BCBSND district offices closed June 10-11

District offices in Bismarck, Grand Forks and Minot are closed June 10-11 for staff training. We will reopen June 12. For help, contact us.

Medicaid Expansion ER Admission Notification

Please complete the following form for any Medicaid Expansion Member who visited the ER and was discharged, NOT admitted to the hospital.

Member

* Required fields

Member First Name

Member Last Name

Member Date of Birth

The date does not appear to be correct. Please try again.

Member ID Number

Member Phone Number

Submitter

Provider First Name

Provider Last Name

Provider NPI

Facility

Submitter First Name

Submitter Last Name

Facility Contact Phone Number

Reason for the ER Visit

Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121