Blue Cross Blue Shield of North Dakota (BCBSND) has recently seen an increase in the improper use of the Appeal Form and wants to provide clarification regarding its use.
An appeal is a provider expressing disagreement with an inquiry determination and requesting a change in that decision. The types of appeals include:
- Pre-service claim for benefits appeals
- Retrospective review claim for benefits appeals
- Post-service claim for benefits appeals
In these cases, the Appeal Form should be used to communicate with BCBSND any additional information to help a favorable decision be made on the adverse determination. The Appeal Form is located in the Forms & Documents section of the provider website:
The form must be completed in its entirety and documentation must be submitted. If an incomplete form is submitted, the request will be denied as an invalid appeal request.
Please note, the Appeal Form should not be used to submit a claim correction, medical records or EOBs. For help with these separate requests, reference HealthCare News or the Provider Manual.