Availity Provider Portal Precertification Request

BCBSND has been providing monthly tips reminding providers of functionality in our Availity Provider Portal. One Availity tip is submitting a precertification request. Availity is used to submit precertification requests for both inpatient and outpatient services. Precertification does not guarantee payment, this is determined based on member’s eligibility and benefits.

Determining whether a precertification is required first can save time and resources before starting the request in Availity. Some services, procedures and equipment require precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.

Listed below are some Availity Provider Portal submission tips:

  • The Availity Portal currently does not have the functionality to determine if a code requires precertification
  • Precertification verification information can be located on our BCBSND website at https://www.bcbsnd.com/providers
  • Located on the BCBSND Provider webpage toolbar
  • Click Policies & Precertification
  • Select Precertification
  • Determine if the member is in network or out-of-area (network)
  • Search for the CPT/HCPCS code (in-network) or enter the three-alpha prefix (out-out-area)
  • NOTE: The search results listed do not apply to the Federal Employee Program (FEP) or NextBlue of ND Medicare Advantage plans. Please refer to the FEP or NextBlue provider websites or contact the appropriate Provider Services
  • The Availity Portal does not give specific benefits, but it will indicate if the member is active
  • Contact Provider Service at 1-800-368-2312 for verification of benefits
  • Requests that do not require precertification and have a published BCBSND medical policy will be cancelled
  • Providers will be directed to contact Provider Service for benefits or questions related to your request
  • Submit the required clinical documentation for any requests submitted via the Availity Portal
  • Referencing our BCBSND medical policies at https://www.bcbsnd.com/providers/policies-precertification/medical-policy/disclaimer can assist in determining what clinical documentation is required for review
  • Once a determination is made, the provider will receive a response through Availity
  • Provider will also receive a request for additional information or clarification if needed via the Availity Portal
  • If all information required is received, providers may see the determination shortly in the Availity Portal
  • A fax will also be sent to the number the request was submitted from
  • Determination letters will also be mailed to both provider and member