Appeal Process for ND Medicaid Expansion Providers
BCBSND administers coverage for North Dakota’s Medicaid Expansion Program. If a provider or enrolled member disagrees with a BCBSND benefits determination, the decision may be appealed.
BCBSND administers coverage for North Dakota’s Medicaid Expansion Program. If a provider or enrolled member disagrees with a BCBSND benefits determination, the decision may be appealed.
Three types of benefit appeals
1. Standard Pre-Service Request
2. Pre-Service Expedited Appeal
3. Post Service
Response timelines
The timelines for standard or expedited appeals may be extended by up to 14 days if:
Additional details on extended timelines are available in the Medicaid Expansion Provider Manual.
If BCBSND fails to follow these timeline requirements, the enrolled member will have exhausted the BCBSND appeal process and may initiate a state fair hearing.
Appeal process
An individual enrolled in Medicaid Expansion, their provider or an authorized representative may file an appeal to an Adverse Benefit Determination within 60 days.
The appeal is considered by a BCBSND staff member not involved in the original determination or their subordinate. The decision maker may be a health care professional with appropriate clinical expertise, and the decision maker may consider information that was not part of the initial determination.
BCBSND provides a notice of the appeal resolution within the time frames noted above. View the full Appeals Process
If the resolution is not wholly in the member’s favor, BCBSND includes information about:
How to file an appeal
Prefer to print form and submit?
Provider Appeals Form
Phone: 1-833-777-5779, Monday through Friday, 8 a.m. to 5 p.m. CST
Mail: Blue Cross Blue Shield of North Dakota
PO Box 1570
Fargo, ND 58107-1570
Grievance process
If a provider, an enrolled member, or member’s authorized representative is dissatisfied on a matter other than an Adverse Benefit Determination, a verbal or written grievance may be filed with BCBSND.
Phone: 1-833-777-5779, Monday through Friday, 8 a.m. to 5 p.m. CST
Mail: Blue Cross Blue Shield of North Dakota
PO Box 1570
Fargo, ND 58107-1570
Claims correction
Appeals cannot be requested for claim corrections. To correct, void or cancel claims, use the claims correction process on Availity Essentials.