Medicaid Expansion Provider Resources

View the Provider Manual for Medicaid Expansion.

Search services and equipment which may require the ordering provider to obtain precertification.

Watch educational videos to learn topics like eligibility, claim submission, Primary Care Provider (PCP), appeals and more.

If you disagree with a BCBSND benefit determination, you may appeal the decision within 60 days.

We are required by the state of North Dakota to contact all Medicaid Members within 72 hours of being discharged from the Emergency Room (ER). To assist us, please submit the attached form as soon as possible after discharge.

Note: if the Medicaid Member is admitted to the hospital, there is no need to submit a form.

Providers delivering crisis services for Medicaid Expansion members must notify BCBSND by submitting the member information and services provided through the Medicaid Expansion Crisis Utilization form.

• This form is to be used to submit a Provider Dispute. The Provider Complaint system permits the submission of a dispute on BCBSND’s policies, procedures, or any aspect of BCBSND’s administrative functions, including proposed actions, claims/billing disputes, and service authorizations.
• For any disputes not related to Medicaid Expansion, visit the Provider Manual for direction.

The program may apply to Medicaid Expansion Members who are using emergency department medical and/or pharmacy-related services at a frequency or amount that may not be medically appropriate and necessary, to ensure these Members receive services that match their medical needs.

Forms that apply to both Commercial and Medicaid Expansion lines of business can be found here:

1915(i) providers who deliver home and community-based services to individuals with behavioral health conditions can view the 1915(i) provider page for more information.

Once credentialed with NDDHS ND Medicaid, learn more on how to participate in the BCBSND Medicaid Expansion network.

North Dakota residents can learn if they qualify for Medicaid Expansion and apply for coverage through the State of North Dakota’s Department of Human Services (DHS).

DHS also administers the retail outpatient pharmacy benefits. If you have questions about pharmacy benefits or covered drugs, please call 800-775-2604 (TTY: 711).

Arkos is a population health management company that works collaboratively with health insurers and patients’ primary care team to help provide supplemental coordinated care to Medicaid Expansion patients at no additional cost to the patient or provider.

Learn more about Arkos Care Management Support

Providers submitting claims for North Dakota Medicaid Expansion members must include a taxonomy code, a 10-character code that designates the provider’s classification and specialization.

View details about taxonomy codes from the State of North Dakota and the US Centers for Medicare & Medicaid Services.