Ambulance Recredentialing Application
Behavioral Health – Institutional Provider Recredentialing Application
Durable Medical Equipment Recredentialing Application
Healthcare Organization Recredentialing Application Use this form for all other specialities.
Home Infusion Recredentialing Application
Medication-Assisted Treatment Facility Recredentialing Application
Optical Supplier Recredentialing Application
Public Health Unit Recredentialing Application
Ambulance Credentialing Application
Behavioral Health – Institutional Provider Credentialing Application
Durable Medical Equipment Credentialing Application
Healthcare Organization Credentialing Application Use this form for all other specialities.
Home Infusion Credentialing Application
Medication-Assisted Treatment Facility Credentialing
Optical Supplier Credentialing Application
Public Health Unit Credentialing Application
Dental Provider Applications
Apply to become a UCD network dental provider.
BCBSND's partners with United Concordia Dental for network management (provider contracting), claims administration and member/provider customer service.
Our products continue to be Blue branded and we partner with United Concordia to develop and market dental products.
Vision Provider Applications
Apply to become a vision provider.
BCBSND partners with Vision Service Plan (VSP) for network management (provider contracting), claims administration and member/provider customer service.
Our products continue to be Blue branded and we partner with VSP to develop and market vision products.
Medicaid Expansion Program
If you are not already a credentialed BCBSND provider, get started by completing the applicable form(s) above. If you are already credentialed and want to be a part of the Medicaid Expansion network, request an addendum by sending an email to email@example.com. 1915(i) non-emergency medical transportation and meal and lodging providers can be credentialed through the State of North Dakota.
Providers who bill as a rendering/performing provider on claims (including Pharmacists) need to complete the Practitioner Credentialing Application found above.
The following forms are located in Availity Essentials within the Payer Spaces under the Resources tab:
Electronic Remit and EFT requests can be submitted through Availity Essentials under My Providers, then Enrollment Center.