Question 1

How do I submit a medical claim form?

Accepted Answer

BCBSND providers will file claims on your behalf. If you receive care outside of the BCBSND doctor network and need to file your own claim, use the Member Submitted Claim form.

Question 2

What options do I have to pay my bill?

Accepted Answer

Online: Pay your bill on the online Member Services portal. Choose the Pay Premium link.

By phone: Follow the payment and billing prompts on the automated phone system at 844-363-8457.

Question 3

How do I read my EOB?

Accepted Answer

Read the "Making Sense of Your EOB" article here .

Question 4

Is my EOB a bill?

Accepted Answer

No. It details how your claim was processed—the portion of the charge paid by BCBSND on your behalf and the portion that is your responsibility. The bill for your portion comes from your provider.

Question 5

How do I change my password?

Accepted Answer

Once logged in to online Member Services, go to Account Settings and follow the prompts to change your password.

Question 6

I forgot my username. How can I retrieve it?

Accepted Answer

Access the forgot password page and follow the prompts for information. Be sure to have your member identification information available.

Question 7

I forgot my password. How can I reset it?

Accepted Answer

Access the forgot password page and follow the prompts for information. Be sure to have your member identification information available.

Question 8

How can I change the security questions tied to my online Member Services account?

Accepted Answer

Once logged in to online Member Services, go to Account Settings and follow the prompts to change your security questions.

Question 9

Can I access online Member Services after my plan is cancelled?

Accepted Answer

No. Access to online Member Services is available only while your BCBSND health insurance plan is active. You can call us to help you with any questions.

Question 10

What is a deductible?

Accepted Answer

Your deductible is the amount you owe for health care services before your insurance begins to contribute. After you have met your deductible, you and your insurance company will share the cost of covered services.

Check out this article to learn more about health insurance terminology.

Question 11

What is a copay?

Accepted Answer

It’s a specified amount you pay for each covered health care service—things like prescription refills, physical therapy appointments or a visit to the emergency room. Providers may request payment of the copayment amount at the time of service.

Check out this article to learn more about health insurance terminology.

Question 12

What is coinsurance?

Accepted Answer

Some of the services covered by your plan may require that you pay a percentage of the cost (coinsurance) instead of a set fee (copay). In most situations, your deductible must be met before coinsurance will apply.

Check out this article to learn more about health insurance terminology.

Question 13

What is an out-of-pocket maximum?

Accepted Answer

There’s an upper limit to what you’ll contribute each year known as your out-of-pocket-maximum. After you’ve met that amount, your health insurance policy will pay 100% of the allowed amounts on your behalf.

Check out this article to learn more about health insurance terminology.

Question 14

How do I get an approved referral?

Accepted Answer

A BCBSND provider requests authorization for you to receive care from a provider who is not part of your chosen network. You will need to work with your provider to initiate the referral process.

Question 15

What services require precertification?

Accepted Answer

Check the listing of services that require precertification.

Question 16

Where do I find BCBSND medical policies?

Accepted Answer

Find medical policies here.

Question 17

Where do I find forms?

Accepted Answer

Find common forms here.

Question 18

What is an appeal, and how can an appeal be submitted?

Accepted Answer

When you disagree with the claim determination you can submit an official inquiry.

There are two major types of appeals—preservice or post service. An appeal can be verbal or written.

Verbal appeals: call 844-363-8457

Written appeal: use this form and mail or fax to:

Fax: 701-277-2209
Mail: Blue Cross Blue Shield of North Dakota, P.O. Box 1570, Fargo, ND 58107-1570

Question 19

What is the difference between formulary and nonformulary drugs?

Accepted Answer

The formulary is a list of drugs proven to be safe, therapeutically effective, high quality and cost effective, as determined by a committee of physicians and pharmacists. Formulary drugs are covered at the highest benefit level.

A non-formulary drug is a drug that is not included on the formulary listing.

Question 20

What is the difference between brand name and generic drugs?

Accepted Answer

A brand name drug is the registered trademark name given to a prescription medication by its manufacturer. Generics are lower-cost alternatives developed after the original drug’s patent has ended. Brand name and generics are the same in dosage, safety, effectiveness, strength, stability, quality and delivery system.

Question 21

How do I submit a pharmacy claim?

Accepted Answer

BCBSND participating pharmacies will submit medication claims on your behalf. For medications purchased outside the network, complete a Pharmacy Member Submitted Claim form.

Question 22

When is open enrollment?

Accepted Answer

Open enrollment for the upcoming year is typically from early November through mid-December. Outside of the open enrollment period, enrollment is limited to those with special life circumstances.

Question 23

What is the Advanced Premium Tax Credit?

Accepted Answer

Some households qualify for Advanced Premium Tax Credits to help pay the monthly insurance premium. See if you qualify.

Question 24

What is a high deductible health plan?

Accepted Answer

With a high deductible health plan, also known as a consumer directed plan, you pay a lower monthly premium cost, but more for your medical costs, at least until you’ve met your deductible.

With a high deductible plan, you pay for your care until you meet your deductible. Most often, people pay those expenses from a special tax-free savings account called an HSA. Once you meet your deductible, the insurance plan kicks in and shares the cost.

The exception is preventive services and wellness benefits, which are covered from the start, with no copays.

Question 25

How do I access HealthyBlue online wellness center?

Accepted Answer

Log in to the online Member Services portal and choose the wellness tab. After you complete the annual Authorization for Release of Information - Wellness Programs, you’ll have access to HealthyBlue anytime, 24/7.

Learn more about how you can use HealthyBlue

Question 26

What should I do if I don’t receive the HealthyBlue cash card I redeemed?

Accepted Answer

Call the number on the back of your BCBSND member ID card if you’ve not received your cash card after three weeks after redemption.

Question 27

How do I sign up for Health Club Credit (HCC)?

Accepted Answer

Present your BCBSND card to a participating health club and fill out the enrollment form. Learn more about setting up and using HCC.

Question 28

What should I do if I don’t receive my HCC points?

Accepted Answer

Check with your health club or online at nihcarewards.org.

Common reasons for not receiving your credit include misspelled names, incorrect date of birth, failure to meet minimum visit criteria and no completed authorization on file.

Question 29

How do I prove to my club that I am eligible for SilverSneakers?

Accepted Answer

Visit www.silversneakers.com to check your eligibility and print your SilverSneakers member ID. If the site doesn’t recognize you, call the number on the back of your BCBSND member ID card.

Please note: The earliest the SilverSneakers site will recognize newly eligible members is the first Friday after your health plan coverage is effective.

Question 30

What plans are available?

Accepted Answer

There are many options. Please consult with a BCBSND agent on what is available for your business. Plans will differ based on size of employer and what risk the employer is willing to take.

Question 31

How much of the premium do I, the employer, need to pay?

Accepted Answer

Employers must pay at least 50% of the employee only premium.

Question 32

Can I offer this plan to only some of my employees?

Accepted Answer

Employers must offer the same benefits to employees within the same class.

Question 33

How quickly can I set up a plan for my employees?

Accepted Answer

We can set up coverage on the first of any month. In order to provide the best customer experience, we advise a 30 day window for implementation of employer group coverage.

Question 34

How do I submit an appeal?

Accepted Answer

To submit an appeal , complete the appeal form and return the form by fax, 701-277-2209 or by mailing to Blue Cross Blue Shield of North Dakota, Box 1570, Fargo ND 58107-1570

Question 35

Where do I locate Medical Policies?

Accepted Answer

You can easily search by code or keyword by visiting the Medical Policy page

Question 36

I need to find a specific HealthCare News article?

Accepted Answer

Visit the HealthCare News page to easily search by article number or keyword.

Question 37

Where do I find the Provider Manual?

Accepted Answer

View and download the Provider Manual or the Medicaid Expansion Provider Manual.

Question 38

What can I do in Availity Essentials and where do I access/login?

Accepted Answer

Availity Essentials offers secure online access to multiple payers and the ability to check eligibility and benefits, manage claims and remittances, request authorizations and referrals, and complete other secure administrative tasks online. Login to Availity Essentials. Not registered? Register with Availity.

Question 39

How do I get credentialed for Medicaid Expansion?

Accepted Answer

If you are a current BCBSND provider who wants to become credentialed for the North Dakota Medicaid Expansion Program, the Provider Network Team will reach out to you to sign an addendum to your current contract. To request an addendum, send an email to prov.partners@bcbsnd.com. If you have an immediate question about this process, email prov.net@bcbsnd.com.

Providers who are not part of the BCBSND network can apply by completing the credentialing forms. Providers of 1915(i) services, meals and lodging, and non-emergency medical transportation, can find credentialing information on the North Dakota Department of Health website.

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