Credentialing & Recredentialing Policy Updates

Recent updates have been made to the Blue Cross Blue Shield of North Dakota (BCBSND) Credentialing & Recredentialing Policy. Providers can view the policy and its changes by visiting the following link https://www.bcbsnd.com/providers/credentialing/credentialing-applications.

The below pages, have had changes made:

  • Page 6       
    • Added Medicare participation is required for Medicare Advantage network
  • Page 9       
    • Update made to describe changes made to the quality review process for credentialing applications
  • Page 10       
    • Update made to call out that work history for the past five years is reviewed during initial credentialing
    • Added information regarding Medicare participation, in addition to a signed agreement for Medicare Advantage
  • Page 15 
    • Removed the Director Quality Management title, due to no longer being valid
  • Page 17 
    • Updated to explain what happens if a provider misses their three-year recredentialing date
  • Page 20 
    • Updated to include the monthly review of Medicare opt outs in our ongoing monitoring process
  • Page 21 
    • Updated to include mention of directory information shared on the marketplace
  • Page 22 
    • Updated to include Medicare Advantage reference
    • Added information regarding continuity of care on Member notifications

Questions?

If you have any additional questions regarding these changes, please email prov.net@bcbsnd.com