Q: What options do I have to pay my bill?

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 .

Q: I forgot my username. How can I retrieve it?

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

Q: I forgot my password. How can I reset it?

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

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 ›

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 prior authorization?

Accepted Answer

Use the Prior Authorization Search tool to check the listing of services that require prior authorization.

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: Submit the online appeal form ›

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. Get a quote and calcuate your savings.

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

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 26

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 27

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 28

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 29

How do I submit an appeal?

Accepted Answer

For more information on Medicaid Expansion go to this Appeals page.

For BCBSND Commercial plans go to this Appeals page.

Question 30

Where do I locate Medical, Coding and/or Reimbursement Policies?

Accepted Answer

You can easily search by code or keyword by visiting the Policies & Precertification page.

Question 31

I need to find a specific HealthCare News article?

Accepted Answer

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

Question 32

Where do I find the Provider Manual?

Accepted Answer

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

Question 33

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. You can use the BCBSND Availity Essentials tip page to learn more. You can also login to Availity Essentials.

Not registered? Register with Availity.

Question 34

How do I get credentialed with BCBSND?

Accepted Answer

Learn more about contracting and credentialing by viewing the applicable page.

For Medicaid Expansion, visit the Medicaid Expansion Credentialing page.

For BCBSND Commercial plans, visit the New Provider Tools page.

Question 35

Where can I find information for NextBlue of North Dakota Medicare Advantage plans?

Accepted Answer

Visit https://www.nextbluend.com/providers for more information.

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