March is Colorectal Cancer Awareness Month and Blue Cross Blue Shield of North Dakota (BCBSND) is continuing with a colorectal cancer screenings campaign. We are looking for ways to support our members and partner with our provider community to decrease mortality, ensure affordability and increase access to services for our members.
In 2024, BCBSND partnered with Exact Sciences, the vendor of Cologuard. Cologuard screening kits are available to overdue members on the following plans:
- Several Commercial self-funded groups
- Medicaid Expansion members who were overdue for screening
- NextBlue of North Dakota Medicare Advantage
On behalf of BCBSND, in 2024, Exact Sciences issued over 13,000 Cologuard kits to our members. Results showed 20% of the tests were returned, 37% coming from our NextBlue population and 13% tested as a positive result. It is because of our partnership with the provider community that we were able to get those members the help they needed in the time they needed.
Starting in April and throughout 2025, BCBSND and Exact Sciences will continue issuing the Cologuard kits for overdue members on the above plans.
What Providers Need to Know
For 2025, BCBSND and Exact Sciences is working to improve supplemental data to determine if our member has had a kit already issued or if a previous kit or colonoscopy procedure was completed. BCBSND has updated the member-education letters, providing additional information to our members.
Providers are asking for a list of members who are receiving kits. We hear you. Currently, we are not able to provide the information. However, we are committed to working through that request and will keep you informed if that is something we can offer in the future.
The Cologuard process:
- The Cologuard test kit is being sent to selected BCBSND groups by Exact Sciences along with a letter to our members’ home addresses.
- Our member completes the Cologuard test and returns the kit to Exact Sciences.
- Test results are shared with members, providers and payers.
- When the provider receives the test results.
- Test results are then issued to our member’s attributed Primary Care Provider (PCP). Exact Sciences faxes the results to the PCP.
- If your organization would like a general location to where the members' test results are sent, please contact prov.partners@bcbsnd.com.
- The provider follows up with the member results if necessary.
- Test results are then issued to our member’s attributed Primary Care Provider (PCP). Exact Sciences faxes the results to the PCP.
Connecting Members with Primary Care
If a member receives a positive test result, our team proactively reaches out to those without an identified Primary Care Provider (PCP). This outreach ensures members understand their results and the recommended next steps. We make multiple attempts to connect members with a PCP for follow-up care. We also monitor claims to track the completion of necessary procedures like colonoscopies.
BCBSND Benefit: Zero Cost for Designated Tests
When ordered through BCBSND, selected members have 100% coverage with no co-pay or deductible. However, members are responsible for the cost of test kits if:
- They are not one of the selected recipients.
- They complete a test kit from another organization outside of BCBSND.
We are committed to informing our members of the importance of colorectal cancer screenings and working with their PCP to live a healthier life.
Questions?
Email prov.partners@bcbsnd.com
