Commercial Provider Manual Update

Updates have been made to the Commercial provider manual

New sections include:

  • Electronic Remittance Advice (ERA)
    • Added information about Claim Adjustment Reason and Remittance Advice Remark Codes
  • Unsolicited Refunds
    • Unsolicited refunds refer to refunds that were not requested by BCBSND.
      • Also referenced as a refund/return of overpayments
  • Documentation Requests
    • Third-Party Documentation
    • Insufficient Documentation
  • Payment Integrity Program
    • Added information about the reconsideration process

Revised sections include:

  • Use NPI When Calling BCBSND Provider Service
    • Added information on self-services tools available
  • Electronic Funds Transfer (EFT)
    • Added sentence: Providers must be enrolled to receive Electronic Remittance Advice (ERA)’s to enroll for EFT.
    • Added information about bank accounts
  • ID cards
  • Contiguous Counties/Overlapping Service Areas
    • Added an additional example for overlapping service areas
  • National Provider Identifier (NPI)
    • A claim should only be submitted with one Billing Provider and one Rendering provider. Availity Essentials may have the option to submit additional rendering NPI's on each claim line, but our system will not recognize that information for claims processing. A separate claim should be filed for any service(s) that are rendered by a different provider, NPI.
  • Professionals in Training
    • Added master’s level psychologist
  • Services Requiring Precertification
    • Added link to Predictal guide
  • Authorized (Network) Referrals
    • Added more information about DakotaBlue
    • Removed BlueChoice and SelectChoice information as products are no longer available
  • Appeals
    • Restructured information
  • Federal Employee Plan Disputed Claims Process/Guidelines
    • Updated wording
  • Definitions
    • Added, updated, and removed language

Contact our Provider Service Center at 1-800-368-2312.