District offices in Bismarck, Grand Forks and Minot are closed June 10-11 for staff training. We will reopen June 12. For help, contact us.
BCBSND district offices closed June 10-11
We want to make prior authorization easier for you.
Prior authorization helps you get safe, effective, affordable care. It also helps keep costs in check for members, employers, and the health care system.
To begin your search, enter your Member ID and the procedure code or service description.
What Is Prior Authorization?
Prior authorization is when your doctor checks with your health insurance company before you get certain types of care. You may hear it called pre-approval.
This step helps make sure:
1. The care follows nationwide best practices for care
2. New treatments are reviewed for safety and effectiveness
BCBSND carefully reviews new medical treatments and technology. This includes:
- Watching for approval from the U.S. Food and Drug Administration (FDA)
- Researching and reviewing the safety and effectiveness of new technology
3. Bills are accurate so you avoid surprise costs
Your doctor and our doctors, nurses, and other clinically qualified experts work together to support your care.
Making Prior Authorizations Easier, Faster
You can use the Prior Authorization Search tool at any time to see which medical items and services require prior authorization. You will need your member ID number and a procedure code or service description.
Watch the video to learn more about using the search tool.
What You Can Do to Help with Prior Authorizations
Plan Ahead.
Standard requests can take up to 7 days. Urgent requests may take up to 72 hours.
Keep your doctor updated.
Tell your provider right away if your health insurance company or plan changes.
Stay Involved.
Check in with your doctor or BCBSND if you want an update on your request.
Use the search tool.
Look up services on your own or with your doctor so you know what needs approval.
When Prior Authorization is Needed
Only about 1% of all 68,000 medical services require prior authorization. Most care does not need approval.
To get the most accurate and up-to-date information for your plan, use the Prior Authorization Search tool.
Code | Description | Prior Authorization Status |
V5095 | Semi-implantable middle ear hearing prosthesis | PA Required |
T1030 | Nursing care, in the home, by registered nurse | PA Required |
Above: How a medical service code might look with a description and if it requires prior authorization.
How We Review Requests
When your doctor sends a request, our doctors, nurses and other clinically qualified experts review it to confirm:
- The service is covered by your plan
- The service is medically necessary
Medically necessary services help prevent, find, or treat health problems and follow nationwide best practices for care.
Prior Authorization Transparency
View yearly prior authorization information required by federal law ›
