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COVID-19 for Members
Do you have an Authorization to Release Information (ARI) form completed for this member? *
Sorry for the inconvenience
Legally, BCBSND cannot process this appeal without a completed Authorization to Release Information (ARI) form.
Please complete the ARI form and return to submit your provider appeal.
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To verify your ARI status for this member, call 800-368-2312.
Max size for upload is 10MB. Acceptable file formats include: .pdf, .doc and image files.
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Your appeal will be reviewed within 72 hours.
Print this page for your records before submitting the appeal.
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