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.