Accepting New Patients Verification
In order to help our members find BCBSND participating providers that are accepting new patients, we are asking you to assist us with keeping our provider directory up to date. If you have had a recent change in whether or not you are accepting new patients at any location, please complete the form below and we will update your file.
Legacy Institutional Claim Adjustment – removed June 1, 2021
Legacy Professional Claim Adjustment – removed June 1, 2021
Please note: To request a copy of the Legacy claims adjustment forms, contact the Provider Service Center at 1‑800‑368‑2312.
Use the Legacy adjustment forms to adjust a claim that processed in the BCBSND legacy system. Claim adjustment is the appropriate process for the following members:
1. Host (out-of-area) members with a date of service (DOS) prior to July 1, 2018;
2. FEP members (prefix of R) with DOS prior to September 1, 2018; or
3. BCBSND members with any of the following prefixes: BSB, DDU, DEW, OTO, RDO, SHV, THI, TNT, USZ, YQA, YQB, YQC, YQE, YQG, YQI, YQJ, YQP, YQQ or YQU with a DOS prior to January 1, 2019.
Use the claim correction process outlined in the provider manual for all other claim corrections.
Participation and credentialing
The following forms are located in Availity Payer Spaces under the Resources tab:
Electronic Remit and EFT requests can be submitted through Availity under My Providers, then Enrollment Center.
Recredentialing Applications - Fillable PDF's
Ambulance Recredentialing Application
Behavioral Health – Institutional Provider Recredentialing Application
Durable Medical Equipment Recredentialing Application
Healthcare Organization Recredentialing
Home Infusion Recredentialing Application
Medication-Assisted Treatment Facility Recredentialing Application
Optical Supplier Recredentialing Application
Practitioner Recredentialing Application
Public Health Unit Recredentialing Application
Retail Pharmacy Forms
If your benefit plan is subject to PPACA preventive services, you may request a Copay Waiver for a product within a preventive service class that is not a designated preventive service product.