High call volumes
Our member and provider services may be experiencing higher than normal call volumes from 12/22/25-1/9/26 due to a large number of staff being out of office. We encourage you to utilize alternative forms of communication including secured messaging through online Member Services and Availity Essentials Provider Portal.
BCBSND district offices will be closed to the public on Friday, Dec. 26.
This includes Bismarck, Grand Forks, Jamestown and Minot. Need help? We’re here for you! Log in at BCBSND.me or call 844-363-8457.
We are unable to accept walk-ins on Friday, Dec. 26, and Friday, Jan. 2., due to short staffing.
BCBSND has enhanced our core claims processing with the Payment Integrity Program. The program will enhance current capabilities to ensure payments are correct, assigned to the right payer and consistent with national standards and guidelines.
We have partnered with Cotiviti, a leading health care analytics company, to bring a new level of accuracy to claims processing. This new enhanced level will supplement our core in-house system of robust checks and balances.
The Payment Integrity Program consists of Retrospective (post-pay) and Prospective (prepay) analysis of claims.
To learn more about the Payment Integrity Program, types of audits and timelines:
Use the below link to aid in determining why the claim denied and next steps.
Requires review of medical records including complex Diagnosis Related Group (DRG).
Often related to provider billing issues, such as split bills and excessive units being billed.
This is a program that reviews level 4 and 5 E/M services on outlier providers.
Identifies when another carrier or entity should be responsible for paying on a claim.
Uses advanced data analytics to identify claims at an elevated risk for incorrect coding and claim reimbursement.
A process within PPM where complex claims can be briefly paused and sent for clinical review.
