New Provider Tools

Are you a new provider wanting to work with us? If so, find helpful tools and links below.

Becoming a Participating Provider with BCBSND

Thank you for your interest in becoming a participating provider with Blue Cross Blue Shield of North Dakota.

There are two components to becoming a participating provider with BCBSND:

Contracting
Credentialing

Contracting with BCBSND

To request a Group Participation Agreement (contract) with BCBSND, please send the following information to providercontracting@bcbsnd.com:

Copy of business W-9
List of practitioners and NPIs, if applicable
Organization NPI
Services you provide
Preferred business name to be listed in the Provider Directory
Member Accessible phone number
- The phone number members will utilize to contact your office to set up appointments

Credentialing with BCBSND

After requesting to contract with BCBSND, you will need to submit a completed credentialing application found on our Credentialing Application page.

Applications should be done as soon as possible because BCBSND will not be able to execute the Group Participation Agreement to add your organization to our network(s) until the credentialing process has been completed. Ensure you use the proper application for your entity type and fill it out completely.

If you have questions on the applications, please contact prov.net@bcbsnd.com.

Applying as a practitioner

Fill out the Credentialing application (practitioner)
If you have not registered with the CAQH Provider Data Portal, follow these steps:
- Register at https://proview.caqh.org/PR/Registration
- Gather your credentialing details (ID numbers, practice locations, and supporting documents).
- Login and follow the prompts to complete your profile and upload your documents.
- Attest to the accuracy and completeness of your credentials and authorize BCBSND to access your profile.

Applying as a facility or organization

A facility or organization is any entity billing for services that is not a person. Please use the most appropriate application, for example:

Non-hospital based ambulances should use the Ambulance Credentialing Application
Psychiatric Hospitals, Residential Treatment Centers (RTC), Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) for Psychiatric and Substance abuse should use the Behavioral Health - Institutional Provider Credentialing Application
General Hospital, Swing Bed, Skilled Nursing Facility should use the Healthcare Organization Credentialing Application

Facility applications must also include malpractice/liability insurance information and Medicare/Medicaid numbers if applicable.

Completing the process

When you return your Group Participation Agreement, please also include the required credentialing documents. Both sets of documents will be forwarded to a Credentialing Specialist on the Credentialing and Data Management Team, who will establish your record in our system.

Once the Credentialing Specialist receives the completed application, the credentialing process can take up to 90 days. Applications must have all requested information, so it is very important that you respond timely to requests for clarification from the Credentialing Specialist.

After the application has been processed and completed, you will receive an approval notification letter via mail from BCBSND. Please do not submit any claims until you have received this notification. Our system will deny your claims until that notification has been shared.

Questions on credentialing process?
If you have additional questions, please review our Credentialing and Recredentialing Policy, contact us at prov.net@bcbsnd.com.

Credentialing and Recredentialing Policy

NPI

The National Provider Identifier, or NPI, is a 10-digit number unique to each provider that is issued by the Centers of Medicare and Medicaid Services (CMS). The NPI is required for providers to submit transactions to federal and state agencies, as well as file claims with private health plans.

Individual providers must obtain a Type 1 (Individual) NPI. Organizations must obtain at least one Type 2 (Organization) NPI. The number of Type 2 NPIs an organization obtains is an individual business decision.

Type 1 NPI - Physicians and non-physician practitioners
Type 2 NPI(s) - Physician groups, hospitals, nursing homes, group practices, pharmacies, suppliers and others

Get help with NPI application
Use the helpful tips below to complete your NPI application either online or via paper.

Completing an NPI application online

Completing the NPI application via paper

Register for Tools

As a BCBSND participating provider there are a few tools you will use on a regular basis in your partnership with us. Each of the tools below requires a one-time setup.

Availity Essentials

Submit eligibility and benefits inquiries
Submit claims and review status
Request referrals
Claim submission (837P/I/D)
Electronic remittance advice (ERA) (835)
Eligibility and benefits inquiry and response (270/271)

Availity Essentials for Electronic Data Interchange (EDI)

Electronic Funds Transfer EFT / Direct Deposit

Sign up to receive 835 payment listings and EFT payments through Availity Essentials.

Policy and News Updates

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Understanding the claims process

Understanding the claims process will help you get paid faster and allow you to represent your patients well. This section will provide all the information you need to get started.