1073580973,1154346898,1245349497,1265451918,1306363973,1306904255,1326242611,1346655578,1356030316,1437484581,1457381600,1477949915,1538182043,1548223027,1548497381,1558987552,1568800811,1578067468,1578905154,1588127328,1598029704,1609836253,1639332182,1639397680,1659803930,1669812806,1720377989,1760846877,1801115878,1811967771,1881900595,1972529279,1992231591,1992732507]}]}]},{"tin":[{"type":"ein","value":"26-0683186"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1245231430]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1558110361]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1477515351,1518674290,1609412998,1639633456,1750759833]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1376013706,1528453388,1568519411]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093306433,1124046420,1144554395,1376070342,1386962876,1568494359,1598261703]}]}]}]},{"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":[1063088326,1063731453,1073580973,1154346898,1245349497,1265451918,1306363973,1306904255,1326242611,1346655578,1356030316,1437484581,1457381600,1477949915,1538182043,1548223027,1548497381,1558987552,1568800811,1578067468,1578905154,1588127328,1598029704,1609836253,1639332182,1639397680,1659803930,1669812806,1720377989,1760846877,1801115878,1811967771,1881900595,1972529279,1992231591,1992732507]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1477515351,1518674290,1609412998,1639633456,1750759833]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1376013706,1528453388,1568519411]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1558110361]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093306433,1124046420,1144554395,1376070342,1386962876,1568494359,1598261703]}]}]}]},{"name":"Syst Bp Ge 130 - 139Mm Hg","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3074F","description":"Syst Bp Ge 130 - 139Mm Hg","allowed_amounts":[{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528453388]}]}]},{"tin":[{"type":"ein","value":"56-2153034"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1720075955]}]}]},{"tin":[{"type":"ein","value":"56-1976679"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1285612374]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1477515351,1518674290,1609412998,1639633456,1750759833]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1144554395,1386962876,1568494359,1598261703]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1063731453,1073580973,1154346898,1245349497,1306012679,1306363973,1306904255,1346655578,1356030316,1437484581,1457381600,1518394527,1548223027,1568800811,1578067468,1578905154,1588127328,1639332182,1639397680,1659803930,1669812806,1720377989,1760846877,1801115878,1811967771,1972529279,1992732507]}]}]},{"tin":[{"type":"ein","value":"56-1479712"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1801275706]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1558110361]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1407627037]}]}]},{"tin":[{"type":"ein","value":"58-2003803"}],"service_code":["50"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104813625]}]}]}]},{"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":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1063088326,1063731453,1073580973,1154346898,1245349497,1306012679,1306904255,1326242611,1346655578,1356030316,1437484581,1457381600,1477949915,1538182043,1548497381,1578067468,1578905154,1588127328,1598029704,1609836253,1639332182,1659803930,1700046547,1760846877,1801115878,1811967771,1972529279,1992231591,1992732507]}]}]},{"tin":[{"type":"ein","value":"26-0683186"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1245231430]}]}]},{"tin":[{"type":"ein","value":"58-2003803"}],"service_code":["50"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104813625]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1407627037]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093306433,1144554395,1376070342,1568494359,1598261703]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1477515351,1518674290,1750759833]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528453388]}]}]}]},{"name":"Diast Bp  90 Mm Hg","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3079F","description":"Diast Bp  90 Mm Hg","allowed_amounts":[{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073580973,1154346898,1265451918,1306904255,1326242611,1538182043,1588127328,1609836253,1639397680,1972529279,1992231591]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1477515351,1609412998]}]}]},{"tin":[{"type":"ein","value":"56-1976679"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1285612374]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1407391733]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093306433,1376070342]}]}]}]},{"name":"Diast Bp 80-89 Mm Hg","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3078F","description":"Diast Bp 80-89 Mm Hg","allowed_amounts":[{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528453388]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1407627037]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1144554395,1386962876,1568494359,1598261703]}]}]},{"tin":[{"type":"ein","value":"58-2003803"}],"service_code":["50"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1104813625]}]}]},{"tin":[{"type":"ein","value":"56-2153034"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1720075955]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1518674290,1639633456,1750759833]}]}]},{"tin":[{"type":"ein","value":"56-1479712"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1801275706]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1063731453,1245349497,1306012679,1306363973,1346655578,1356030316,1437484581,1457381600,1518394527,1548223027,1548497381,1568800811,1578067468,1578905154,1588127328,1639332182,1659803930,1669812806,1720377989,1760846877,1811967771,1992732507]}]}]}]}]}